Current Medicine-cabinet- News Results

Discourse on safe drug use: symbolic logics and ethical aspects.

Drug Saf. 2010 Aug 1; 33(8): 623-9
Fainzang S

Drug safety is not a matter for healthcare professionals alone. Patients are also involved, at three different levels: (i) in the behaviours patients adopt to reduce the adverse effects of the drugs; (ii) in regard to what some doctors say to their patients about drug risks; and (iii) in what the pharmaceutical industry says about self-medication and risks. This article will examine these aspects on the basis of information gathered in France during anthropological studies on drug use. (i) Patients' concerns about reducing adverse effects give rise to a series of behaviours relating to drug use. Patients start with the identification of what they regard as a risk inherent in the substances or linked to the uncontrolled use of drugs, and try to neutralize the risk by modifying or modulating the prescriptions in line with various parameters. Dimensions as varied as the nature of the prescribed drugs, the quantity, the dosage and the preservation of certain functions or organs are taken into account, and patients follow their own rules of conduct in order to reduce risks. These dimensions bring into play characteristics of both the drug and the individual, and take into account the effects or the risks of drugs in their physical, psychic, behavioural and social aspects. (ii) Doctors' discourse towards patients regarding the risks and possible effects of drugs is examined, in particular the discourse of those who choose to hide the undesirable effects of drugs from their patients with the aim of not jeopardizing the patient's compliance. This situation involves comparing two logics: ethics of care versus ethics of information. (iii) Regarding the pharmaceutical industry's discourse on self-medication and risks, although on the one hand it promotes self-medication on the basis of patients' growing desire for autonomy and competency, on the other hand it discourages the use of the home medicine cabinet for reasons of safety, which questions the ability of patients to use drugs properly. This article aims to demonstrate that the various behaviours and discourses relating to the risks of drugs are embedded with symbolic, ethical and cultural logics. As a consequence, above and beyond work carried out on the question of pharmacovigilance, examining the issue of safe drug use involves studying the human - social and cultural - aspects that govern part of the behaviours and practices relating to drug safety.

Nonadherence to medications among pharmacy clients and their attitude toward medications kept a medicine cabinet at home.

Medicina (Kaunas). 2009; 45(12): 1013-8
Dauksiene J, Radziūnas R

OBJECTIVES: To assess self-reported adherence among pharmacy clients and to detect if there are any differences in medication use or storage between genders. MATERIAL AND METHODS: The data were collected by means of questionnaires. A standard 45-item questionnaire was developed and used to assess adherence and nonadherence to medications. It was distributed to all pharmacy customers who entered pharmacies chosen by us. RESULTS: Of the 162 (45 men and 117 women) pharmacy clients participating in the study, 36.42% were considered nonadherent. No significant difference in adherence rates between genders was observed (P>0.05). Women more often named themselves as being responsible for a medicine cabinet at home (P<0.001) and used more sources of information on medications (P<0.05). Women also more frequently checked the expiry date of medications in a medicine cabinet home than men (P<0.05). CONCLUSIONS: The problem of nonadherence to medications exists among pharmacy clients. There is no significant difference in the rate of self-reported adherence between male and female pharmacy clients. Women are the ones named as responsible for a medicine cabinet at home. They also are important health decision makers. Women are more interested in information on medicines and their use; therefore, this demand should be satisfied.

What's in your medicine cabinet? It could save you a trip to the doctor.

Mayo Clin Health Lett. 2010 Jan; 28(1): 6

A role for community health promoters in tuberculosis control in the state of Chiapas, Mexico.

