Prescription Medications and the Responsibilities of a Patient

Prescription Medications and the Responsibilities of a Patient

by Andi Surya Amal

General practice prescribing is a co-operative exercise between the patient/client, physician and pharmacist. Good communications between all three leads to a successful outcome. This essay will look at some of the suggestions with special emphasis on the responsibilities of patients to their prescription drugs.

It is important to underscore the fact that studies of medication usage in USA performed over the past 15 years have shown that more than 50 % of patients take their prescription drugs incorrectly. There are a variety of reasons that contribute to this wasteful and sometimes hazardous practice. However, we are still to need an accurate data about consideration by the patients to their prescription drugs for achieving a successful outcome.Related this issue, see more : [1], [2], [3], [4]

James W. Long had written six points for consideration by the patient in his book : Essential Guide to Prescription Drugs, 1993. I would like to quote several points of them that important followed if you are a patient. The information you need to know for safe and effective drug use. The following suggestions are offered to reduce confusion and misunderstanding and to increase the likelihood that you take the right drug for the right reason at the right time and the right way.

The first suggestion is if you are being treated for a recurrent or chronic disorder  (such as asthma or diabetes), learn as much as you can about the nature and medical management of your condition. Ask your physician and pharmacist for written information they may have available for distribution; visit your local libraries and book stores for pertinent publications; consult local chapters of national  organization that provide educational materials for specific disorders. The more you know about your disorder and its treatment, the more able you will be to use your prescribed medications safely and effectively. 

Secondly, cooperate fully with your physician and pharmacist to ensure that the diagnosis of your disorder is as accurate as possible and that treatment prescribed is the most appropriate for you. It is incumbent upon you to share the responsibility for obtaining safe and effective drug treatment.

Thirdly, do not be unduly influenced by seductive advertising of prescription drug products to the public through television commercials, magazine displays, celebrity endorsements, etc. Ask your physician and pharmacist for unbiased, objective information regarding the drug’s benefits and risks-and its appropriateness for you.

The other important suggestions you require to do for save and effective drug use, and the points will become your responsibilities – to yourself – as a patient, among others :

a.       Know both the generic and brand name of all drugs prescribed for you.

b.      If you are taking more than one drug, be sure that the label of each container includes the name of the drug and the condition it treats.

c.       If you do not clearly understand the directions for using a drug, consult your physician or pharmacist before taking it.

d.      Follow all dosing instructions carefully and completely. Comply fully to obtain the maximal benefit the drug can provide. If you have trouble remembering to take your medications “on time”, ask your pharmacist for a dosing calendar or a weekly medication box.

e.       If you are taking medications prescribed by more than one physician, check the generic names of all prescriptions to ensure that you are not taking duplicate drugs with different brand names. This could cause serious overdosage.

f.       Nonprescription drugs can interact unfavorably with prescription medications. Ask your physician or pharmacist before you begin taking any new over-the-counter preparations.

g.      Be certain all drugs you take are “in date”-have not expired according to the dating on the label.  

Additionally, the criteria for selection of a drug include the following that the drug is used to treat a serious or significant disease or disorder, and it is recognized by experts to be among ‘the best choices’ within its class. The benefits of the drug equal or exceed its risks. Furthermore, the safe and effective use of the drug requires special information and guidance for both the health care practitioner (physician, dentist, pharmacist, nurse) and the health care consumer (patient and family). 

Finally, health authorities need to make it a priority to educate the public on this issue through publicity and educational program. Beside that, the physician and pharmacist thus work together, with the pharmacist sometimes providing a safety net for errors arising out of a physician’s prescription and book stores for pertinent publications haste or inexperience. Naturally if a patient already has a clear idea on the medical condition outcome is much more likely to be assured.

***************

WMA Declaration of Lisbon on the Rights of the Patient

Adopted by the 34^th World Medical Assembly, Lisbon, Portugal, September/October 1981
and amended by the 47^th WMA General Assembly, Bali, Indonesia, September 1995
and editorially revised by the 171^st WMA Council Session, Santiago, Chile, October 2005

PREAMBLE

The relationship between physicians, their patients and broader society has undergone significant changes in recent times. While a physician should always act according to his/her conscience, and always in the best interests of the patient, equal effort must be made to guarantee patient autonomy and justice. The following Declaration represents some of the principal rights of the patient that the medical profession endorses and promotes. Physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and uphold these rights. Whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them.

