In the first part of this 2-part discussion on medication, we dealt with what is medications. In this article, we shall deal with the important safe handling medication. Detailed explanations will be given to help the Reader to understand the principles.
There is a lot of confusion globally, about whether medications should be taken before or after meals. And also, medication is to be taken with how much of what liquid? It is hoped that these issues will be clarified.
Homes or communities are by far the commonest place for the administration of oral medications. Some common mistakes that occur when taking medication in the community will be explored. Advice that includes recommended devices for online purchase, will be provided.
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BEFORE MEALS vs AFTER MEALS
This is an important aspect of taking medication. Unfortunately, it is an area of great confusion. If a medication is not taken correctly in relation to meals, it may be rendered partially or totally ineffective, or it may pose risks to the patient.
The guiding principle is that medications need to travel through the gastrointestinal tract and be absorbed without hindrance or competition from other substances. (Isn’t that what we all want when driving or walking to an important appointment?) That is why, the majority of medications should be taken before meals, on an empty stomach. This prevents obstruction along the path of the medication, and competition for absorptive mechanisms (such as “receptors” on the surface of the large bowel), by food.
In the event that no explicit instruction about when to take a medication is given verbally or written on the packaging, it is safe to say that patients should assume they have to take it before meals. Before meals usually means by one hour. But half an hour can sometimes suffice. Please note also, that three hours after the last meal is acceptable for such medicines, because food takes about three hours to leave the stomach.
There is a minority of medications which are best, or sometimes strictly taken with or after meals. The reasons differ. Some medications are taken in this manner simply because food improves their absorption. Examples are vitamins and the antibiotic / antiflagellate, metronidazole. Others need to be taken in this fashion because they cause irritation to the lining of the stomach or duodenum (first part of the small intestines), which can cause small wounds or ulcers, and even bleeding. An example is the non steroidal anti-inflammatory drugs (NSAIDs) such as INDOMETHACIN, diclofenac, aspirin and ibuprofen.
WATER AS AN ACCOMPANIMENT OF TABLETS
It is true that being unable to swallow tablets, which is a defect that affects a proportion of the world’s population, is a sad state of affairs. But then those who are skilled or endowed with the ability to swallow tablets and capsules, should not take it to mean that they can swallow them as is, without accompanying water.
Adequate amounts of water should always be taken when swallowing pills, for two reasons:
1. there should be enough water to flush the medication down the gullet (oesophagus) and into the stomach. This prevents harm to the oesophagus, a condition called chemical oesophagitis.
2. on reaching the stomach, the medication should mix with a good quantity of water in order to dissolve and enhance absorption.
CAN AN ALTERNATIVE FLUID BE USED?
Some patients occasionally or preferentially take their medication with fluids such as tea or coffee. In some cases, it is because water is regarded as being unpalatable. In other cases, it is in an effort to economise on time, and tie medication time to tea time.
Taking medication down with a liquid other than water does cause problems. Among these, is the fact that the liquids such as beverages contain several chemicals including sugar. These chemicals may not cause a mechanical obstruction like solid food, but they compete with the medications, for a place on the absorptive mechanisms of the bowel. And they will also interfere with the liver’s handling of the medication.
OTHER COMMON MISTAKES IN THE HANDLING OF MEDICATIONS
1. Not handling medicines hygienically. This includes handling them with unclean hands, or sticking hands or fingers into a container-full of tablets.
2. Not storing medications in child tamper-proof containers such as this:
3. Leaving tablet bags or medicine bottles open for too long enables infections to enter, or can cause the problem in 4 below.
4. Improper handling of medication, or leaving it in an environment with a lot of moisture, introduces the moisture into the medication and reduces its efficiency. This is the other problem with sticking fingers into tablet bags.
5. Mixing different tablets in one container, or reusing a medicine container for a different medication without thorough washing. Medications are chemicals, and dangerous reactions can occur. Also, for medicine collections for the whole family, this mixing can and does cause inadvertent taking of a drug to which someone is allergic to.
6. Not adequately, or not at all shaking liquid medications such as suspensions before use.
7. Not using medication dispensers for the Elderly, who easily forget and mix up their medications. For your convenience:
Every year, the equivalent of more than a Trillion US Dollars is spent on medications of all kinds globally, to improve the quality of life and to treat diseases of varying duration and severity. Unfortunately, many of these medications do not yield the ideal efficiency that they are capable of. Or they cause unnecessary adverse events. All these happen because of inadequate understanding of the medicines’ indications, pharmacological properties and storage requirements.
Education of the end-users of these pharmacological agents, being patients and their caregivers, is of paramount importance in order to achieve results that are as close to maximum, and adverse events that are as minimal as possible.
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