J Community Health. 2010 Apr; 35(2): 182-9
Herce ME, Chapman JA, Castro A, García-Salyano G, Khoshnood K

We conducted a qualitative study employing structured interviews with 38 community health workers, known as health promoters, from twelve rural municipalities of Chiapas, Mexico in order to characterize their work and identify aspects of their services that would be applicable to community-based tuberculosis (TB) control programs. Health promoters self-identify as being of Mayan Indian ethnicity. Most are bilingual, speaking Spanish and one of four indigenous Mayan languages native to Chiapas. They volunteer 11 h each week to conduct clinical and public health work in their communities. Over half (53%) work with a botiquín, a medicine cabinet stocked with essential medicines. Fifty-three percent identify TB as a major problem affecting the health of their communities, with one-fifth (21%) of promoters reporting experience caring for patients with known or suspected TB and 29% having attended to patients with hemoptysis. One-third of health promoters have access to antibiotics (32%) and one-half have experience with their administration; 55% complement their biomedical treatments with traditional Mayan medicinal plant therapies in caring for their patients. We describe how health promoters employ both traditional and allopathic medicine to treat the symptoms and diseases they encounter most frequently which include fever, diarrhea, and parasitic infections. We contend that given the complex sociopolitical climate in Chiapas and the state's unwavering TB epidemic and paucity of health care infrastructure in rural areas, efforts to implement comprehensive, community-based TB control would benefit from employing the services of health promoters.

Medication taking behavior of students attending a private university in Bangladesh.

Int J Adolesc Med Health. 2009 Jul-Sep; 21(3): 361-70
Chowdhury N, Matin F, Chowdhury SF

The objective of this study was to investigate the patterns of self-reported medication use, including both prescription and OTC drugs, and to assess the possible predictors of self-medication and medication non-compliance (non-adherence), for 929 non-medical undergraduate students of the American International University, a private university situated in Dhaka city, Bangladesh. Although a high proportion (69%, n = 644) of students of this university had fallen sick in the last six months before the study, the rate of visiting qualified health practitioners was much lower (53%). A good proportion of the sick students were reported to have practiced self-medication (16%, n = 100) and medication non-adherence (15%, n = 98). The average treatment cost involved in self medication was much lower than that offered by a qualified physician (Tk 463 vs Tk 2546 per case). Those students living with parents were more likely to have visited qualified health practitioners (56%, p < .05), and students whose families kept a well-stocked medicine cabinet at home were more likely to have completed the full course (39%, p < .05) of prescribed medicine. No significant difference was found in the rates of self medication and medication compliance incidence for variables like age groups, gender, residence status, financial level, engagement in part-time jobs etc. The study also showed that antimicrobials are widely available (170 incidents) in the home medicine cabinets of the Dhaka City population. The storage of leftover antibiotics in the home constitutes an alternative potential source of self-medication that can have untoward consequences. Further elaborate studies are required to reveal the true pattern of antibiotic usage in Bangladesh.

[Self-medication and the elderly. The reality of the home medicine cabinet]

Aten Primaria. 2009 May; 41(5): 269-74
Vacas Rodilla E, Castellà Dagà I, Sánchez Giralt M, Pujol Algué A, Pallarés Comalada MC, Balagué Corbera M

OBJECTIVE: To estimate the prevalence of self-medication in the elderly, to describe the characteristics of self-medication and home medicine cabinets. DESIGN: Cross-sectional descriptive study. SETTING: An urban primary health care (PHC) centre in Spain. PARTICIPANTS: A total of 240 patients 75 years of age or older. MAIN MEASUREMENTS: A structured questionnaire filled in by home care nurses from April to June 2006. Self-medication was classified into 4 sub-groups: pharmacological or herbal, exclusively pharmacological, exclusively herbal and pharmacological and herbal. The study variables were: age, sex, living alone, number of chronic diseases, number of chronic prescriptions and medicine cabinet characteristics (drugs accumulation, expired drugs, chronic drugs out of prescription, location of medicine chest and periodic review). Other variables were: drug types, source, and acute/chronic reason for self-medication. RESULTS: Self-medication frequency was 31,2% (95% CI, 26-36), with 22.9% (95% CI, 17.5-27.5) being pharmacological and 15.4% (95% CI, 23.1-17.3), herbal. The drugs most used in self-medication were analgesics (30.9%) and cold remedies (27.2%). The pharmacy was the most usual source (49.3%). A total of 41.6% contained drugs that were out of chronic prescription, and 34.4% accumulated more than three boxes of the same medication. CONCLUSIONS: There is a significant prevalence of self-medication among the elderly. Accumulating drugs in homes is a very extensive practice. Pharmacists and PHC professionals need to be trained in the responsible use of chronic and self-medication. Although self-care has to be encouraged, PHC professionals must make their patients aware of the harmful effects of self-medication.