PRINCIPLES

1. Right to medical care of good quality
1. Every person is entitled without discrimination to appropriate medical care.
2. Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgements without any outside interference.
3. The patient shall always be treated in accordance with his/her best interests. The treatment applied shall be in accordance with generally approved medical principles.
4. Quality assurance should always be a part of health care. Physicians, in particular, should accept responsibility for being guardians of the quality of medical services.
5. In circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.
6. The patient has the right to continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care.
2. Right to freedom of choice
1. The patient has the right to choose freely and change his/her physician and hospital or health service institution, regardless of whether they are based in the private or public sector.
2. The patient has the right to ask for the opinion of another physician at any stage.
3. Right to self-determination
1. The patient has the right to self-determination, to make free decisions regarding himself/herself. The physician will inform the patient of the consequences of his/her decisions.
2. A mentally competent adult patient has the right to give or withhold consent to any diagnostic procedure or therapy. The patient has the right to the information necessary to make his/her decisions. The patient should understand clearly what is the purpose of any test or treatment, what the results would imply, and what would be the implications of withholding consent.
3. The patient has the right to refuse to participate in research or the teaching of medicine.
4. The unconscious patient
1. If the patient is unconscious or otherwise unable to express his/her will, informed consent must be obtained whenever possible, from a legally entitled representative.
2. If a legally entitled representative is not available, but a medical intervention is urgently needed, consent of the patient may be presumed, unless it is obvious and beyond any doubt on the basis of the patient's previous firm expression or conviction that he/she would refuse consent to the intervention in that situation.
3. However, physicians should always try to save the life of a patient unconscious due to a suicide attempt.
5. The legally incompetent patient
1. If a patient is a minor or otherwise legally incompetent, the consent of a legally entitled representative is required in some jurisdictions. Nevertheless the patient must be involved in the decision-making to the fullest extent allowed by his/her capacity.
2. If the legally incompetent patient can make rational decisions, his/her decisions must be respected, and he/she has the right to forbid the disclosure of information to his/her legally entitled representative.
3. If the patient's legally entitled representative, or a person authorized by the patient, forbids treatment which is, in the opinion of the physician, in the patient's best interest, the physician should challenge this decision in the relevant legal or other institution. In case of emergency, the physician will act in the patient's best interest.
6. Procedures against the patient's will

Diagnostic procedures or treatment against the patient's will can be carried out only in exceptional cases, if specifically permitted by law and conforming to the principles of medical ethics.

7. Right to information
1. The patient has the right to receive information about himself/herself recorded in any of his/her medical records, and to be fully informed about his/her health status including the medical facts about his/her condition. However, confidential information in the patient's records about a third party should not be given to the patient without the consent of that third party.
2. Exceptionally, information may be withheld from the patient when there is good reason to believe that this information would create a serious hazard to his/her life or health.
3. Information should be given in a way appropriate to the patient's culture and in such a way that the patient can understand.
4. The patient has the right not to be informed on his/her explicit request, unless required for the protection of another person's life.
5. The patient has the right to choose who, if anyone, should be informed on his/her behalf.
8. Right to confidentiality
1. All identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind must be kept confidential, even after death. Exceptionally, descendants may have a right of access to information that would inform them of their health risks.
2. Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law. Information can be disclosed to other health care providers only on a strictly "need to know" basis unless the patient has given explicit consent.
3. All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its storage. Human substances from which identifiable data can be derived must be likewise protected.
9. Right to Health Education 

Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services. The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility of everybody for his/her own health should be stressed. Physicians have an obligation to participate actively in educational efforts.

10. Right to dignity
1. The patient's dignity and right to privacy shall be respected at all times in medical care and teaching, as shall his/her culture and values.
2. The patient is entitled to relief of his/her suffering according to the current state of knowledge.
3. The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible.
11. Right to religious assistance 

The patient has the right to receive or to decline spiritual and moral comfort including the help of a minister of his/her chosen religion.

VITAMIN E

VITAMIN E

Other Names:
All Rac-Alpha-Tocopherol, Alpha-Tocopherol, Alpha Tocopherol Acetate, Alpha Tocopheryl Acetate, d-Alpha-Tocopherol, d-alpha Tocopherol, d-Alpha Tocopheryl Acetate, d-Alpha-Tocopheryl Acid Succinate, d-Alpha Tocotrienol, dl-Alpha-Tocopherol, d-Beta-Tocopherol, d-Delta-Tocopherol, d-Gamma-Tocopherol, d-Gamma Tocotrienol, Fat-Soluble Vitamin, Mixed Tocopherols, RRR-Alpha-Tocopherol, Tocopherol, Mixed Tocotrienols, Tocotrienol, Beta-Tocopherol, Delta-Tocopherol, Gamma-Tocopherol, Alpha Tocotrienol, Beta Tocotrienol, Delta Tocotrienol, Gamma Tocotrienol, Palm Tocotrienols, Tocopherol Acetate, Tocopheryl Acetate, Tocotrienols, Vitamin E Acetate, Vitamin E Succinate.

