1. Taking Control of Your Medicine! Kathy Orrico, Pharm.D. Assistant Clinical Professor University of California, School of Pharmacy

2. Goals for Today To give you tips to help ORGANIZE your medications To give you tips to help ORGANIZE your medications To give you tips to help you REMEMBER to take your medications To give you tips to help you REMEMBER to take your medications To Keep You WELL To Keep You WELL

3. We Know it’s Difficult!

4. Step 1 – Map it Out Chart the NAME, STRENGTH, COLOR of each pill or capsule. (generic name and brand name) Chart the NAME, STRENGTH, COLOR of each pill or capsule. (generic name and brand name) Chart the PURPOSE for taking it Chart the PURPOSE for taking it Chart your DOSE Chart your DOSE Chart the TIME(S) each day or week to take each medication Chart the TIME(S) each day or week to take each medication

5. Step 1 – Map it Out Update your chart when medications are stopped and started Update your chart when medications are stopped and started List any Drug Allergies on your chart List any Drug Allergies on your chart Bring it with you to your appointments and to the pharmacy Bring it with you to your appointments and to the pharmacy Give copies to your close family and friends Give copies to your close family and friends

6. Step 2 - Set It Up! Pill Boxes – Fill at a fixed time each week Pill Boxes – Fill at a fixed time each week Calendars – Help you log missed doses and act as reminders! Calendars – Help you log missed doses and act as reminders!

7. Step 3 – Jog your Memory If possible link medication administration times with daily and weekly activities. Teeth Bushing, Before bed, Making coffee, Going to Worship If possible link medication administration times with daily and weekly activities. Teeth Bushing, Before bed, Making coffee, Going to Worship Strategically place your medication bottles to serve as reminders. Be Careful Strategically place your medication bottles to serve as reminders. Be Careful Use Calendars Use Calendars

8. Weekly Pillboxes Great organization tool Great organization tool Easy to see when next dose is due, if you missed a dose, etc. Easy to see when next dose is due, if you missed a dose, etc. Features may include: Features may include: Removable daily boxes Removable daily boxes Multiple compartments: Multiple compartments: Morning Morning Noon Noon Evening Evening Bedtime Bedtime

9. Step 4: Plan for Special Situations Traveling Tips Traveling Tips Know both brand and generic name of your medications Know both brand and generic name of your medications Know what your medications are for Know what your medications are for Get extra supply Get extra supply Carry your insurance card and physician’s information Carry your insurance card and physician’s information

10. Step 4: Plan for Special Situations Patients with a pacemaker, defibrillator or other implanted medical devices Patients with a pacemaker, defibrillator or other implanted medical devices Carry a Patient ID Card Carry a Patient ID Card Diabetic Patients Allowed to carry insulin or other injectable medications, lancets, an unlimited number of syringes, and sharps disposal containers on airplanes.

11. Step 4: Plan for Special Situations Emergency Situations Emergency Situations Plan Ahead Plan Ahead Have a supply ready to go! Have a supply ready to go! Missed Doses Missed Doses NEVER double up unless you know that it is OK to do so. NEVER double up unless you know that it is OK to do so. Ask your pharmacist and doctor how to handle a missed dose for EACH of your medicines. Note it on your chart Ask your pharmacist and doctor how to handle a missed dose for EACH of your medicines. Note it on your chart

12. Good Questions for your Good Health Ask Me 3 1.What is my main problem? 2.What do I need to do? 3.Why is it important for me to do this?

13. We Want to Empower You to Take Control of Your Medicines!

14. Green Medication Disposal

15. Risks of Improper Disposal Practices Environmental Impact? Environmental Impact? We don’t know! Accumulation in waterways may have potentially harmful effects on wildlife and humans Accumulation in waterways may have potentially harmful effects on wildlife and humans Prevent accidental ingestions in children Prevent accidental ingestions in children Prevent illegal use or theft Prevent illegal use or theft

