The topic addressed in this essay is not regarding prescription medicines per se, or supplements.  Rather it has more to do with the potential dangers that can arise when medicines get thrown into a mix with “natural” remedies and then second, prescription safety in general.

More than 300 new medicines have been approved by the Food and Drug Administration in the past decade.  In Calendar Year 2011 alone, the Food and Drug Administration’s Center for Drug Evaluation and Research approved 30 novel new medicines, known as new molecular entities.pills1

Although the annual output of new medicines has dramatically increased over the last century, the public’s expectation for health and healing to come in the form of a pill or tonic hasn’t changed.

Back in the mid-1800’s, peripatetic salesmen   traveled the country-side hawking their nostrums; patented medicines frequently made by the pills2salesman himself which he sold with false or exaggerated claims. These medicines generally had no scientifically demonstrable value but people bought and used them anyway.pills3

Currently, millions of dollars are spent in research and development of new medicines. Pharmaceutical companies often start advertising a drug within a year of FDA approval, long before anyone knows whether the benefits outweigh the long-term risks. Television advertisements often try to minimize the known risks by running distracting or reassuring images while the voice over rapidly, almost incomprehensibly, describes potential negative side effects.pills4

Aside from prescription medications, many of us take a variety of vitamins, minerals, and supplements in an effort to improve and maintain health. Well intentioned as that may be, the use of some of these products remains controversial. Depending on the particular supplement, medical research is divided on the issue of the clinical usefulness. Regardless, we continue to fill our medicine cabinetsand load our kitchen counters with these items in the belief that as long as something is touted as “natural” it must therefore be “harmless”.

One supplement, for example, is Ginkgo Biloba. Gingko is a plantpills6 that has been growing on this earth for millions of years. But not until about the last 30 has it gained the distinction of being the most well researched herb. At least 300 clinical studies can be found investigating its potential medicinal benefits.  It is suspected that Ginkgo increases blood flow throughout the body’s vascular system. And since blood carries oxygen, it is presumed that Ginkgo would increase the delivery of oxygen to vital tissues and organs.  Hence, its purported usefulness in a multiplicity of situations where increased oxygen by way of increased blood flow would be helpful.

The Mayo Clinic website states the following:

Ginkgo is used for the treatment of numerous conditions, many of which are under scientific investigation. Available evidence demonstrates ginkgo’s efficacy in the management of intermittent claudication, Alzheimer’s/multi-infarct dementia, and “cerebral insufficiency” …Although not definitive, there is promising early evidence favoring the use of ginkgo for memory enhancement in healthy subjects, altitude (mountain) sickness, symptoms of premenstrual syndrome (PMS), age-related eye disorders, and the reduction of chemotherapy-induced end-organ vascular damage.


Since the brain uses about 20% of the body’s available oxygen at any one time, Ginkgo has gained notoriety as the supplement of choice to enhance memory and concentration.   For this reason, many especially senior citizens, incorporate Ginkgo Biloba into their daily regimens. This is not wrong to do; however, it poses a potential problem when the use of Ginkgo is not disclosed to a prescribing medical provider. Whether out of embarrassment or fear that the provider would disapprove or because the patient simply thinks it not to be relevant, the fact of the matter is that even though the supplement’s origin is in the plant world, its properties do have distinct and significant physiologic effects.  These effects can and do also influence and impinge upon the way prescribed proprietary agents (SEE DEFINITIONS) affect the body. Ginkgo, because of its influence on blood, can pose a problem for people who also take prescription medications that affect the components of circulation.

Classes of Medication that interact with Ginkgo Biloba:

Anticonvulsants:  medications that help prevent seizures and/or nerve pain.

Antidepressants:  medications that help elevate the mood of severely depressed individuals.

Antihypertensive:  blood pressure medications.

“Blood-thinners”:   medications that really do not make the blood thin, but rather interfere with its ability to form clots.

Diabetes medications.