Inside the medicine cabinet: making children's medicines a grown-up issue.

J Pharm Sci. 2008 Dec; 97(12): 5074-9
Barnes PW

Children need medicines that are properly designed and formulated specifically for pediatric use. However, the majority of medicines prescribed for children have insufficient clinical data to support pediatric use or to determine how children will react to such medicines. In particular, children living with HIV/AIDS have limited access to pediatric-specific antiretroviral drugs used to fight the disease. Recent improvements to U.S. and European pediatric drug testing laws may help generate more drugs tested and approved for children, but more must be done to ensure that children do not lag behind in access to lifesaving AIDS medicines, particularly in resource-poor countries.

Do you know what's in your medicine cabinet?

Johns Hopkins Med Lett Health After 50. 2008 Oct; 20(8): 7

Medicine Cabinet: Drug treatment of depression.

West J Med. 1999 Aug; 171(2): 102-5
Martensson B, Spigset O

Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study.

Neurology. 2008 Jul 29; 71(5): 344-50
Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD

OBJECTIVE: Evidence of a relation between use of lipid lowering drugs and cognitive outcomes is mixed. This study aimed to test the association between use of statins and incidence of dementia and cognitive impairment without dementia (CIND) over 5 years of follow-up. METHODS: Data were from a population-based cohort study comprising 1,789 older Mexican Americans. All participants had cognitive and clinical evaluations performed every 12 to 15 months. Participants who fell below specified cutpoints on cognitive tests were then evaluated clinically. Dementia diagnoses were finalized by an adjudication team. A total of 1,674 participants free of dementia/CIND at baseline were included in these analyses. Statin use was verified at each participant's home by medicine cabinet inspection. Cox proportional hazards models were used to evaluate the association between statin use and incidence of dementia/CIND. RESULTS: Overall, 452 of 1,674 participants (27%) took statins at any time during the study. Over the 5-year follow-up period, 130 participants developed dementia/CIND. In Cox proportional hazards models adjusted for education, smoking status, presence of at least one APOE epsilon4 allele, and history of stroke or diabetes at baseline, persons who had used statins were about half as likely as those who did not use statins to develop dementia/CIND (HR = 0.52; 95% CI 0.34, 0.80). CONCLUSION: Statin users were less likely to have incident dementia/cognitive impairment without dementia during a 5-year follow-up. These results add to the emerging evidence suggesting a protective effect of statin use on cognitive outcomes.

Stress response pathways in protozoan parasites.

Cell Microbiol. 2008 Dec; 10(12): 2387-99
Vonlaufen N, Kanzok SM, Wek RC, Sullivan WJ

Diseases caused by protozoan parasites have a dramatic impact on world health. Emerging drug resistance and a general lack of experimental understanding has created a void in the medicine cabinet used to treat these widespread infections. A novel therapeutic idea that is receiving more attention is centred on targeting the microbe's response to the multitude of environmental stresses it encounters. Protozoan pathogens have complex life cycles, often having to transition from one host to another, or survive in a cyst form in the environment until a new host arrives. The need to respond to environmental cues and stress, and endure in less than optimal conditions, is paramount to their viability and successful progression through their life cycle. This review summarizes the research on parasitic stress responses for Apicomplexa, kinetoplastids and anaerobic protozoa, with an eye towards how these processes may be exploited therapeutically.

Beyond the medicine cabinet: an analysis of where and why medications accumulate.

