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Medication History

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muhammad ijaz
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14 views23 pages

Medication History

Uploaded by

muhammad ijaz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Medication history

The medication history is a vital component to the patient interview and


is the area where the pharmacist will dedicate the most time. Medications
include prescription and over-the-counter (OTC) drugs as well as herbal
products.

The various components of the medication history are listed below.


i. Medication Name
ii. Strength and Dose
iii. Frequency
iv. Frequency of a prn Medication
v. Timing
vi. Indication
vii. Adverse Reactions
viii. Past Medication Use
ix. Medication Adherence
x. Allergies
1. Medication Name

The name of the medication can be located on the label or the


medication list. One way to obtain this information is to ask, “What
are the names of the medications that you are currently taking?” When
obtaining this information, make sure to determine if the medication is
extended release (ER), long acting (LA), sustained release (SR), or
immediate release (IR), and whether the patient is taking the brand
name or generic version.
For example, if a patient states that he or she is taking metoprolol,
you must determine if it is tartrate or succinate.
With regard to generic versus brand name, for some medications
with narrow therapeutic indexes, such as levothyroxine or warfarin,
changing between manufacturers may cause fluctuations in drug
levels in the blood; therefore, including manufacturer information is
beneficial. If a patient does not know this information, another way
to ask this question is,
“Does your levothyroxine tablet look the same as it always has?”
2. Strength and Dose

Information for strength and dose is also found on the label or on a


medication list. You can also ask the patient, “What is the dose of the
medication you are taking?” Make sure to include information for
both the strength and its corresponding units.

For example, levothyroxine 50 mcg or metoprolol ER 50 mg.


3. Frequency

Although this information is often included in the directions

written on the label, you should ask the patient, “How often do you

take this medication?” In some cases, the patient may be taking the

medication differently than written on the label. This could occur

for several reasons.

For example, a patient may have been told by his or her physician

to double or lessen the dose, or the patient may have misread the

directions or be confused about the correct way to take it.


4. Frequency of a prn Medication

Obtaining the actual frequency of a PRN (i.e., as needed)


medication enables you to assess whether the patient is taking the
medication appropriately and whether the disease state is being
managed effectively. One way to determine this frequency is to ask
the patient, “In a typical day (or week), how many times do you
take this medication?” or “How many tablets do you take at a time
and how often do you take them?”
For example, if a patient states that he or she is taking albuterol most
days of the week for shortness of breath, it is important to ask the patient
how many inhalations are taken at one time, how many times a day the
medication is taken, and what the time interval is between doses. This
enables you to ensure that the patient is at or below the maximum dosage
and potentially assess the severity of the patient’s asthma.
5. Timing

To determine the timing of medication administration, you can ask


the patient, “When do you take this medication?” If it is a medication
requiring dosing at multiple times during the day, be certain to find
out the amount of time between doses. For example, if a patient says
that he or she takes a thrice-daily medication with breakfast lunch
and dinner, you should ask, “What is the time for breakfast, lunch
and dinner?” because the medication may require 8 hours between
doses but the amount of time between the patient’s breakfast, lunch
and dinner may be only 6 hours.
Another reason that timing is key is because some medications need
to be taken at certain times of day or in relation to a meal. For
example, some statins are most effective when taken in the evening,
whereas other medications need to be given on an empty stomach or
separated from other drugs.
Determination of timing is especially important for a patient who
is being admitted to the hospital. It is necessary to obtain the timing
of each medication so that this same schedule can be followed in the
hospital. Also, the time of the last dose of each medication is vital to
ensure that a patient does not receive an additional dose of a
medication on the day of admission that he or she may have already
taken that morning at home.
6. Indication

Inquiring about the indication for each medication enables you


to assess the patient’s understanding of his or her medications
and to provide patient- specific education. You can determine
the indication by asking the patient, “What are you taking this
medication for?”
7. Adverse reactions

Ask the patient, “What side effects are you experiencing with any of
your medications?”

You can also use a closed-ended question, such as “Do you think any
of your medications are causing you to feel anything out of the
ordinary?” Sometimes a patient may complain of a symptom that is
actually an adverse reaction.
Additionally, it is important to get detailed information about the
adverse reaction so that you can assess the severity of the adverse
reaction and determine the next course of action, which may include
discontinuing the medication, adding a medication to counteract the
adverse effects, and/or obtaining laboratory tests or recommending
further testing to determine the cause or severity of the adverse
reaction.
8. Past Medication Use

At times, it can be helpful to find out what medications the patient has
taken in the past. For example, certain patients with diabetes need to be
on an angiotensin-converting enzyme inhibitor (ACE-I) such as
lisinopril. After conducting the medication history, you may discover
that the patient is not taking an ACE-I even though the guidelines
recommend this. Prior to discussing this with the patient’s physician,
you should inquire whether the patient has taken an ACE-I in the past.
For example, you might ask a probing question, such as “Have you
taken any medications for blood pressure or for your kidneys in the
past?” or “Have you taken a blood pressure medication in the past that
may sound like there is a ‘pril’ at the end of the name, such as lisinopril
or enalapril?”
9. Medication Adherence

A key component to the medication history is an assessment of


medication adherence. As the saying goes, a medication only works
well if it is being taken. Assuming that a patient is taking the
medication is not always a safe assumption. Therefore, it is important
to ask the patient how many doses of each medication are missed,
what the reasons are for missing doses, and what the patient does if a
dose is missed.
You could ask the patient, “How often do you miss doses of any of
your medications?” or “In the last week, how many doses did you
miss of your medications? Which medications? What caused you to
miss those doses? What did you do when you realized that you
forgot to take the medication?” By asking these questions, you are
learning how adherent a patient is to the medication regimen and
what may be causing the patient to miss doses.
The information you gain about adherence will enable you to better
target your medication counseling. For example, you may learn that
a patient is taking a daily medication every other day because of the
high cost or because of feelings of dizziness whenever he or she
takes it.
Once you understand the patient’s reasoning, you can make
appropriate adjustments to the regimen, if necessary. For example, if
the patient is unable to afford the drug, you may be able to
recommend a less expensive therapeutic alternative; if the reason for
missed doses is due to an adverse reaction, further evaluation is
warranted to determine whether the adverse reaction is truly because
of the medication or possibly due to another reason. Additionally,
you may learn that a patient merely forgets to take the evening dose
of a twice-daily medication. In this case, you can see if a once-daily
option is available or provide suggestions to improve the patient’s
ability to remember the dose, such as using a cell phone alarm or
leaving the medication next to the bed.
10. Allergies

Inquiring about any allergies the patient may have experienced at


any point in his or her life is just as important as learning about all
the medications the patient is taking. Ask the patient about any
allergies to medications or foods and to describe what type of
reaction occurred. You must determine the allergy trigger; the type
of reaction, including its severity; and how the allergic reaction was
resolved. This information will help you determine whether the
reaction is truly an allergy or rather an adverse effect.
You could ask the patient, “What allergies do you have?” A closed-
ended question would be, “Do you have any allergies to any
medications you have taken or any foods?” Once you determine
which allergies the patient has, you should ask, “What happened
when you took that medication? By documenting all of this
information, you can determine which medications to avoid in the
future based on cross-reactivity that may occur between different
classes of drugs or because of the severity of the reaction.
For example, if a patient says that she is allergic to amoxicillin and refuses
to take it ever again in the future because of the stomachache she
experienced, then in the future you may be likely to recommend a
cephalosporin;

however, if the reaction to the amoxicillin was anaphylaxis, you would


most likely avoid cephalosporin due to the risk of cross-reactivity .
THANK U
ALL

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