antibiotics

7 overused medications

What 7 drugs are overused? Find out here.

This week I discuss 7 groups of medications that are overused. This, and the next post about drugs which are underused, has many links; you may want to bookmark for future review.

medication capsules — Sometimes we need medication, but sometimes we don’t.

I call these drugs overused. However, I do not mean

That you should never take them
That you should quit using them
That your doctor should not prescribe them
That you should quit taking them if your doctor prescribed them
That they are bad or dangerous drugs

We should think more about when, why and how to use these drugs.

By drugs and medications, I consider any substance we put into our bodies to treat or prevent a disease or symptom, whether prescribed or over-the-counter (OTC), synthetic or “natural”. I’m not considering foods,nor any substance that is illegal or mostly recreational in this discussion.

I picked classes of drugs that I am most familiar with as a family physician so excluded highly specialized medications like cancer chemotherapy, cardiovascular drugs, anti-rheumatics and neurological drugs.

I based my assessment on my professional experience as well as medical literature and the opinions of other physicians. As always, your best source of information about the right drugs for your conditions is your personal physician.

Every infectious disease expert says we use too many antibiotics unnecessarily-but we keep doing it. Doctors and patients share the responsibility of using antibiotics appropriately.

Reasons to avoid antibiotics

They don’t help most of the things we use them for, namely respiratory infections which are usually caused by viruses.

They add to the cost of medical care.

They frequently cause side effects; they are one of the top four causes of adverse drug reactions that lead to ER visits and hospital admission.

They can change the balance of the good bacteria that live in our bodies, the microbiome.

Here is a previous post about the use and misuse of antibiotics for respiratory infections, the most common culprit in the inappropriate antibiotic battle.

How to navigate the antibiotic highway

Opioid pain medication

These are the drugs that comprise the current opiate epidemic. Like antibiotics, they are a frequent cause for ER visits and admissions for adverse reactions. Unlike antibiotics, they can create physical and mental dependency and addiction, and can be fatal in overdose which is happening more often. The New York Times reports

Opioid poisonings increase in toddlers and teenagers

Some of the overdose deaths are accidental, especially in children, but in adolescents and adults are too often intentional.

Used properly, opiates relieve severe pain due to cancer, trauma,and surgery, but doctors and patients should consider other alternatives for less severe pain first, especially if it is a long term condition.

Dr. Sanjay Gupta, CNN medical correspondent, suggests doctors and patients work together to achieve pain relief without the risk of addiction.

“But most simply, we as doctors need to engage our patients and discuss treatment with them, whether its short term opioids or alternatives like physical and occupational therapy. We need to help set realistic expectations for our patients: Living entirely pain free is not always possible. As doctors, we need to have follow-up conversations with our patients to see how treatment is going. If we better understand our patients, we can provide better treatment and help develop pain strategies that are effective and safe.”

Talk to your doctor if you believe your use of opiate pain medication has become a problem.

Doctors must lead us out of our opioid abuse epidemic

lying woman with palm full of pills — Deaths from accidental and intentional opioid overdoses are skyrocketing.

Anti-inflammatory drugs

These are the non-steroid anti-inflammatory drugs, referred to as NSAIDs. This includes generic ibuprofen and naproxen, available in both otc and prescription strengths. ( Brand names include Motrin, Advil and Aleve.) There are other NSAIDs but these are most frequently used.

When these drugs first hit the market, we were excited to have effective drugs for people with joint pain from arthritis. Then we recognized they also worked well for headaches, menstrual pain, and other forms of muscle and joint pain.

Now they seem to have become the go-to drugs for almost any discomfort or symptom, with people taking multiple doses daily (often exceeding the recommended dose) without medical supervision.

Although usually well tolerated, they do pose risk to the kidney, heart and liver, especially in people who already have disorders of those organs. And they can cause stomach ulcers with bleeding in anyone.

Acetaminophen

The name Tylenol has become synonymous with the drug acetaminophen, although there are other brands and generic versions. Sometimes abbreviated APAP, this drug relieves pain and reduces fever, and is used frequently by adults who also give it to their children. It does not carry the risk of stomach ulcers as do the NSAIDs. However, it also can cause harm to the liver and kidney.

At this link you can

understand your OTC pain reliever options better

Sleeping medications

Many people have trouble falling asleep, staying asleep, or getting a restful sleep and turn to medications, both prescription and non-prescription for help.

Sleep specialists avoid the routine use of sleeping medications, due to lack of effectiveness long term and potential side effects and risks. They recommend altering conditions related to sleep such as bedtime, sleeping arrangements, temperature and activities, often called sleep hygiene, or mind-body interventions like meditation, hypnosis, yoga, tai chi and music.

Here is a Consumer Reports review of

Sleeping pills for insomnia

person sleeping on a couch — Sometimes getting a good night’s sleep can be a challenge.

Rescue inhalers for asthma

People use quick acting or rescue inhalers for asthma or COPD symptoms. The inhalers usually relieve symptoms promptly and if they aren’t, people may believe the inhaler “isn’t working”.

Instead, it may mean that the lungs aren’t “working” to full capacity and need more aggressive treatment. Continuing to use the inhaler repeatedly with little or no relief can be dangerous and lead to respiratory failure. Instead, you need to seek medical attention at a clinic or hospital emergency room.