Vitamin E exists in eight different forms ("isomers"): alpha, beta, gamma, and delta tocopherol; and alpha, beta, gamma, and delta tocotrienol. Alpha-tocopherol is the most active form in humans. Dosing and daily allowance recommendations for vitamin E are often provided in Alpha-Tocopherol Equivalents (ATE) to account for the different biological activities of the various forms of vitamin E, or in International Units (IU), which food and supplement labels may use. Vitamin E supplements are available in natural or synthetic forms. The natural forms are usually labeled with the letter "d" (for example, d-gamma-tocopherol), whereas synthetic forms are labeled "dl" (for example, dl-alpha-tocopherol).

Vitamin E is a fat-soluble antioxidant that stops the production of ROS formed when fat undergoes oxidation. [1] Dietary and supplemental vitamin E is absorbed and delivered to the liver, but of the various antioxidants with vitamin E activity, only alpha-tocopherol is preferentially recognized by the alpha-tocopherol transfer protein (alpha-TTP) and is transferred to plasma, while the other vitamin E forms (e.g., gamma-tocopherol or tocotrienols) are removed from the circulation. Hepatic alpha-TTP is required to maintain plasma and tissue alpha-tocopherol concentrations. The liver is the master regulator of the body's vitamin E levels in that it not only controls alpha-tocopherol concentrations, but also appears to be the major site of vitamin E metabolism and excretion. Vitamin Es are metabolized similarly to xenobiotics they are initially omega-oxidized by cytochrome P450s, undergo several rounds of beta-oxidation, and then are conjugated and excreted. As a result of these various mechanisms, liver alpha-tocopherol and other vitamin E concentrations are closely regulated; thus, any potential adverse vitamin E effects are limited. [Traber MG, Annu Rev Nutr. 2007;27:347-62]

Vitamin E is an important component of our antioxidant system. It is considered a master antioxidant because: [Papas AM. The Vitamin E Factor, HarperCollins Publishers, Inc., New York, NY. 1999]

1. Tocopherols and tocotrienols are chain-breaking antioxidants – they break the chain reaction of lipid peroxidation, the process that turns lipid rancid.
2. The structure of vitamin E makes it unique and indispensable in protecting cell membranes. Vitamin E, primarily alpha-tocopherol, anchors itself strategically in the membrane with the hydrophobic (water hating) tail in the interior of the membrane. The hydrophilic (water loving) head is in the hydrophilic area of the membrane.
3. Vitamin E is the master inhibitor of oxidation of the bad cholesterol LDL - which is believed to be the first step in atherosclerosis.  

Vitamin E is more than the master antioxidant, it has additional important functions. For example:

1. Vitamin E inhibits the activity of the enzyme PKC (protein kinase C) which is associated with inflammation.
2. Vitamin E exhibits anticoagulant properties. Oxidized alpha-tocopherol (called alpha-tocopheryl quinone) is also a powerful anticoagulant.
3. Vitamin E compounds reduce the production of inflammatory compounds such as prostaglandins.
4. Tocotrienols and gamma-tocopherol have other unique functions.

The main sources of vitamin E in the diet are vegetable oils (especially safflower oil, sunflower oil, and cottonseed oil), green leafy vegetables, nuts, cereals, meats, egg yolks, wheat germ, and whole wheat products. Vitamin E deficiency is rare and occurs almost exclusively in people with an inherited or acquired condition that impairs their ability to absorb this vitamin.

Table: Recommended Dietary Allowances (RDAs) for Vitamin E (Alpha-Tocopherol) [4]

* Adequate Intake (AI)

Table lists the RDAs for alpha-tocopherol in both mg and IU of the natural form; for example, 15 mg x 1.49 IU/mg = 22.4 IU. The corresponding value for synthetic alpha-tocopherol would be 33.3 IU (15 mg x 2.22 IU/mg).