Environ Int. 2008 Nov; 34(8): 1157-69
Ruhoy IS, Daughton CG

Active pharmaceutical ingredients (APIs) from medications can enter the environment as trace contaminants, at individual concentrations generally below a part per billion (microg/L). APIs enter the environment primarily via the discharge of raw and treated sewage. Residues of unmetabolized APIs from parenteral and enteral drugs are excreted in feces and urine, and topically applied medications are washed from skin during bathing. These trace residues may pose risks for aquatic life and cause concern with regard to subsequent human exposure. APIs also enter the environment from the disposal of unwanted medications directly to sewers and trash. The relative significance of this route compared with excretion and bathing is poorly understood and has been subject to much speculation. Two major aspects of uncertainty exist: the percentage of any particular API in the environment originating from disposal is unknown, and disposal undoubtedly occurs from a variety of dispersed sources. Sources of disposal, along with the types and quantities of APIs resulting from each source, are important to understand so that effective pollution prevention approaches can be designed and implemented. Accumulation of leftover, unwanted drugs poses three major concerns: (i) APIs disposed to sewage or trash compose a diverse source of potential chemical stressors in the environment. (ii) Accumulated drugs represent increased potential for drug diversion, with its attendant risks of unintentional poisonings and abuse. (iii) Leftover drugs represent wasted healthcare resources and lost opportunities for medical treatment. This paper has four major purposes: (1) Define the processes, actions, and behaviors that control and drive the consumption, accumulation, and need for disposal of pharmaceuticals. (2) Provide an overview of the diverse locations where drugs are used and accumulate. (3) Present a summary of the first cataloging of APIs disposed by a defined subpopulation. (4) Identify opportunities for pollution prevention and source reduction.

Making medicines in the early modern household.

Bull Hist Med. 2008; 82(1): 145-68
Leong E

This article is a study of household medicine production and consumption through an examination of the papers of Elizabeth Freke (1641-1714) and a wider survey of around nine thousand medical recipes in printed and manuscript collections from seventeenth-century England. It investigates the sorts of medicines that may have been produced in early modern households and the production methods, ingredients, and equipment used. Focusing on three inventories of medicines compiled by Freke between 1710 and 1712 as well as her manuscript recipe collection and medical reading notes, I contend that she kept on hand a number of cure-alls and medicines for general weaknesses, while holding onto recipes for more-specific ailments; the recipes, in these cases, would be the "just-in-case" medicine cabinet. I also argue for a close relationship between commercial and domestic medicine, and present the idea that household practitioners purchased not only ingredients (both processed and unprocessed) and equipment, but also medical knowledge.

The eating disorders medicine cabinet revisited: a clinician's guide to ipecac and laxatives.

Int J Eat Disord. 2007 May; 40(4): 360-8
Steffen KJ, Mitchell JE, Roerig JL, Lancaster KL

OBJECTIVE: To describe the frequency of alternative medication use in bulimia nervosa (BN), and to review available nonprescription emetic (ipecac) and laxative products and their potential toxicities. METHOD: Survey data were collected from 39 consecutive treatment-seeking patients with BN or subthreshold BN. Survey data of the available nonprescription and herbal products from local retail stores were also collected. Toxicology information was reviewed on these agents from MEDLINE and herbal textbooks. RESULTS: Ipecac use occurred in 18% of the 39 patients. Laxatives had been used at some point to control weight or "get rid of food" by 67% of the patients. Of these, 31% had abused laxatives during the month prior to evaluation. In the product survey, 248 laxative-containing products were identified. CONCLUSION: There are numerous laxative products readily available to patients, and many of them have significant associated toxicities. Patients with BN tend to endorse high rates of laxative use. While ipecac is used infrequently, it can have deleterious consequences. Patients with BN should be screened for use of both ipecac and laxatives and should be educated about the potential consequences associated with the misuse of these agents.

Mechanisms of prescription drug diversion among drug-involved club- and street-based populations.

