A “Small Dose” About Medication Reconciliation

Medication reconciliation is a term used in healthcare that describes the process of comparing a patient’s medication orders in a healthcare institution (hospital or nursing home) to what the patient has been prescribed and taking at home.

The purpose of this short column is to point out that many times patients are admitted to an institution, sometimes in an emergency, and it is difficult to determine what medications have been taken at home. Often when asked about their medicWilliam-Garst-HS.jpgations the response is “I take a blood pressure drug, a blood thinner, something for cholesterol, and something occasionally for arthritis pain.”

Just those four categories of medications probably describe several dozen, if not more, potential medications. What is needed is an exact listing of the medications with their dose (strength), how often they are taken, and when they are taken.

 

The perfect list of medications would be an official one from the patient’s primary care physician or provider. However, often what is presented at the institution is a handwritten list with the barest of information.

I am suggesting in this short column that a person, each time they see their primary care physician, request a current list of their medications with doses and instructions, to be printed for them or even emailed to them for reference in case of an emergency.

This list would also be helpful to take to their pharmacist for comparison to what the pharmacy has on file in their computer profile. In this way, the pharmacist could request a prescription to be there at the pharmacy before it is needed, if there have been changes to the drug, dose, or how often the medication is taken. In addition, the pharmacist may want to notify the primary care physician of other medications that have been prescribed that are not on the primary care physician's record.

This brings up another important aspect: sometimes other physicians (specialists or emergency department physicians) have prescribed medication for a patient and the primary care physician is unaware and would need to know this addition, even if temporary, for a complete listing of medications.

It is vital that medication regimens be accurate as patients transition between healthcare environments as a matter of safety and proper medication administration. Keep the list handy or scan it into your computer for ready reference.

I hope this column was informative; prosper and be in health.

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William Garst is a consultant pharmacist who lives in Alachua, Florida. He is semi-retired and works part time at Lake Butler Hospital in Lake Butler, Florida. William received his pharmacy degree at Auburn University and a Doctor of Pharmacy from Colorado University. The Pharmacy Newsletter is a blog where you can find other informative columns. He may be contacted at garstcph@gmail.com.

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Martin Luther King Jr. Day

“I say to you today, my friends, though, even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream. I have a dream that one day this nation will rise up, live out the true meaning of its creed: ‘We hold these truths to be self-evident, that all men are created equal.’” These words are as moving today as when first spoken by Dr. Martin Luther King, Jr., the passionate and influential civil rights leader who stood as a “pillar of hope and a model of grace” in his fight towards equality for all.

On January 17, we will reflect on the life and legacy of Dr. King, who, with his brave supporters, stood in strong opposition to racial discrimination, as well as the wrongful and unequal treatment of people who differed in national origin and religious beliefs.

The State of Florida continues to carry Dr. King’s legacy forward, committed to ending discrimination and ensuring all within our state have fair and equal access to employment and housing - because every person deserves to live the American Dream. The Florida Commission on Human Relations (FCHR) was established in 1969 to enforce the Florida Civil Rights Act and address discrimination through education, outreach, and partnership. Annually, the FCHR recognizes and honors Floridians who advance civil rights throughout the state in the Florida Civil Rights Hall of Fame.

As we take this time to honor Dr. King, let us consider how we can improve our own communities. Everyone should have the opportunity to live the American Dream. Dr. King paved the way for our society to embrace equality, and it is our job as Americans and Floridians to ensure the civil rights of all people.

Angela Primiano, Vice-Chair

Florida Commission on Human Relations

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The Pharmacy Newsletter: The Story of The First Drug to Treat Alcoholism

The first drug developed to treat alcohol use disorder (AUD), the modern term for alcoholism, was disulfiram (Antabuse). Today disulfiram is still used, but as a second line William Garst HSdrug behind acamprosate (Campral) and naltrexone (Revia, Vivitrol). Disulfiram works by blocking the enzymatic breakdown of alcohol and allowing a metabolite to build up in the blood, producing very unpleasant effects. People taking disulfiram will be deterred from ingesting alcohol because they know they will become very ill. The drug is used as an aid to help alcoholics overcome their cravings and addiction.

Disulfiram (a compound that contains sulfur) was first synthesized in 1881 as an industrial chemical, and in the early 1900s was introduced in the manufacturing of rubber. Adding sulfur in rubber manufacturing produces varying degrees of hardness in the final rubber compound.

During the late 1930s sulfur compounds, including disulfiram, were being investigated because of the antimicrobial effects of drugs containing sulfur, and the search was intense. Two scientists at the Danish firm of Medicinalco, Erik Jacobson and Jens Hald, began investigating disulfiram for treatment of intestinal parasites. This company had a group of employees called the “Death Battalion” who would experiment on themselves.

