Ep 3 - Pills & Potions - Managing The Meds

The meds on this journey can be confusing and overwhelming – we provide tips on managing new, different and changing medications.
An interview with Nik Wild, a pharmacist for over 30 years who has been involved with hospice for over 15 years and has an l in-depth understanding of palliative and end of life medications 

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Transcript

Ep 3: Pills and Potions - Managing the Meds            

 Kia Ora and welcome to The Ending Life Well Podcast. This podcast series for carers focuses on advice and practical solutions for carers who have been thrown into the deep end looking after a loved family member or friend in their last days, weeks or months of life.

Our episode today is “Pills and Potions - Managing the Meds”.

 Denise
Hi, I'm Denise van Aalst, a senior palliative care nurse and educator at Otago Community Hospice and today I'll be talking with Nik Wild, a pharmacist for over 30 years. She's been involved with hospice for over 15 years and has a real in-depth understanding of palliative and end of life medications. Hi Nik. 

Nik
Hi, Denise, how are you? 

Denise
Good. Nik, thanks for joining us today. Often, when people are in a palliative phase or are approaching end of life, medications have gone through a lot of change and there's a lot of new stuff to be dealing with. I'm sure you have people coming into your pharmacy, probably just about tearing their hair out, as to what to do with all these medications. 

Nik
It can be very daunting, knowing what to take, when to take it, why you need to take it. It can get very confusing, especially as more and more medications are added into the mix. Your pharmacist is a great person to help you sort it out and there are different ways of planning on when to take the medications.

Denise
Often there's a mixture isn't there? So we've got long acting medications, and they’re more regular at regular times and then there's all these other medications to take when they're needed.

Nik
Exactly. So it's really important to have an understanding of what medications should be taken at regular intervals and what can be added into the mix on an as-required basis. And the two should be separated and the understanding should be there on what to take when. By taking regular medication at the prescribed time, and adding in as-required medication when it's needed, can really help to manage, especially pain. 

Denise
So there's a few long acting medications and the most common of those, of course, is morphine. But what are some of the other ones that you see commonly as well, Nik.

 Nik
So other long acting medications or medications that should be taken say twice a day, are morphine. Oxycodone is another one that is used quite frequently. There are also things like fentanyl patches which are a patch that releases medications slowly over a three-day period but most long acting medication should be taken twice a day, and preferably 12 hours apart, and this is the best way to keep the blood levels stable that so that pain especially is kept under control. 

Denise
So Nik, alongside those long acting medications, there's also ones that work quite quickly and help out when we've got pain or other symptoms in between times, isn't there?

Nik
Exactly – we refer to those as short acting medications, and they typically have an effect up to about four hours. So if someone is taking the regular or slow release medications, 12 hours apart, it is really important to record how many in-between doses are needed. And if that begins to increase, the doctor can look at how much has been taken in between and increase the strength of the 12 hour medication, and it's a really good way of keeping your pain under control.

Denise
So Nik often people now have got a whole lot of new medications. Are there ways of managing this to make it a little easier to keep control of?

Nik
So regular medication – and that's not just palliative care medication, because people do continue on other medication for diabetes and blood pressure and things to a point. So for regular medications, it can be packed by your pharmacy into a compliance package, and there are ones called Medico packs, or some pharmacies have robots that make the medication into little sachets and these are typically organised over a week or four weeks. 

You can also buy yourself a pill or medication organiser from your pharmacy and these can have a single slot or they can have a breakfast, lunch, dinner, bed slot for a seven day period, and initially that can be done yourself. But there are certainly many different products that can help with the management of medication.

Denise
So it would really pay to actually have a chat with your pharmacist. I take a few pills each night and I find it means I only have to check my pills once a week, do them, and it's sorted. And I find that's also helpful because then I can see at a glance – have I taken these pills tonight, in case I'm forgetting. So it's helpful as a reminder.

Nik
It is really difficult to take medication regularly and to remember, so compliance packaging or compliance aids can be really beneficial.

Denise
And talking to your pharmacist, you're going to be able to help advise on the one that's going to best suit their needs for keeping track of that.

Nik
Most pharmacies will have some sort of system they use to help people in that way.

 Denise
So it's good to know that there are some that the pharmacy can do, and there are some that you can do for yourself, because some people still like to be managing things and feeling that they've got some control over it.

Nik
Exactly. 

Denise
Some of the symptoms – and I'm thinking in particular, constipation is often an issue when people are on opioid medication – and people should have a script for that. But that's often something that the pharmacist can also help with, isn't it?

