Q&A with Dr. K
Do you have questions about your health? Need help navigating the health care system or understanding certain conditions, medications or other treatments? With decades of health care experience, Mountain Pacific Chief Medical Officer Dr. Doug Kuntzweiler (Dr. K) has the answers. And on Q&A with Dr. K, the doctor is always in.
Q&A with Dr. K
Being an Empowered Patient - What Is My Role in Medication Safety?
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Taking any medication can have risks, but those risks increase when we do not know key information about the medication, do not take the medication when or how we are supposed to or take multiple medications. Dr. K and special guest Kyla Newland, Mountain Pacific pharmacist, provide tips on how to be more confident in your knowledge and routines so taking your medications is easier -- and safer.
Additional resources for this episode
Centers for Disease Control and Prevention (CDC) Medication Safety and You: https://www.cdc.gov/medication-safety/about/index.html
Johns Hopkins Medication Management and Safety Tips: https://www.hopkinsmedicine.org/health/wellness-and-prevention/help-for-managing-multiple-medications
Search for financial help for a specific medication: https://needymeds.org/
If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous.
Welcome to Q and A with Dr. K, a podcast by Mountain Pacific Quality Health, where we sit down with Dr. Doug Kuntzweiler and get your health questions answered, because on Q and A with Dr. K, the doctor is always in. Hello, everyone. This is your host, Beth Brown, and as usual with us today is the wonderful Dr. Doug Kuntzweiler, the knowledgeable and special chief medical officer from Mountain Pacific. And we have a very special guest with us. Also joining us today is Kyla Newland, who is a pharmacist with Mountain Pacific, and she's here because we are going to take a deep dive into how to be an empowered patient when it comes to medications. So thank you, both, for joining today. Good to see you. Beth, yeah. Thank you, Beth, yeah. Thanks both. So let's go ahead and jump in. We are continuing with part two in our series about how to help patients feel empowered, give them some confidence, let them know what kind of questions they should be asking, which is what we talked about last month. And this month, we're going to talk about another way to make sure that you are in charge of your health and part of your health care team, and that's with medications. So we're going to talk about medication safety today, and medication safety, that term probably sounds pretty straightforward. You know it's being safe with medications, but we're going to talk about what that really means. And I think we're going to start with you, Dr K, and ask about when it comes to medication safety, a big factor, especially for older folks, is polypharmacy. What is that? What do we mean when we talk about that?
Dr. Doug Kuntzweiler:Well, polypharmacy means taking a number of medications at the same time, and I've seen various definitions, but most people seem to agree that if you are taking five or more medications, your potential for adverse interactions between the medicines goes up, your potential grabbing side effects goes up, but it kind of depends on the person. I mean, sometimes three medicines is a lot, but generally when you get up around five then then you have to look pretty carefully to make sure that they're all compatible with each other, that they're not causing you any side effects.
Beth Brown:Because what are the risks there potentially?
Dr. Doug Kuntzweiler:Well, primarily, interactions with each other. Once you start taking drugs, they can interfere with the metabolism of another drug that you're taking. They can either raise or lower the levels of another medication that you're taking. I know personally, it makes it more difficult to keep your medicine straight and make sure that you're taking the correct medicines at the correct dose, at the correct time, in the correct way. And I use pill minders, but even at that, I have to fill them, and it's surprisingly easy to mess it up.
Beth Brown:And once people start getting on five or more medications, and like you said, everyone is different. How do doctors and pharmacists -- Kyla, jump in here too, if you'd like-- know that these medications are doing what they're supposed to be doing. Or do you really rely on the patient talking to you about the difference that they're feeling with being on those medications?
Dr. Doug Kuntzweiler:Well, I would say, and I want to hear what Kyla has to say, too, but it depends on the medication. Some we check levels on so you know exactly where you're at. But some it is by interviewing the patient, seeing how they're doing.
Kyla Newland:Yeah, I mean, I think those are both good points, and then also doing like a med review every year is a good idea where you would meet with either your pharmacist or doctor, and they would match up all your medications with what you're taking them for and making sure that they're effective and that they're doing what they're supposed to be doing. And then, of course, if you're treating something like high blood pressure, diabetes, you're going to check labs to make sure that that the medications are working how they're supposed to be.