During this phase of testing the drug on themselves, they discovered they became ill after ingesting alcohol. This discovery was made in 1945, but a few years later disulfiram was considered to be used in the treatment of alcoholism as an aversive-reaction drug therapy. Jacobson and Hald’s work was finally published in 1948 and disulfiram was approved by the FDA in 1951.

The discovery of disulfiram led to a renewed interest in the metabolism of alcohol in the body. It was known alcohol was metabolized in the liver and broken down to acetaldehyde then to acetic acid and carbon dioxide by unknown enzymes. In 1950 it was discovered that disulfiram blocked the action of the enzyme that converts acetaldehyde, thus causing an accumulation of acetaldehyde in the bloodstream, which is the cause of the unpleasant effects.

Effects that occur when disulfiram is taken with alcohol include flushing, sweating, nausea and vomiting, chest pain, shortness of breath, and lightheadedness. One should not take disulfiram within 12 hours of alcohol ingestion or 14 days from the last dose of the drug. In addition, products that contain alcohol such as aftershave, cologne, perfume, antiperspirant, and mouthwash can produce unpleasant reactions for people taking Antabuse. Other products to avoid are paint thinners, solvents, and stains, along with dyes, resins and waxes, because even small amounts of alcohol absorbed through the skin can produce the effects.

Other drugs can produce adverse reactions, commonly called the “antabuse-like reaction.” The most notable of these drugs are metronidazole (Flagyl, an antibiotic), griseofulvin (an antifungal), and some cephalosporin antibiotics. If a drug is known to have this side effect, it should be pointed out to the patient by the prescriber and the pharmacist. Always read the drug information given to you when starting a new medication that tells you about side effects that may occur and how to avoid them.

Substance abuse of any kind is not good, but alcohol abuse has been especially devastating to society, families, and individuals because of the convenient availability, relative inexpensiveness, and its association with festivities. In addition, the abuse of alcohol leads to lack of inhibitions and unpredictable behaviors, which are many times violent and destructive. When people take disulfiram, they are acknowledging their problem, and they know that very unpleasant reactions will occur if alcohol is consumed, thus it helps to deter the first drink.

The history of disulfiram is still being written. Currently, it is being studied to treat certain cancers, parasitic infections, HIV, and Covid-19.

Stay informed and stay healthy.

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William Garst is a consultant pharmacist who resides in Alachua, Florida. He received his B.S. in Pharmacy from Auburn University in 1975. He earned a master’s degree in Public Health in 1988 from the University of South Florida and a Master’s in Pharmacy from UF in 2001. In 2007, he received his Doctor of Pharmacy from the University of Colorado. Dr. Garst is a member of many national, state, and local professional associations. He serves on the Alachua County Health Care Advisory Board and stays active as a relief pharmacist. In 2016, he retired from the VA. Dr. Garst enjoys golf, reading (especially history), and family. He writes a blog called The Pharmacy Newsletter (https://thepharmacynewsletter.com/). William Garst can be contacted at communitypharmac
ynewsletter@gmail.com.

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Social Security and Protecting Elders From Scams

World Elder Abuse Awareness Day is on June 15. On this day, and throughout the month, communities, seniors, caregivers, governments, organizations, and the private sector unite to prevent the mistreatment of and violence against older people.

Social Security imposter scams are widespread across the United States. Scammers use sophisticated tactics to deceive you into providing sensitive information or money. They target everyone – even the elderly – and their tactics continue to evolve.

Most recently, Social Security’s Office of the Inspector General (OIG) has received reports of phone scammers creating fake versions of the identification badges most Federal employees use to gain access to Federal buildings. The scammers may text or email photos of the fake badges to convince potential victims of their legitimacy. These badges use government symbols, words, and even names and photos of real people, which are available on government websites or through internet searches.

If you receive a suspicious letter, text, email, or call, hang up or do not respond. You should know how to identify when it’s really Social Security. We will NEVER:

  • Text or email images of an employee’s official government identification.
  • Suspend your Social Security number.
  • Threaten you with arrest or other legal action unless you immediately pay a fine or fee.
  • Require payment by retail gift card, wire transfer, internet currency, or cash by mail.
  • Promise a benefit increase or other assistance in exchange for payment.
  • Send official letters or reports containing your personal information via email.

We only send text messages if you have opted in to receive texts from us and only in limited situations, including the following:

  • When you have subscribed to receive updates and notifications by text.
  • As part of our enhanced security when accessing your personal my Social Security account.