Pain Med. 2007 Mar; 8(2): 171-83
Inciardi JA, Surratt HL, Kurtz SP, Cicero TJ

OBJECTIVE: Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician's office, the retail pharmacy, or the patient. However, empirical data on diversion are limited. METHOD: In an attempt to develop a better understanding of how specific drug-using populations are diverting prescription opioids and other medications, or obtaining controlled drugs that have already been diverted, qualitative interviews and focus group data were collected on four separate populations of prescription drug abusers in Miami, Florida--club drug users, street-based illicit drug users, methadone maintenance patients, and HIV positive individuals who abuse and/or divert drugs. RESULTS: Sources of abused prescription drugs cited by focus group participants were extremely diverse, including their physicians and pharmacists; parents and relatives; "doctor shopping"; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment flyers advertising telephone numbers to call; and "stealing from grandma's medicine cabinet." CONCLUSION: While doctor shoppers, physicians and the Internet receive much of the attention regarding diversion, the data reported in this paper suggest that there are numerous active street markets involving patients, Medicaid recipients and pharmacies as well. In addition, there are other data which suggest that the contributions of residential burglaries, pharmacy robberies and thefts, and "sneak thefts" to the diversion problem may be understated.

[Antibiotics in the medicine cabinet]

Orv Hetil. 2006 Oct 29; 147(43): 2103-4; author reply 2104
Simon T

Risk of mortality with vitamin E supplements: the Cache County study.

Am J Med. 2007 Feb; 120(2): 180-4
Hayden KM, Welsh-Bohmer KA, Wengreen HJ, Zandi PP, Lyketsos CG, Breitner JC,

PURPOSE: A recent meta-analysis reported increased mortality in clinical trial participants randomized to high-dose vitamin E. We sought to determine whether these mortality risks with vitamin E reflect adverse consequences of its use in the presence of cardiovascular disease. METHODS: In a defined population aged 65 years or older, baseline interviews captured self- or proxy-reported history of cardiovascular illness. A medicine cabinet inventory verified nutritional supplement and medication use. Three sources identified subsequent deaths. Cox proportional hazards methods examined the association between vitamin E use and mortality. RESULTS: After adjustment for age and sex, there was no association in this population between vitamin E use and mortality (adjusted hazard ratio [aHR] 0.93; 95% confidence interval [CI], 0.74-1.15). Predictably, deaths were more frequent with a history of diabetes, stroke, coronary artery bypass graft surgery, or myocardial infarction, and with the use of warfarin, nitrates, or diuretics. None of these conditions or treatments altered the null main effect with vitamin E, but mortality was increased in vitamin E users who had a history of stroke (aHR 3.64; CI, 1.73-7.68), coronary bypass graft surgery (aHR 4.40; CI, 2.83-6.83), or myocardial infarction (aHR 1.95; CI, 1.29-2.95) and, independently, in those taking nitrates (aHR 3.95; CI, 2.04-7.65), warfarin (aHR 3.71; CI, 2.22-6.21), or diuretics (aHR 1.83; CI, 1.35-2.49). Although not definitive, a consistent trend toward reduced mortality was seen in vitamin E users without these conditions or treatments. CONCLUSIONS: In this population-based study, vitamin E use was unrelated to mortality, but this apparently null finding seems to represent a combination of increased mortality in those with severe cardiovascular disease and a possible protective effect in those without.

[Storage of antibiotics in Spanish households]

Rev Esp Quimioter. 2006 Sep; 19(3): 275-85
González J, Orero A, Prieto J

This study aimed to determine how many antibiotics were stored in Spanish households, analyzing their origin and characteristics (number, antibiotic type and pharmaceutical form). In addition, some general characteristics of the "home medicine cabinet" were investigated. The study was conducted by telephone interviews with one of the heads of the family in 1,000 randomly chosen Spanish homes, but in accordance with a territorial distribution proportional to the Spanish population and to the urban and rural setting. According to the results obtained, there was at least one antibiotic packet in 37% of Spanish households, mostly corresponding (96.5%) to broad-spectrum semisynthetic penicillin (amoxycillin or clavulanic-amoxycillin). A total of 59.2% of the packets found corresponded to solid oral forms (tablets, capsules, etc.) and 40.4% corresponded to liquid oral forms (syrup, suspension, sachet). The antibiotics were mostly obtained by medical prescription (84.9%), self-medication being the origin in almost 15% of them. There was a member of the family under antibiotic treatment at the time of the study in only 30% of the households that had one or more containers. The financial evaluation of the "leftover" antibiotic doses makes it possible to estimate a cost of about 18 million euros, more than 12 million of which would have been financed by the Health Care Administration. The results show that storing of antibiotics continues to be important in Spain, even though a considerable decrease has been observed in the last 10 years. This could be related to a progressive abandonment of self-medicating attitudes.

