Osher Mini-Medical School for the Public Too Much of a Good Thing: Medication Risks and Polypharmacy Tuesday, October 25, 2016

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1 Optimizing Aging Collaborative Osher Mini-Medical School for the Public Too Much of a Good Thing: Medication Risks and Polypharmacy Tuesday, October 25, 2016 John Newman, MD, PhD Assistant Professor Division of Geriatrics, UCSF Kirby Lee, PharmD, MAS Associate Professor School of Pharmacy, UCSF Dear Mini-Medical School Attendees, Welcome to Week Three of the UCSF Osher Mini-Medical School for the Public! As part of our series in Optimizing Well-Being in Older Age, tonight s session covers medication risks and polypharmacy. Included in this packet are a series of handouts and materials you will find helpful: 1. Presentation Slides 2. HealthInAging.org Prescription Drug Materials 3. Free Internet Resources for Medication Information 4. Medication Safety Tips 5. Resources for Drug Cost-Containment Programs 6. San Francisco Pharmacies Available to Help 7. Strategies to Remember to Take Your Medicine 8. List of Pharmacies Offering Medi-Sets and Blister Packs We are grateful for your attendance. Should you need additional information or have questions, please contact us at OAC@ucsf.edu. --- The Optimizing Aging Collaborative at UCSF is supported by the UCSF Geriatrics Workforce Enhancement Program: Health Resources and Services Administration (HRSA) Grant Number U1QHP28727.

2 HEALTHINAGING.ORG A website created by the American Geriatrics Society which provides up-to-date information on issues related to health and aging. Healthinaging.org hosts information about the Beers Criteria, a list of medications that should be avoided or used with caution in older adults. Ask your doctor if they know about the Beers Criteria! The Medications & Older Adults section contains Tip Sheets you can download on important topics around the safe and effective use of medications: Alternatives for Medications on the Beers Criteria Avoiding Over Medication and Harmful Drug Reactions Medications Older Adults Should Avoid (in English and Spanish) What to Do if a Medication You Take is Listed in the Beers Criteria

3 FREE INTERNET RESOURCES FOR MEDICATION INFORMATION AVAILABLE ON THE INTERNET For more information about medications, including drug interactions, side effects, or diseases and conditions, please visit the following freely available and reliable websites: 1. Drug information, tools for drug interactions and pill identification 2. Drug information, tools for drug interactions and pill identification 3. Drug information and tools for drug interactions 4. Drug and disease information about a variety of conditions 5. Drug and disease information about a variety of conditions 6. Drug and disease information about a variety of conditions 7. American Association of Retired Persons, contains a lot of useful information about medications, conditions, drug interaction and drug savings tools

4 Medication Safety Tips Ask about safety risks Make a list Update your list Read the pill bottle Over the counter medications and herbs used for problems such as pain, runny nose, cough, or trouble sleeping may cause harm. Ask your doctor, nurse, or pharmacist about safety risks before taking them. Keep a list of all the medications you take. Include on the list: The reason you take each medication (example: for diabetes). The dose of each medication you take (example: one 10mg tab). When you take each medication (example: at bedtime, or every Monday 30min before breakfast). The way you take each medication (example: by mouth or eye drops). Any over the counter medications, vitamins, or herbs you take that are not prescribed by your doctor. Write down any allergic reactions or bad side effects to drugs you have had in the past. Bring this list to all of your medical appointments. Remember to update your list: At every medical appointment if you see more than one doctor this is VERY important! After any surgery or hospital visit. When any medication is started, stopped, or the dose is changed. Tell your doctor if there is any change in over thecounter medicines, vitamins, or herbs you take. Check the medication label to make sure you are taking the right dose of the right drug at the right time. Follow directions on how to take the medication. For example, some medications should be taken on an empty stomach, while other medications should be taken with food. Check the expiration date on the bottle to make sure the medication is not too old. Page 1 of 4

5 Medication Safety Tips Simplify Ask questions Report problems Try to get all of your medications from the same pharmacy. This helps the pharmacist get to know you so that they can help you avoid harmful drug reactions or side effects. Tell your pharmacist about any allergic reactions you have had to medication in the past. Make sure your doctor or nurse is aware of all of the medications you take including any medication prescribed by a specialist. For any new medication, be sure to ask your doctor, nurse, or pharmacist: What is the reason for taking the medication? When and how should the medication be taken? What should you do if you miss a dose? What side effects or warning signs of a drug reaction should you watch out for? Is it safe to drive, use machinery, or drink alcohol when taking these medications? Is a lower cost medication available? Ask for help if you have difficulty with: o Remembering to take your medications, o Opening pill bottles, or o Reading medication labels. If you begin to have new symptoms after starting a new medication, you may be having a reaction to the drug. Call your doctor, nurse, or pharmacist right away if you start to feel any new symptoms such as those listed below: drowsy or confused headache upset stomach skin rash dizzy or losing your balance constipation or and falling diarrhea If you have a serious reaction, such as difficulty breathing or swelling in your throat, call 911 and go to the emergency room. Page 2 of 4

Medication Safety Tips Always Always throw away medication that has expired.