 Generally speaking, mixing a supplement with a prescription medication can do one of three things: It can enhance the known effects of the medication, interfere with and therefore decrease the intended effects of the medication, or have no effect either way.  When you are given a prescription for any medical condition, always let your prescriber know what vitamins, minerals and/or supplements are being taken. Just because a substance is “natural” does it mean it would not interact with prescription drugs with unintended consequences?  If two prescription medicines sometimes do not go well together, it stands to reason that a medicine and a supplement might not go well together or that the doses of either may need to be adjusted accordingly.  Just remember that supplements found in nature can have powerful properties of their own.

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pills7Another safety issue has to do with prescriptions themselves.  Combine the sheer volume of prescriptions written per year with poor penmanship on the part of the prescription writer and what do you get?  A possible unfortunate and unintended error on the part of the dispensing pharmacist.  Too frequently the names of two medications resemble each other.  Avapro is not Avelox, Clonidine is not Klonopin, and Panlor is not Pamelor. Is it any wonder that more frequent mistakes are not made?

Since the first time someone administered a medication to another human being, those who nurse others to health have learned the five R’s pills8of medication dispensing:  The RIGHT patient, the RIGHT medicine, the RIGHT dose, the RIGHT time, and the RIGHT route (by mouth? by injection?).  What happens if one of these “RIGHTs” becomes wrong somewhere along the path from prescriber to patient?  The patient may then innocently suffer the consequences, sometimes significant, sometimes only minor.

Nurses have learned the five R’s of medication dispensing which have existed since long before Florence Nightingale’s time .

The patient then innocently suffers the consequences, sometimes significant, sometimes only minor.

You can blame the original writer of the prescription or you can blame the pharmacist but patients must shoulder some of the responsibility if mistakes occur with dispensed prescription medications.  When patients resist a more active involvement in their personal health by not knowing the names of the medicines that have been prescribed or the doses and the purpose of each medicine, they relinquish an assurance that the five RIGHTs have been satisfied.

Nurses have learned the five R’s of medication dispensing which have existed since long before from prescriber to patient?  The pharmacist may believe he/she is dispensing the prescription correctly, when in fact the patient could go home not knowing that a mistake has occurred.

The patient then innocently suffers the consequences, sometimes significant, sometimes only minor.  You can blame the original writer of the prescription or you can blame the pharmacist but patients must shoulder some of the responsibility if mistakes occur with dispensed prescription medications.  When patients resist a more active pills11involvement in their personal health by not knowing the names of the medicines that have been prescribed or the doses and the purpose of each medicine, they relinquish an assurance that the five RIGHTs have been satisfied.

If you are one of the many Americans who take more than one prescription medicine (and these days two or three medicines are frequently prescribed simultaneously for one medical problem) you really need to know their names and doses or at the very least carry an up-to-date list with you in your wallet or purse.  Remember how Mom always said to wear clean underwear just in case you end up in an emergency room?  Well, the cleanliness of your underwear is not nearly as great a concern to emergency personnel as is ascertaining your current medication and supplement usage.  What if you are unable to communicate that information?  Finally, do not expect healthcare professionals to be able to identify medicines by color or shape.

Always check your prescriptions before you leave the pharmacist’s counter and do not be afraid to ask questions. Regrettably, mistakes do occur in medical offices, hospitals, and pharmacies.  Knowing what to look for and what to expect in various medical venues can minimize those mistakes.  Learn how to read prescriptions and expect professionals to perform safety checks when appropriate such as verifying basics as name and birthdate.



Patients can do their part to minimize the risk of medication errors by

1)      Knowing their medicines, vitamins, and supplements by name and by dose.

2)       By questioning the prescriber if the instructions read differently than what he/she had instructed verbally to the patient.

3)       By questioning the pharmacist if the pills look different than a previously filled prescription of the same medicine.



pills12CAPTION READS:  AN ALARMING MESSAGE.  “If you please, sir.  Mother’s taken the lotion, and rubbed her leg with the mixture!”