Symptoms of vitamin E deficiency include muscle weakness, visual problems (especially at night), and a poor sense of balance. Over a long period, vitamin E deficiency may progress to blindness, heart disease, and impaired thinking. Supplements are usually only necessary or recommended for people with vitamin E deficiency or a condition that puts them at risk for this deficiency. [5] Possible Risks of Vitamin E Use include increased bleeding and inhibition of clotting function (if taken in excess of 1,000 mg/day). And, some studies indicate an increase risk of heart problems among people who are taking high doses of vitamin E (more than about 300 mg/day). Vitamin E has no known side effects when taken in moderate doses. It’s rare for anyone to be allergic to Vitamin E. But if you do experience a severe reaction (rash, itching, swelling, severe dizziness, trouble breathing) see a doctor immediately. [6]

Vitamin E, a potent peroxyl radical scavenger, is a chain-breaking antioxidant that prevents the propagation of free radical damage in biological membranes. Scientist consider the evidence for potential sites in cellular metabolism and signal transduction where vitamin E may have a structure-specific role in addition to its antioxidant function. The roles of tocopherol-binding proteins in cellular trafficking of vitamin E, especially the incorporation of RRR-alpha-tocopherol into nascent lipoproteins, and the delivery of RRR-alpha-tocopherol to the nucleus are considered. [7] Scientists are investigating whether, by limiting free-radical production and possibly through other mechanisms, vitamin E might help prevent or delay the chronic diseases associated with free radicals. [8]

Perhaps not surprisingly, vitamin E which has been touted to be potentially beneficial for a variety of disorders, including cancer, heart disease, and Other health benefits of vitamin E, based on its function as an antioxidant. [9] The most reliable studies on this issue are controlled clinical trials, such as a large 1994 study of antioxidant vitamins and cancer conducted by the National Cancer Institute (NCI) and the National Public Health Institute of Finland. The study was designed to find out whether antioxidant vitamins in higher doses than the RDA (50 milligrams) could reduce the incidence of lung cancer, other types of cancer, and other illnesses among 29,000 male smokers. The study found no beneficial effect of vitamin E supplements on lung cancer incidence. It found lower rates of prostate and colorectal cancer among those who received vitamin E, but higher rates of bladder, stomach, and other types of cancer. [10,11]

Vitamin E has been linked to the prevention of cardiovascular disease (CVD) based on the hypothesis that oxidation of LDL initiates the development of atherosclerotic plaque. This hypothesis, although not universally accepted, is supported by studies in vitro, in animals, and in humans. This background in basic science and a number of epidemiological studies, led to the initiation of clinical intervention trials.

G. Oriani et. al. in their study suggest that vitamin E plays an important role in the regulation of serum concentrations of cholesterol and lipoproteins in weanling rabbits. Consequently, the maintenance of an adequate nutritional status of vitamin E in the postweaning period is important to avoid alterations of serum lipid pattern ( J Anim Sci. 1997 Feb;75(2):402-8.) [12].

Support for the role of vitamin E in heart disease prevention has come from observational studies, particularly 2 cohort studies which were published in 1993. In the 1st study, the Nurses' Health Study, the researchers concluded that among 83,234 middle-aged women who participated in the study, there was a 40% reduced risk of coronary artery disease for those who took vitamin E supplements compared to those who did not (New England Journal of Medicine 1993;328: 1444-9). The 2nd study, the Health Professionals Follow-up Study, involved over 39,000 males and showed evidence of a significant association between a high intake of vitamin E from supplements and a lower risk of heart disease (New England Journal of Medicine 1993; 328:1450-1456). [13]

The following is a very brief overview of the role of vitamin E in wellness and disease prevention, Andreas M. Papas, Ph.D in NutriNews, January/February 2008 to explain other health benefits of vitamin E including Alzheimer’s disease, aging and immunity, cataracts, and skin health.

1. Alzheimer’s disease: A collaborative study at major medical centers across the United States found that in Alzheimer’s patients taking large doses of vitamin E (2,000 IU/day), progression of the memory-robbing disease was delayed by approximately seven months.
2. Aging and immunity: Studying healthy elderly people, researchers at Tufts University, reported that vitamin E increased the power of disease-fighting T-cells, improved delayed-type hypersensitivity skin response (DTH) by 65 percent and antibody response to hepatitis B six-fold. It also increased significantly the antibody titer to tetanus vaccine. A recent study in Netherlands reported no benefit in acute respiratory tract infections in elderly person from vitamin E supplementation.
3. Cataracts: A Canadian study compared the consumption of vitamin supplements by 175 cataract patients with that of 175 cataract-free controls. People in the control group were taking significantly more supplements of vitamins C and E than the cataract group.
4. Skin health: Vitamin E has been shown to reduce the damage to skin from exposure to UV radiation and ozone. 

Updated : Benefits of Vitamin E