Beth Brown:Perfect. And yeah, you've talked about this a little bit, Dr. K, with them interacting with each other, and that's another term we're going to throw out here really quickly that some people may or may not have heard before, and that's adverse drug events. And that's something that we talk a lot about at Mountain Pacific with the work that we do. But what does an adverse drug events entail. What all does that mean?
Dr. Doug Kuntzweiler:Well, in my mind, that means an unwanted, harmful effect of the drug, and it could be almost anything. It could be dizziness, it could be headache, visual disturbance, nausea, vomiting, those are common ones. Diarrhea, trouble emptying the bladder, there's all sorts of things, but basically an effect of the medication that is not the therapeutic effect you're looking for, but it's something that's that's bothersome.
Kyla Newland:And it can either be something that we expect from a medication that's a known side effect, or it could be something that maybe we dose it inappropriately, and the patient had an adverse reaction because of that. So it's kind of a pretty broad term, and it's it's kind of hard to define exactly what it means.
Beth Brown:Sure, that makes sense, because everyone is different, too, and just because some people respond to medication in a certain way, there could be that one person out there that takes it and has a very different experience. And that that could certainly be the case, but we also know that there are some medications that are sort of on that "watch out" list where we know they can be the ones that tend to maybe tend to cause some issues, or people end up having to go to the ER, see their doctor. So let's talk about some of those usual suspects that we know what to watch out for, because they can be the ones that tend to cause those adverse drug events. Kyla, maybe can you talk about...?
Kyla Newland:Yeah, yeah, I can absolutely speak to that. What we've seen in the literature is that there's three kind of drug groups that are highest risk for causing adverse drug events. So that's going to be opioids, which are medications used for pain, diabetes medicines and anticoagulants, or what we commonly refer to as blood thinners. So we know those are the highest risk. So if you're taking any of those medications, you are at higher risk of having one of those adverse drug events.
Beth Brown:And what do those look like, those events?
Kyla Newland:So with our diabetes medicine, it's going to be primarily low blood sugars. A lot of times, folks will end up in the ED or the urgent care due to either taking too much of their diabetes medication or maybe it's not adjusted properly. With the anticoagulants, it's going to be usually a bleed, so either a stomach ulcer or some other kind of bleed that's happening that makes it so a person has to seek additional care, and then with the opioids, it's going to be mostly like respiratory depression or dizziness, and in the worst case scenario, I guess it would be an overdose from opioids.
Beth Brown:And so is it fair to say that it's the medication is doing its job, but to an extreme that causes an issue within a person? Or why is it that those are the three that tend to show up the most when folks run into issues?
Kyla Newland:So if there's some drugs that they call narrow therapeutic index, drugs, drugs like warfarin, which is a blood thinner, it has to be monitored with lab values continually. And it can be the levels of some of those drugs can be affected by what you eat, even. And then if we look at other drugs you're taking, it maybe you added a new drug and there was a drug interaction that maybe caused your level to change. That's just one that kind of comes off the top of my head. But when we see those drug interactions, as Dr K. talked about earlier, if you add new drugs or take away drugs, then sometimes the levels of other medications will change. And then with diabetes medicines, I mean, when you're using insulin, or there's some diabetes oral medicines that have higher risk of causing you to have low blood sugars, and that's just kind of always, always a battle with managing people with diabetes and keeping those sugars in the right range.
Dr. Doug Kuntzweiler:And I will say that, as a provider, I've really benefited from the pharmacist catching when a patient that I prescribed something for was on another medication that could potentially interfere with it or or have an adverse reaction, and sometimes providers don't really have an accurate description of all the medicines that a patient's taking. Most of the time when you go to a provider now, when the nurse does your intake, checks your vital signs and your weight, they will also ask you about your medications, run over your medication list, so make sure that it's up to date, because that it can change so quickly, especially if you're seeing more than than one provider, it can change really quickly and and you won't necessarily recall everything that you're on.
Beth Brown:So let's talk about that then. And since we are focusing on how to help patients be empowered, be more confident, better understand their health and their care when we talk about medication safety, and I would like to hear from both of you on this, what role does the patient play in being safe with their medications? What does that look like?
Dr. Doug Kuntzweiler:I'll go first. I felt pretty strongly about this one.
Beth Brown:Okay, great.