Nik
Absolutely. Unfortunately, one of the worst side effects of any opioid medication is constipation, and we have a saying that the hand that writes an analgesic order must also write the laxative order, meaning that if you are prescribed any sort of opioid, you should be prescribed laxatives as well. There are many different types of laxatives that can help, but they are also, the majority of them, available over the counter. So if you haven't been given a script for laxative, and you think that constipation is a problem, or is going to be a problem, you can have a chat to your pharmacist and they can sell you medication for constipation also.

Denise
Yeah, which is just handy to know if the script runs out that your pharmacy is going to be able to help you out there. You touched before Nik, on the fact of other medications continuing, so do you find that people have to sort of blend together their medications they've always been on, plus all these new ones?

Nik
Yeah, and this is what makes the medication difficult, when more and more are added into the mix. It is a good idea, again, to have a chat with your pharmacist when more medication is taken on board, so you do have an understanding of what things are taken, for what reason. But generally, people will continue to take their regular medication, for blood pressure, for diabetes, for cholesterol and things like that. At some point, they will be stopped, but at the start of the journey, those medications will continue. So it’s a really good idea to have it clear in your mind what medications are taken and for what reason.

Denise
And Nik, you and I have spoken in the past about the value in using one pharmacy, because you've then got a really good overview of everything that that person is taking. I'm aware that sometimes people will end up getting prescriptions from different sources – it might be from their GP, maybe a hospital specialist, possibly a hospice doctor. And sometimes communication is not always as it should be, and there might be some overlap there. Do you see that from time to time where you're picking up a medication that's perhaps going to clash with another medication or the dosage has changed? 

Nik
We see it frequently. And that is, I think, a reason why, if you can, to stick with one pharmacy. Medications can interact with each other and produce sometimes quite severe interactions. Also, medications can add to each other's side effects, so you could get increasing drowsiness if some medications are taken together – and some medications just cannot be taken together. So by going to one pharmacy, they've got the complete overview of everything that you've been prescribed. So, as you mentioned, from your GP, from your hospice doctor, from the specialist, they sometimes don't Nik cont…have the full picture of what medication someone's taking, so by going to one pharmacy, that is the one place that has the complete overview of the medication history. 

Also, if you've had an intolerance or a reaction to a medication, that's recorded at your regular pharmacy, so I think there are many reasons while why establishing a really good relationship with one pharmacy is very beneficial.

Denise
That's a good point, because if I've had a reaction to something in the past, that might have been five years ago, 10 years ago, and I've forgotten about that. But if I get that prescribed again, it's going to show up on my record when I come in to you and you're going to say ‘Hold on a minute.’

Nik
So yeah, lots of reasons why going to one pharmacy is beneficial. Also if things do go wrong, if you've got an established relationship with a pharmacist, they're in a much better position to be able to help, so that's another reason to try to stick to one pharmacy.

Denise
Yeah. But if somebody has ended up getting medications, maybe they've been out of town and they've had to pick up an urgent script somewhere, that's fine, but they can just come and let you know that it's been added to the to their list of meds and you'll record that. I like that idea of somebody overseeing things and I know you guys are often able to pick those little anomalies up that might otherwise just go under the radar and cause a few problems.

Nik
Yeah, exactly. And it's something we do on a daily basis, check in with a doctor to say, ‘Look, you've prescribed this, but it does interact with this other medication.’ So it's part of our job.

Denise
Well, you know doctors are trying to think of a whole lot of things, aren’t they, and your focus is able to be on the medication. 

Nik, the other thing I was going to talk to you about is, often people have got a whole bunch of extra medications at home because they've been prescribed something and maybe it didn't quite work, so they're not taking that one any more. Is it better to just stick it in the back of the cupboard, because you might need it again one day or better to move it on?

Nik
No, move it on, take it back to the pharmacy – we take back unused medication, and it's destroyed. So always give it back to your pharmacy. The thing is, if you have it lying around home, and things are getting complicated, you may accidentally start taking them again, if they're sitting there. So anything that's been stopped, it’s a really good idea to return to your pharmacy for destruction. 

Denise
And I am aware of instances where somebody had been managing their medications fine, but became less well, someone else started helping them out with those medications, found the other ones and presumed that they were still in use. So, better to get rid of it, and much better to be destroyed by you guys than flushed down the loo at home. 

 Nik
Exactly.

Denise
I think that the key message here really is if you have any questions about your medication, have a chat with your pharmacist.

Nik
Yeah, absolutely. 

Denise
Hey, thank you, Nik. And thank you for joining us today. 
This podcast was brought to you by Otago Community Hospice, with support from Hospice New Zealand. If you found this discussion helpful, check out our other episodes of Ending Life Well, a podcast series for carers. You can also find more resources for caring for a person who's dying at otagohospice.co.nz/education