Always get medications refilled before you run out.

your medications. Always keep a three day supply of medication in case of an emergency.

Never Never share your medication with someone or take medication that is not prescribed to

Never stop taking medication without talking to your doctor, nurse, or pharmacist first.

Upset stomach Headache Constipation or Drowsiness diarrhea Itchy skin or rash Confusion

6 Medication Safety Tips Always Always throw away medication that has expired. Always make a list of your medications and know what each one is for. Always ask questions. Always get medications refilled before you run out. Always use a pillbox, calendar, medication log, and/or alarm to help you remember to take your medications. Always keep a three day supply of medication in case of an emergency. Always store medication as directed and keep it away from children. Never Never share your medication with someone or take medication that is not prescribed to you. Never take medication that has expired. Never stop taking medication without talking to your doctor, nurse, or pharmacist first. Never take more or less medication than it says to on the drug label without talking to your doctor, nurse, or pharmacist first. Common drug reactions you should tell your doctor, nurse, or pharmacist about right away: Upset stomach Headache Constipation or Drowsiness diarrhea Itchy skin or rash Confusion Dizziness or losing your balance and falling This is not a complete list of possible side effects. If you have ANY new symptoms after starting a new medication call right away! If you have a serious reaction such as difficulty breathing or throat swelling, call 911 and go to the emergency room. Page 3 of 4

7 Medication Safety Tips References American Geriatrics Society Health in Aging Foundation, (2012). Avoiding overmedication and harmful drug reactions. Retrieved from American Geriatrics Society Health in Aging Foundation, Tips for preventing problems when taking multiple medications, (DHHS Publication number 8SOW PA PHYS06.359). Retrieved from iple%20meds.pdf National Council on Patient Information and Education: Medication Use Safety Training for Seniors, (2011). 6 ways to help your older parents use medications the right way and prevent problems. Retrieved from Page 4 of 4

8 Resources for Drug Cost-Containment Programs For ALL patients: Discounted Generics: o o o o o For our UNINSURED patients: Covered California: For our UNDERINSURED patients: Co-Pay Assistance: o o o o PANF (7263) o o For our MEDICARE PART D patients: Medicare Part D Information: Medicare Part D Plan Finder: Medicare: MEDICAR(E) ( ) Low-Income Subsidy Application: HICAP: hicap.org; ; in San Francisco

9 San Francisco pharmacies willing to help! Pharmacies that can assist with medicine insurance questions or issues Name Address Phone/Fax Hours Pharmacist 1 Lucky 1515 Sloat Blvd (415) M-F 9am-8pm Sa 9am-5pm Su 10am-5pm Ed 2 CVS 445 Castro St M-F 8am-6pm CarePlus (next to Castro (415) Sa 10am-3pm Pharmacy Theatre) Jessica 3 Safeway 4 Safeway 6 Walgreens 7 Walgreens 8 Walgreens 9 Walgreens 10 Walgreens 11 Walgreens 12 Walgreens 1335 Webster (between O'Farrell and Ellis) 298 King St (King & 4th) 45 Castro St (CPMC, Davies Campus) 1300 Bush St (NWC Larkin & Bush) 5260 Diamond Heights (Diamond Heights & Gold Mine) 500 Parnassus Ave J level MU Divisadero St (SWC of Divisadero & O'Farrell) 2100 Webster St Rm 105 (CPMC, Pacific Campus) 300 Gough St (NEC of Gough & Fell) (415) (415) M-F 9am-8pm Sa/Su: 9 am-5:30pm M-F 9am-8pm Sa/Su 9am-5:30pm George Jenny (415) M-F 9am - 6pm Steve (415) (415) (415) (415) M-F 9am-9pm Sa 9am-5pm Su 10am-6pm M-F 9am-9pm Sa 9am-5pm Su 10am-6pm M-F 8:30am-8:30pm Sa/Su 9am-5pm M-F 9am-9pm Sa 9am-5pm Su 10am-6pm Jimmy Brian Jonathan Angelica (415) M-F 8:30am-6pm Mike (415) M-F 8am-9pm Sa 9am-5pm Marilyn Prepared by: Brian Macapinlac, Priya Jayachandran, Adele Feng, Katherine Gruenberg, Jeanna Wong, and Jeremiah Gitiha (UCSF Pharmacy Students) Last updated: February 3, 2016

Strategies to Remember to Take Your Medicine Taking your medications as prescribed is important

Listed below are some ideas that have reminded others, like you, to take their medications.

Place your pill box in a place that you visit during your morning & evening routines.