Dr. Doug Kuntzweiler:I can't tell you how many times in the ER, I asked a patient, what, what meds are you on? But they would say, Well, I don't know. You've got a list of it here. Look it up. Or they would say, Well, I'm on that little blue pill. And I take that kind of bigger gray pill, and then I take this capsule and you say, right, there's only 3000 little white pills. So yeah, I think it's patients' responsibility, as we talked about in the past, you should have some interest in your own health, and a big part of that is keeping an accurate list of what you're taking and and knowing, and in general sense, what it's for. You don't need to know. You know all the pharmacology of a medicine, but you might write down the medication and that it's for your high blood pressure, or I'm taking this medicine it and it's for my thyroid. I'm taking this medicine for whatever, keeping that just on a little index card and and trying to keep that up to date is is pretty viable. If you always go to the same pharmacy, they should have a pretty accurate list to what you're currently taking.
Beth Brown:Yeah, we've heard that right. Use the same pharmacist so that they can help you better understand your medications.
Kyla Newland:Yeah, and especially, as Dr K mentioned, if you're seeing different providers, then the whole picture is going to be there. If you use the same pharmacy and the same pharmacist as to what's going on with your medicines. There's also, if you are technologically inclined, you can actually track your medications on your phone. If you have an iPhone, I know specifically, there's a health app on there, and you can add all your medications in there. And you can even, I just was looking at it this morning. You can even ask it about interactions on there as well, which is pretty cool. And then you can set a timer if you have trouble remembering you take your medications. You can set reminders on there that will remind you when to take your medication. So that's another cool thing that you could explore if you have access to that technology.
Beth Brown:Yeah, that's great. I mean, there's an app for that, right? There's an app for everything out there, so yeah,
Kyla Newland:I'm sure there's other apps too.
Beth Brown:So yeah, that's great for those folks who, I mean, we live on our phones, and we always have them with us. So even in your example, Dr K, going into the ER or the emergency department, odds are you probably have your phone on you, and so you can check that list and tell your doctor what you're on and what it's for.
Kyla Newland:Well, and, as we're talking about, like if you go to the emergency department, or if you have a hospital stay, is a lot of times your medications get changed, and so that's a really good time to make sure that you update that list, that you understand the medications that you're supposed to be taking, and also that you communicate with your providers so your pharmacist and your your doctor about The changes, because what I've seen happen, the local pharmacy, the provider may not notify the pharmacy that you're not taking that anymore. And then if you don't know what you're taking, and you come in and you say, I need my blood pressure medicine. You don't know the name or you know the color, but you know whatever you might get the wrong medication if there's been a recent change. So I think those instances where you're like either utilizing specialists to add medications, or when you're have a hospital stay or ER visit, is a good, really good time just to do that double check on your list.
Beth Brown:That's a great point. I appreciate that. And I think it does really nail home the thought that it takes a team to manage your health, and it is the provider who prescribed medication, it's the pharmacist who is helping you with that medication, and it's you knowing what you're on and why you're taking it, so that you can be a part of that team as well. And so speaking of the team, let's talk about the pharmacist, because I feel like the pharmacist is such an underutilized treasure as part of the healthcare team, you have to make an appointment to get in to see your doctor, unless you're trying to get into urgent care or emergency department. So your doctor can sometimes be very difficult to access. Sorry, Dr K, but you know that, so you have that pharmacist, and pharmacies are crazy busy these days as well, but you can walk in and wait in line and talk to a pharmacist. So let's talk a little bit, Kyla, about how does the pharmacist play a role in medication safety and in just being part of that health care team?
Kyla Newland:Yeah, so, we've historically been referred to as the most accessible health care professional, because you can, you can walk up to a pharmacy anytime. You can call a pharmacy, and you can say, I want to talk to the pharmacist, and we can answer a multitude of questions related to your medications. And in some cases, if you have coverage on certain insurance plans, we can sit down with you and do like, a more extensive review of your medications. So that's something that you could ask about. Yeah, we do four years of training specifically about medications, so we do have expansive knowledge. And I encourage everybody to utilize their pharmacists to the highest extent that they can.
Dr. Doug Kuntzweiler:And I would like to point out as a provider, that I often talked to pharmacists and ask them about especially dosages, medication interaction and things like which would be the best antibiotic for this condition. Medicine has gotten so complex and it changes so quickly. Every year there are a multitude of brand new medications, and as a provider, it's very difficult to keep up, and I always found that the pharmacists were an invaluable resource for me to help me prescribe accurately and carefully.