This article explains

Inhaled asthma medications

Vitamins, minerals and other supplements

People spend $37 billion annually on vitamins, minerals and other supplements with little to no proof that they prevent or treat anything. Most nutrition scientists teach that appropriate eating will supply our requirements for vitamins and minerals.

Vitamins and/or minerals are recommended in some medical situations, including-

Pregnancy and nursing
People with intestinal disorders who absorb nutrients poorly
People with restricted diets for any reason
People with or at high risk of macular degeneration, a cause of blindness

Find out why

most adults don’t need dietary supplements

In a future post I will discuss non-drug alternatives to these drugs and others.

Listen to a podcast by two physicians at 2 Docs Talk

Are supplements good medicine?

Come back in 2 weeks to find out what 7 medications I call underused.

Do you know the best questions to ask about your healthcare?

expectations, concerns, obstacles-medical communication #askthedoctor

I blog about healthcare communication because you need to understand your doctor better and we doctors need to understand our patients’ expectations, concerns and obstacles.

Physicians should use clear understandable plain language with patients. Patients should also be clear and specific when they talk to their doctor.

You may think your doctor knows exactly what you mean, but sometimes we are left trying to read between the lines of what you tell us.

Dr. Aletha talking to a mother and her son — Talking to a patient through an interpreter makes communication extra challenging.

You know it’s important to tell us details of your symptoms, medical history, family history, habits, and other medical facts. But besides medical information about you , we need to know

Your expectations about your care,

Your concerns about your care,

Your obstacles to getting care,

You may wonder, won’t or shouldn’t my doctor ask me theses questions? Sure, we can ask and probably will, but by volunteering it , you start dialogue that gets you and your doctor communicating effectively much faster. Your doctor knows about disease, but you as the patient know the experience of the illness much better.

Let me illustrate by giving you some examples. These are all statements patients say to me in my daily practice. The original statements aren’t bad or wrong, but by rephrasing to add some additional detail they give your doctor valuable information that will help provide you the best care possible.

The underlined words can be substituted for others listed in parentheses. The exact words aren’t as important as the message they convey.

Hello doctor, I’m here because I want my thyroid checked.

(substitute heart, lungs, cholesterol, blood sugar, kidneys, etc.)

Instead try-

Hello doctor, I’m tired a lot, and wondered if it might be a thyroid problem or something else. What testing would help us find out what’s wrong with me?

It’s better not to limit your doctor to checking just one thing, when there are many possible explanations for your symptoms. You expect a thyroid check, but you’re open to other possibilities.

Doctor, I feel terrible and think I have pneumonia. The last time I felt like this the doctor said it was pneumonia, so it must be that again.

( sub kidney infection, strep throat, sinus infection)

But if you say this

Doctor, I feel so sick. This illness is similar to when I was diagnosed with pneumonia and I’m afraid I have it again. I am concerned it’s pneumonia again so I’m here to find out what is wrong, as I realize it may be something else.

You’ve told the doctor your concern about pneumonia but you’re not trying to diagnose yourself.

I have a family history of cancer so I want to have a mammogram.

(sub any other cancer, heart disease, stroke and other tests)

That’s good, but this is better.

Doctor, I’m concerned about breast cancer as it runs in my family. My grandmother was diagnosed at age 45 and now my sister has been, and she is 40. Do I need a mammogram or any other testing now?

Knowing who in your family had a disease and at what ages helps the doctor make an accurate recommendation. It also tells your doctor this may be an emotional issue (concern) for you.

I need an antibiotic (anti-inflammatory, muscle relaxer, steroid, shot ) for this; I know because my previous doctor always gave me one for this.

Please try this instead:

When I had this before my doctor prescribed an antibiotic; I wonder if that would be appropriate this time?

This tells the doctor your expectation, but also that you are open to different advice/recommendation. (and avoid getting a medication you don’t need.)

Will my insurance pay for this? How much will this cost me? Is this an expensive drug?

Patients may expect us to know about insurance and cost, but often we don’t. We can work with you on financial issues if we know more about your obstacle. Try asking-

I need to find out if this is covered by my insurance. Can someone in your office look that up, or help me find out?

I’ve had a lot of medical bills this year that have stretched my budget. I will need to find out what my out of pocket cost will be before scheduling this test. Can your office help me with that?

If there is a generic version of this drug that will work just as well, I would like it, to minimize my out of pocket cost. If not, is there another alternative?

Is this drug safe? (effective, good, best, dangerous, harmful)

Few things are 100% safe. But what we can discuss with you is –

What are the risks and side effects of this drug? Is the benefit I get from the drug worth the risks? Are there alternatives that would be effective and less risky?

We always should be concerned about drug use, and safety isn’t the only issue. Don’t hesitate to ask questions.

How long will I be off work? When can I go back to work?

Here’s what your doctor needs to know –

My job requires me to stand and walk for several hours?

(sit and type; talk on the telephone; drive long distances in my car)

And here’s what you need to ask:

How soon should I expect my stamina to return so I can work part time? Full time?

When can I safely work without interfering with my recovery?

What can I do to hasten my recovery so I can return to work sooner?

Both you and your employer, need to know when it is safe to return to work. We have to balance health concerns with your financial concerns and what is expected and allowed by your employer and the law.

If you are clear with your concerns and obstacles and flexible in your expectations it will be easier for your doctor to make the right decision.

These are just a few examples. I’m sure you can think of others.

Whenever you have a need to consult a physician, think ahead of what your

expectations, concerns and obstacles are before you make the visit so you’ll be

prepared to share .