Prescription drug abuse: what is being done to address this new drug epidemic? Testimony before the Subcommittee on Criminal Justice, Drug Policy and Human Resources.

Pain Physician. 2006 Oct; 9(4): 287-321
Manchikanti L

This comprehensive health policy review of the prescription drug abuse epidemic is based on the written and oral testimony of witnesses at a July 26, 2006 Congressional Hearing, including that of Laxmaiah Manchikanti, MD, the chief executive officer of the American Society of Interventional Pain Physicians and additions from review of the literature. Honorable Mark E. Souder, chairman of the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, introduced the issue as follows: "Prescription drug abuse today is second only to marijuana abuse. In the most recent household survey, initiates to drug abuse started with prescription drugs (especially pain medications) more often than with marijuana. The abuse of prescription drugs is facilitated by easy access (via physicians, the Internet, and the medicine cabinet) and a perception of safety (since the drugs are FDA approved). In addition to the personal toll of drug abuse using prescription drugs, indirect costs associated with prescription drug abuse and diversion include product theft, commission of other crimes to support addiction, law enforcement costs, and encouraging the practice of defensive medicine." The Administration witnesses, Bertha Madras, Nora D. Volkow, MD, Sandra Kweder, MD, and Joe Rannazzisi reviewed the problem of drug abuse and discussed what is being done at the present time as well as future strategies to combat drug abuse, including prescription drug monitoring programs, reducing malprescriptions, public education, eliminating Internet drug pharmacies, and the development of future drugs which are not only tamper-resistant but also non-addictive. The second panel, consisting of consumers and advocates, included Misty Fetco, Linda Surks, and Barbara van Rooyan, all of whom lost their children to drugs, presented their stories and strategies to prevent drug abuse, focusing on education at all levels, development of resistant drugs, and non-opioid treatment of chronic pain. Mathea Falco, JD, and Stephen E. Johnson presented issues related to drug abuse and measures to curb drug abuse by various means. Stephen J. Pasierb presented startling statistics on teen drug abuse and various educational programs to deter abuse. Laxmaiah Manchikanti, MD presented an overview of prescription drug abuse, strategies to prevent drug abuse, including immediate funding and rapid implementation of NASPER, education at all levels and improving relations with the DEA and the provider community.

A virtual reality apartment as a measure of medication management skills in patients with schizophrenia: a pilot study.

Schizophr Bull. 2007 Sep; 33(5): 1162-70
Kurtz MM, Baker E, Pearlson GD, Astur RS

Performance on a novel, virtual reality (VR) assessment of medication management skills, the Virtual Reality Apartment Medication Management Assessment (VRAMMA), was investigated in 25 patients with schizophrenia and 18 matched healthy controls. The VRAMMA is a virtual 4-room apartment consisting of a living room with an interactive clock and TV, a bedroom, a kitchen, and a bathroom with an interactive medicine cabinet. After an exploratory phase, participants were given a mock prescription regimen to be taken 15 minutes later from pill bottles located in the medicine cabinet in the bathroom of the virtual environment. The VRAMMA was administered with a validated measure of medication management skills, several neurocognitive tests, and a symptom scale. Results revealed that (1) schizophrenic patients made significantly more quantitative errors in the number of pills taken, were less accurate at taking the prescribed medications at the designated time, and checked the interactive clock less frequently than healthy controls; (2) in patients with schizophrenia, there was significant agreement in classification of adherence vs nonadherence between a validated measure of medication management skills and the VRAMMA; and (3) in patients with schizophrenia, years of education and a measure of verbal learning and memory were linked to quantitative errors on the VRAMMA, while positive symptoms, specifically delusional symptoms, were inversely linked to distance traveled within the VRAMMA. This is the first study, to our knowledge, to provide evidence for the utility of VR technology in the assessment of instrumental role functioning in patients with schizophrenia.