Carry a small pill box with you for the times you forget to take your meds at home.

Medications are organized by the time of day you take your medicines.

10 Strategies to Remember to Take Your Medicine Taking your medications as prescribed is important for your health. Listed below are some ideas that have reminded others, like you, to take their medications. Organize your medications every week in a pill organizer that is kept at home. Place your pill box in a place that you visit during your morning & evening routines. Create a medication list that shows the amount & time to take each of your meds. Carry a small pill box with you for the times you forget to take your meds at home. Some pharmacies will organize, package, & deliver your medications. Medications are organized by the time of day you take your medicines. Eliminates the need to count & organize your pills. Helps to decrease medication errors. Updated: October 2014 Keep medications safely out-of-reach from children. Do not store meds in the bathroom. Check with your pharmacy for availability of this service. Extra fees may apply.

11 Set daily alarm(s) to remind you to take your medicine. Smart phone, watches, or a regular alarm clock can help you remember. Pill-reminder apps are available for your computer or smart phone. Automatic refills assure your medications are ready when you need them. Eliminates the need for you to call the pharmacy for refills. Check with your pharmacy for availability of this service.

12 List of Pharmacies that offer medi-sets and blister packs A-G Pharmacy Address: 3636 Cesar Chavez St, San Francisco, CA Phone: Fax: Makes 30-day blister packs for $ Delivery available for $5 in San Francisco. Labels available in English, Spanish and French. AIDS Healthcare Foundation Address: 100 Church St, San Francisco, CA Phone: Fax: AIDS Healthcare Foundation Address: th St, San Francisco, CA Phone: Fax: Makes biweekly and monthly medisets. Primarily for patients with HIV on HAART. Sometimes approves non-hiv patients; prefer monthly medisets for these patients. Free delivery. Labels in English and Spanish. Makes biweekly and monthly medisets. Primarily for patients with HIV on HAART. Sometimes approves non-hiv patients; prefers monthly medisets for these patients. Free delivery. Labels in English and Spanish Bay Drug Address: 281 Turk St, San Francisco, CA Phone: Fax: Makes biweekly and monthly medisets and28 days blister packs for free. Free delivery to San Francisco within a certain radius of the pharmacy. Labels in English and Spanish. Charlie s Pharmacy Address: 1101 Fillmore St, San Francisco, CA Phone: Fax: Makes 30 day blister packs sometimes makes for 60 day. Co pay from insurance. Delivery in San Francisco for fee. Labels in English only.

13 List of Pharmacies that offer medi-sets and blister packs Daniel s Pharmacy Address: 943 Geneva Ave, San Francisco, CA Phone: Fax: Makes biweekly/monthly medi - sets and 30 and 60 day blister packs for free. Free delivery in San Francisco. Labels in English and Spanish. Mission Wellness Pharmacy Address: 2424 Mission St, San Francisco, CA Phone: Fax: Make biweekly and monthly medi-sets and 30 day blister packs. Free if meets pharmacy criteria. Offers free delivery once a month with addition delivery fee of $10. Labels in English and Spanish. Walgreens Address: th St, San Francisco, CA Phone: Fax: Makes 30 day blister packs for HIV and Hep C patients for free. Offers delivery for $5 in San Francisco. Labels available in a different languages including English and Spanish. Walgreens Address: 45 Castro St suite #124, San Francisco, CA Phone: Fax: Makes 28 and 84 day blister packs for patients with HIV and Hep C. Also makes blister packs for patients with 5 or more medications. Offers delivery for $5. Labels available in different languages including English and Spanish. Walgreens Address: 3400 Cesar Chavez, San Francisco, CA Phone: Fax: Makes 30 day blister packs usually for patients with 15 or more medications. Does not offer delivery. Labels available in different languages, including English and Spanish.

14 List of Pharmacies that offer medi-sets and blister packs Walgreens Address: 2145 Market St, San Francisco, CA Phone: Fax: Makes 30 and 60 day blister packs for free. Free delivery in San Francisco for medicare patients and $5 fee for patients with insurance. Labels available in different languages including in English and Spanish. Walgreens Address: 1300 Bush St, San Francisco, CA Phone: Fax: Make 30 day blister packs for free. Offers free delivery for $5 in San Francisco. Labels available in different languages including English and Spanish. Walgreens Address: 2262 Market St, San Francisco, CA Phone: Fax: Makes biweekly and monthly medisets and 30 day blister packs for free. Does not offer delivery. Labels available in different languages including English and Spanish.

Department of Health and Human Services Food and Drug Administration 5600 Fishers Lane (HFI-40) Rockville, MD February 2000 (FDA)

Department of Health and Human Services Food and Drug Administration 5600 Fishers Lane (HFI-40) Rockville, MD 20857 February 2000 (FDA) 00-3237 Be More Careful With Medicines The Food and Drug Administration,