If you owe money to us, we will mail you a letter with payment options and appeal rights.

We encourage you to report suspected Social Security imposter scams — and other Social Security fraud — to the OIG website at oig.ssa.gov. You may read our previous Social Security fraud advisories at oig.ssa.gov/newsroom/news-release. Please share this information with your friends and family to help spread awareness about Social Security imposter scams.

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Gone Coastal: Tips for Finding A Good Fishing Spot In Open Water

When learning the ropes — and rods — of saltwater fishing, thorough preparation involves more than just a rich arsenal of gear and the appropriate attire. Open-water fishing is challenging and requires technique and prior research.  

If you’re embarking on an open-water adventure for the first time, keep the following saltwater fishing tips in mind.  

Research Your Destination

The key to discovering a spot rich in saltwater fish is ample research. At least a week before your trip, you’ll want to read up on fishing reports, tide charts and weather forecasts.  

For instance, while a rainy morning might deter most anglers, it can also surprise you with better catches — if you know where to look. 

Some areas are more crowded with fishing enthusiasts during different times of the year. Consider whether you are traveling in the spring, summer, fall or winter and do the appropriate research. You can get some ideas of  where to go at MyFWC.com/Marine by clicking “Where to Saltwater Fish.”

Think About Your Target Species

The type of catch you’re after will dictate where you anchor your boat. Targets, such as yellowfin or other tunas, for instance, are surface feeders. Thus, you’ll want to be on the lookout for weed lines and baitfish breaking the surface.  

On the other hand, some species including groupers and snappers are bottom feeders and prefer structures including reefs and wrecks. Angling for these species can require special equipment, such as a fishfinder, circle hooks, dehooking tools, descending devices and more. MyFWC.com/FishHandling explains much of this fishing gear.    

Stay up to date on the latest regulations for saltwater fishing at MyFWC.com/Marine by clicking “Recreational Regulations” or by downloading the Fish Rules app on your smart device. Learn about fish identification at MyFWC.com/FishingLines or by visiting MyFWC.com/Marine by clicking “Fish Identification.”

Use a Bathymetric Map

When it comes to open-water angling, you can never underestimate the usefulness of a map. Bathymetric maps are a type of underwater topographic map that indicates specific depths. Space between lines on the map illustrates whether an area is close to a steep slope, drop off, flat or shoal. Lines that are close together indicate a rapidly changing depth in the area. 

Keep in mind that bathymetric maps can be challenging to find at your local angling shop. If you have trouble coming across a bathymetric map, you can rely on other tools, such as nautical charts or satellite images.    

Speak to the Locals

While ample internet research might suffice, nothing quite compares to gathering input from local anglers. When you have a specific target species in mind, drop by the local bait shop for advice. Or join an online group focused on fishing in your area of interest. 

Some angling hot spots have knowledgeable fishing guides who can direct you to the ideal area for your specific catch. Hop on a trip for a chance to see the area up close with an expert who can teach you how to catch your target species. 

Alternatively, you can venture out into the ocean yourself and observe where other anglers are setting up shop. Just be sure to mind your distance and not crowd other anglers. Learn more about angler etiquette at MyFWC.com/Marine by clicking “On-the-Water Etiquette.”

Make the Most of Angling Technology

Nowadays, you won’t find any shortage of state-of-the-art angling technology available online and at your local bait shop. Make sure that a reliable fish finder is part of your staple arsenal.  

Fish finders use sonar to locate fish within your chosen area. When an echo transmits back to your device, it indicates the presence of fish immediately under or around your vessel. Some wireless fish finders are Bluetooth compatible and will quickly pair with your Android or iOS device.  

You'll want to consider other staple needs for open-water fishing: GPS, VHF 2-way radio, flares, noise-making device, first aid kit and life jacket for each person on board. Wearing a life jacket while on the water is a simple way to prevent you from drowning if you fall overboard due to a boating accident. Learn more about boating requirements and safety at MyFWC.com/Boating. Find more tips and tricks at MyFWC.com/Marine by clicking “How to Saltwater Fish.”

The Bottom Line

If you have recently taken an interest in saltwater fishing, knowing how to target your intended catch will go a long way in the open water. Make the most of your day out by researching your destination beforehand, coming well-equipped, and learning how to identify different kinds of saltwater fish. Consider sharing your catches with scientists through the iAngler app and submitting catches for recognition at FWC’s CatchaFloridaMemory.com

About the Author

Kenneth is an expert at saltwater fishing and the founder of Perfect Captain. He has been angling for over two decades and hopes to provide accessible resources for fishing rookies and veterans.

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