16. How Can Medications Impact the Environment? Expired or unwanted medicines, if flushed down the toilet or drain, are a source of pollution in wastewater. Expired or unwanted medicines, if flushed down the toilet or drain, are a source of pollution in wastewater. These chemicals can be released into streams, lakes, and groundwater and affect fish and other aquatic wildlife These chemicals can be released into streams, lakes, and groundwater and affect fish and other aquatic wildlife

17. How Can Medications Impact the Environment? If our medicines are reaching streams, rivers, and lakes, organisms living in these habitats may be continuously exposed to these drugs If our medicines are reaching streams, rivers, and lakes, organisms living in these habitats may be continuously exposed to these drugs Some aquatic organisms living downstream from wastewater treatment plants are showing signs of developmental and reproductive problems Some aquatic organisms living downstream from wastewater treatment plants are showing signs of developmental and reproductive problems Researchers are working to determine whether pharmaceuticals are causing these effects Researchers are working to determine whether pharmaceuticals are causing these effects

18. Potential Environmental Issues Current scientific data shows no short- term effect of pharmaceuticals on aquatic life Current scientific data shows no short- term effect of pharmaceuticals on aquatic life The potential for long-term effects is currently being evaluated The potential for long-term effects is currently being evaluated Isabelle Robinson & Guillaume Junqua & Raymond Van Coillie & Olivier Thomas. Trends in the detection of pharmaceutical products, and their impact and mitigation in water and wastewater in North America Anal Bioanal Chem (2007) 387:1143–1151

19. Recent Water News Drinking water for Philadelphia tested positive for 17 drugs Drinking water for Philadelphia tested positive for 17 drugs including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems Drinking water for Washington, D.C., and surrounding areas tested positive for 6 drugs Drinking water for Washington, D.C., and surrounding areas tested positive for 6 drugs

20. Recent Water News It is unlikely for any of these amounts of products to have an effect on humans It is unlikely for any of these amounts of products to have an effect on humans Study from 20 water treatment facilities showed medications in the parts-per- trillion range; too small to have human effects Study from 20 water treatment facilities showed medications in the parts-per- trillion range; too small to have human effects Halford, Bethany. Side Effects. Chemical and Engineering News. 86;8: 13-17(Feb 2008)

21. Pharmaceuticals in the Water Even though the USE of medications is the primary pathway for pharmaceuticals to reach the environment (excreted from human body), it remains essential for consumers to know how to dispose of their unused medications Even though the USE of medications is the primary pathway for pharmaceuticals to reach the environment (excreted from human body), it remains essential for consumers to know how to dispose of their unused medications

22. “ Do not flush, place in trash” Flushing pills releases much higher amounts of drug into the water than excretion does. Flushing pills releases much higher amounts of drug into the water than excretion does. Consumers who do not use all of their over the counter and prescribed medications should take the following steps… Consumers who do not use all of their over the counter and prescribed medications should take the following steps…

23. Procedure for Disposal of Medications DO NOT FLUSH unused medications DO NOT FLUSH unused medications DO NOT POUR them down a sink or drain DO NOT POUR them down a sink or drain Dispose of Unused Medication in Household Trash – Destroy First! Dispose of Unused Medication in Household Trash – Destroy First!

24. Protect children, pets, and the environment by… Pour medication into sealable plastic bag If medication is a solid, crush it or add water to dissolve

25. Protect children, pets, and the environment by… Adding kitty litter, coffee grounds, or other substance that makes the medication less appealing or destroys the medication.

26. Protect children, pets, and the environment by… Sealing the plastic bag completely and disposing in the trash.

27. Protect children, pets, and the environment by… Removing and destroying ALL personal identification information (i.e., prescription label )from the medication container Removing and destroying ALL personal identification information (i.e., prescription label )from the medication container Destroy personal information Destroy personal information Recycle plastic container Recycle plastic container

28. Protect children, pets, and the environment by… Mark out personal information Mark out personal information

29. Protect children, pets, and the environment by… Destroy by mixing with Water Water Coffee Grounds Coffee Grounds Cat Litter Cat Litter Dirt Dirt

30. Protect children, pets, and the environment by… Place in opaque container Place in opaque container

31. Protect children, pets, and the environment by… Hide in the trash Hide in the trash

32. Questions