Beth Brown:Yeah, that's great. You each have your own areas where you have to make sure you're up to date on and obviously that's a specialty for pharmacists. So kind of last month, we met without you, but we talked about questions that people should be asking their health care provider, and we had some three main ones, and then we sort of built on those a little bit. I wonder if you have ideas on what a person should be in the routine of asking their pharmacist. Do you have a couple of questions there? Those are the main ones that you should know and be asking your pharmacist, or feel comfortable asking your pharmacist?
Kyla Newland:Yeah, I would say there is some kind of top questions that you definitely should know about each of your medications. First, you should know what you're taking it for. You should know your dose, and you should know what time of day to take that medication and how frequently to take that medication. You should also ask if you need to take it with food or without food, because some medications can upset your stomach. Some medications don't get absorbed as well if you have a lot of food in your system, and so those are good questions to ask as well.
Dr. Doug Kuntzweiler:Sometimes there are things you wouldn't necessarily think of, like there are a number of medications that, if you take grapefruit juice, that interferes with their metabolism and their absorption, then you wouldn't necessarily think about that. Somebody needs to point that out to you, and that typically is the pharmacist who does that.
Kyla Newland:Yeah, that's a good point. There are some like dietary things. Also, like if you take vitamins or supplements, sometimes those can bind to medicines, and then they don't get absorbed as well. So those are also good questions, and make sure you include the medications that you are taking over the counter, because that's important too, especially when we can see those interactions with those just as easily as a prescription medication.
Dr. Doug Kuntzweiler:I think it's important that people first agree with their provider that the medication is is necessary and that and that they agreed that they're going to take it, and so that means they they need a simple, understandable explanation of what their condition is and what the providers proposing to treat it with in in what what that will do, and the provider should give them, you know, at least some basic understanding of side effects to watch out for and those kinds of things.
Kyla Newland:I mean, that's primarily when you come to the pharmacy to get a new prescription. We can tell you all the side effects, and we are required by law, actually, to give that information to you. So take advantage of that and always talk to your pharmacist when you pick up a prescription, because that is a very valuable conversation.
Beth Brown:For sure, and yeah to both of your points then, it's not just the prescribing and even picking up the medication, it's then taking it correctly. That's a big part of medication safety as well. And talking about the over the counter medications that people are taking, or if they're also taking supplements or vitamins, you can see how it gets big fast with all the different things that people might be putting into their bodies to help them feel better or to function better. So tips on that part of it, so that people are, you know, they agree with the doctor, yep, okay, I'm going to take this medication. I went to the pharmacist, I got it. Now I'm at home. How can I make sure I'm keeping everything sorted how it's supposed to be and then I'm taking it how I'm supposed to take it?
Dr. Doug Kuntzweiler:Well, I think that is a place for an app, as Kyla talked about with maybe the reminders, alarms with reminders keyed into it. Or if you're old school, like me, write it down, put it on the refrigerator. If you're elderly and you know, you might have trouble manipulating your medications, or you're having trouble with memory, have somebody help you set them up, a family member, or friend to help you set the medicines up. And if you add any question about what you're supposed to be doing, you should either ask the pharmacist who filled it for you, or ask your prescriber, and then your provider make sure that you got it straight.
Kyla Newland:Yeah, and you can also use pill boxes, and you could do up to, like, a week's worth of then maybe. In two weeks. You can either do a week or two weeks, I think, at a time, in a pillbox. So you know, you have all your medicines you take in the morning, all your medicines you take in the afternoon, all the medicines you take in the evening. And then that kind of keeps you on track as well. And like Dr K said, if you're if you're needing help with that, definitely have somebody help you set that up and do that for you on a regular basis.
Beth Brown:I mean, they really do have the day of the week, morning, noon, evening, bedtime. I mean, they can have all kinds of little compartments in there to help keep all those pills organized.
Dr. Doug Kuntzweiler:Another thing we should point out is that when you are writing down all the medicines that you're taking, a lot of people are taking a number of over the counter meds. And when you ask them, what medication are you taking, they only tell you about the prescription meds. You have to ask them, Are you taking anything else? Are you taking anything over the counter? Sometimes it can be pretty surprising the number of things people are taking that they don't think of as, oh, that's not what the provider was asking.