Reading a prescription isn’t really that difficult.  The first line is generally the name of the medication to be dispensed by the pharmacist.  Next to it should follow the dose the prescriber has determined to be what is required.  This figure would most often include a number and a quantity (in abbreviated form).  The second line of the prescription is the quantity of the medication the prescriber has determined would be necessary to carry the patient through a prescribed course of time.  This number is identified by the hatch sign.  The last line is where the prescriber gives the directions to the patient as to how the medication is to be administered and why.  The “how” is designated by the term “Sig” followed by a sign indicating a quantity of teaspoons or number of pills, etc., to be taken.  The number one is written as a capital letter T with one dot overhead; two consists of two capital “T” letters connected at the top with a dot over each. The number three is likewise three “T” letters with three dots overhead. The why helps patients remember for what each medication is intended.  The prescriber then has the choice of signing his/her name on the line which directs the pharmacist to dispense either a generic substitution or the branded medication as named within the prescription.  As long as the patient’s name and identifying data are included on the prescription you can see how the FIVE R’s are fulfilled.

An example follows:



Worldsbestpatient                                           born 08/08/1980

Worldsbestmedicine       25 mg



SIG:   T tablet p.o. t.i.d. to feel good.


Worldsbestnursepractitioner, APRN

Dispense as written                                         Substitution allowed









ac/pc—before meals/after meals.                                Ante cibum/post cibum

c/s—with/without (noted with a short dash above it)            Cum/sine.

qd—once a day.                                                          Quaque die.

bid—twice a day.                                                       Bis in die.

tid—three times a day.                                               Ter in die.

qid—four times a day.                                                            Quattuor in die

qod—every other day.

qs—a sufficient quantity.                                           Quantum sufficiat.

HS—hour of sleep (bedtime).                                     Hora somni.

prn—as needed.                                                          Pro re nata

po—by mouth.                                                            Per os.

od/ad—right eye/right ear.                                          Oculus dexter/Auris dextra.

os/as—left eye/left ear.                                               Oculus sinister/Auris sinistra.




noc(t)—at night

ggts—drops.                                                               Guttae.

x—“times” (as x2 means times two, or twice)

DAW                                                              Dispense as written (no generic substitution allowed).






Get into the habit of knowing the names of your medications, dosages and purpose.

Most medications should be taken as close to the same time each day as possible.

Get into the habit of ordering a routine refill 7-10 days before you actually run out of pills.

There is nothing wrong with using a multi-pill box to help keep your daily doses of medications organized.  Calendars, charts or sticky notes on your bathroom mirror are OK, too.

Take all medication bottles/containers with you to every healthcare office visit.

Keep an accurate and up-to-date list of your medications and supplements in your wallet.  Include dosage, frequency and purpose.  Do not forget to include medication or supplement allergies.

Fun facts about prescriptions and supplements

 Approximately three billion prescriptions are dispensed per year in this country.

In 2008 alone, the FDA received more than 100,000 reports of serious injuries related to adverse drug events, an increase of about 25 percent over the previous year, according to the Institute for Safe Medication Practices.


The Pharmaceutical Research and Manufacturers of America (PhRMA), claims that the research and development

cost per approved drug was $1.3 billion in 2005.  Pharmaceutical companies spend more money on lobbying than any other industry—over $200 million in 2007—much of which is devoted to maintaining a strong patent system.


When you eat something salty, the sodium level in your blood plasma goes up. To normalize concentrations, the blood dilutes itself by pulling water out of your cells. The dehydrating cells send a signal to the brain, which in turn signals the thirst center to make you reach for something to drink.


The most abundant mineral in the body is calcium, and 99 per cent of this is in the bones and teeth.


Read more: http://www.netdoctor.co.uk/health_advice/facts/vitamins.htm#ixzz2EbFiraGf