Beth Brown:One a day vitamins, or the whatever supplement, or the root of whatever that you're putting in your coffee in the morning. Like, all of those things count. So another part of that, though, is, yeah, you know, I agree I want to take this medication, but I just can't freaking afford it. You know, like, these are some informations are expensive. And for some people, depending on their health insurance, or if they even have health insurance, that's where it gets sticky for them is they would love to adhere to the treatment plan. They would love to take these medications how they're supposed to take them, but they can't go fill the prescription because they can't afford them. But there are options there, right? Kyla, like, what are some of the ways that people can get help paying for their medications, so that they can take them when and how they're supposed to.
Kyla Newland:So there's a couple different options. There's something called patient assistance programs, and those are programs that are sponsored through the drug manufacturer, and so if you're taking a drug that's expensive, you can go to the website. It's called needymeds.org and you can search for any medication on there and see if there is what they call this patient assistance program, which is an income based assistance where in some cases, they will pay 100% of the cost of that medication, and there, there's a lot of them out there. And then the other thing is, there is also patient copay cards. So say your copay, say it's covered on your insurance, but there's still a copay, and it's a high copay, and you still can't even afford that. You can get that copay paid for with what they call a copay card, I guess. And that's something usually your provider will have and be able to distribute. Some of the pharmacies will have those too, and you can ask your pharmacist if they have any of those for you to use. I know with the COVID medications, since they're not covered by the federal government anymore, there is a copay card because they're pretty expensive. So those are a couple different options.
Dr. Doug Kuntzweiler:I think it's important for the providers to have some sense of what are the really expensive medications and and I'm guilty of it too. A lot of times we don't really know how much the medicines cost that we're prescribing. If you are the patient, it would behoove you to let your provider know that cost is a consideration, because oftentimes there are cheaper alternatives. Generic forms of a drug are usually cheaper than the proprietary or the name brand.
Kyla Newland:Yeah, that's a good point too, because you can ask your pharmacist, that's another good question to ask. Is there a medicine in this class that would work similarly, or the same way that I could maybe have my doctor write for instead, so that I don't have to pay this high price? And that that is definitely a valid question, and a lot of times there is cheaper alternatives, and they're totally appropriate and equally as effective.
Beth Brown:I appreciate that, and that's a question, again, that you can either ask the provider or when the time comes with the pharmacist, and that's also part of asking those questions to be an empowered patient, and it might take swallowing some pride, right? Like I don't want to admit that I can't afford this medication. Sometimes they really are ridiculously expensive, but sometimes it's just because of your situation. This is expensive for me, and so I need to be able to say, but I need to take care of my health first, and I'm just going to have to swallow my pride a little bit here and admit I don't know if I can afford this. And can you please help me, whether it's with a generic medication, or going to a website where I might be able to help get something paid for, or the copay card, or whatever it is. So those are great.
Dr. Doug Kuntzweiler:I would look at it as we're all in the same boat too. Even if you have a high income, these medications could still be be very expensive, so you don't have to be too ashamed of it.
Beth Brown:So I just want to end on closing thoughts from you both about medication, safety, any thing that you want to make sure people take away from listening today.
Dr. Doug Kuntzweiler:Well, I'll start. I would say that the important thing is to talk with your provider and understand why they want you to take this medicine. What is it supposed to do? What is the benefit to you? Because you really should agree to it before you walk out of there with a prescription in your hand, and then talk to your pharmacist, make sure that it's the right medication, the right dose, that you understand how and when you're supposed to take it, and know what that little white pill is when, when you go to see a provider.
Kyla Newland:Yeah, and I would just reiterate the fact that you are a part of your health care team, and medications are a huge part of that. So be proactive. Ask questions, and, you know, get as much information as you can from from your health care team, so that you can be the healthiest that you can and get the best benefit from the medications that you take.
Beth Brown:And report back with how those medications are going, especially if they're not going how the prescriber and the pharmacist hoped they would for you. That's important to bring up.
Kyla Newland:Aboslultey.
Beth Brown:Perfect. Well. Thank you both so much for being here today. We, as always, appreciate your experience and expertise. Dr K and it was an absolute pleasure having you, Kyla, to talk about your own experience and expertise from the pharmacy perspective. So thank you.
Dr. Doug Kuntzweiler:Thank you.
Kyla Newland:Thank you!
Beth Brown:And thank you so much for listening. We'll put some resources for you with this episode, including that URL that Kyla mentioned to help out with the cost of medications. And if you have a question for Dr K or any of our mountain Pacific staff who might be able to jump on and lend their expertise, please email us at QandAwithDrK@mpqhf.org, and that email address will be included with this episode as well. Thanks, everyone. Be well.
