C2: THE COMMON HOUSEHOLDS' IMPROPER USE OF MEDICINES AND THEIR RECTIFICATIONS FOR EFFECTIVE HEALTH

 

Hello friends,

Welcome to another step in the journey of the class without walls.

NAKALA YA KISWAHILI YA ANDIKO HILI/ SWAHILI VERSION

This article is the summary of my 1 hour presentation at the Tanzania Students’ Associations Federation in China (TASAFIC) and African Diaspora in China Network (ADiC NET). The slide used is available here (PRESENTATION SLIDE).  The motivation for preparing this topic came due to massive malpractice and misuse of medicine that I have witnessed over the years that not only harm people with disabilities but also some misuses have gone far to cost lives of people. For example, back in 2016, I visited Kigoma, a region in the west of Tanzania during my stint period with national service, because I was new to this area during my one-week break, I had a friend who hosted me. Among the many things that I remember about him during our chat is how he used medicines to get medical relief. He told me that for him to get quick relief when he is sick would triple the dose recommended by the physician. His rationale was it could smash harshly and quickly pathogens therefore he would get a quick cure of disease. Although his argument for that time made sense, after being educated about pharmaceutical sciences his rationale is unhealthy and futile. So, this is just one among many improper uses of medicine.

In a nutshell, in this article you will get through why we need to care about the proper use of medicines, briefly why and how drugs work, glance at basics of drugs interaction with our bodies, this part will us help to make sense of why malpractices are malpractice and are unhealthy, lastly, you will see what are the common misuses, their rectification and what things one should communicate with physician or pharmacist during or before taking medicines. Although the topic it is professional, I have tried my level best to use simplified language for almost anyone to understand.

NB: this article might be long to some people, so if your interest is just to know the common misuse of medicine and their rectification then scroll to the 3^rd and 4^th parts of this article. Otherwise, if it is your interest to understand the common medicine misuse and their rationale, then follow up step by step to the end.

Proper use of medicines is an act of taking medications only that have been correctly prescribed for certain medical reasons, in a correct dosage for a specific allocated duration of time whereas misuse or malpractice are the uses of medicine that are beyond how or when the medicine should be used or stored with repercussions, either compromise the quality of medicines or directly harm the health of a patient.

1.     Why do we need to care about the proper uses of medicines?

We use medicines not for fun or enjoyment rather to cure diseases, the point when the body is at the weak(est) immunity, pain, or any other discomforts. Thus we want to take medicines that are effective in doing what we intend to take them. However, the intention may have diverted when medicines are misused thus leading to ineffective treatment or poisoning. Additionally, medicines are chemical substances that are not part of the body thus to some extent negatively affect the body and, in fact, all medicines have a degree of toxicity implying that any use without care can render them become poison in the body, which is not an effective use of medicines. Thus proper use of medicines not only is protecting and building our health but also gives us a sense of living and participation in productivity and social activities through strong health.

Proper use of medicines helps to save money both at personal and national levels. Recently there has been an antibiotic resistance problem, in which pathogens like bacteria and fungi over a while develops resistance towards medicines which previously were effective in killing them, this phenomenon has been linked with the misuse of antibiotics which affects individual health through chronic diseases, in some cases when virulent bacteria diseases such as pneumonia, meningitis can lead to mental disorder and death. At a national level, this problem puts a burden on governments in terms of expenditures to be invested in research to find new effective medicines. therefore, the effective use of medicines is worth our attention.

2.    The glance at fundamentals of drugs and body to make sense why some common medicines misuses and malpractices are unhealthy.

To this point, someone might be curious like, why do we take medicines? how do they work? what is their fate in our body? do they incorporate to be part of our body or excreted?

We take medicine to cure diseases. The disease is an abnormal condition of the body due to either infection by pathogens such as fungi, bacteria or a failure of regulation of certain processes in the body particularly cellular activities either under activity e.g. diabetes or hyperactivity typically cancer witnessed with excessive grown body tissues, the tumors. Also, the disease can be brought by physical injury. But then, why medicines? simply put, medicines restore the body's situation to normal. Hence, medicines act by either killing pathogens such as bacteria or regulating body conditions to normal conditions through targeting abnormal living cells. It is important to note that despite medicine being very specific to what they do still have side effects (toxicity)

(i) Taking appropriate medicine does not mean treatment or taking medicine does not mean taking poison, rather dose is what separates an effective medicine from poison.

taking appropriate medicine for a particular disease does not mean will cure the disease unless the correct dose is used. The reason for the correct dose is there is an allowable range of drug amount (therapeutic range) that is supposed to be in the body (blood) effective enough to kill the pathogens or regulate misbehaving cells to cure disease. Thus, taking less dose than recommended leads to ineffective treatment implying no relief is attained, while overdose leads to toxicity. The rationale for this therapeutic range is because medicines are foreign substances hence need precise regulation in their level in our bodies such that their level should not go beyond the bearable therapeutic range.

fig. 1: The drug profile in the blood, showing too large amount of drug than therapeutic window (also therapeutic range) causes unacceptable toxicity and too low than the rapeutic range causes poor activity.

 It is interesting to note that drugs have to be cleared away from the body through the actions of the liver and kidney and at the same time drug levels should be maintained in the therapeutic range, to achieve this we take specified doses of medicine multiple times at a specified interval to ensure the level of the drug is in the therapeutic range. Therefore, it is important to adhere to the dose regimen. Prescribed by pharmacists.

(ii) The liver and kidney are important organs in clearing away drugs and many other waste substances from the body.

The liver and kidney play an important role in blood drug level regulation. Drugs and many other foreign substances their level have to be regulated by being broken down into safer forms and then cleared away from the body. For this case, the liver possesses many pieces of machinery purposely for breaking harmful and waste substances into the bearable form which can easily be cleared away from the body.

Fig. 2: The common drug pathway and their fate in the human body after oral route of administration

 Fortunately, the human body is special such that anything that goes through the stomach, when it is absorbed must pass through the liver, this ensures protection of the body against harmful chemicals as most of them are broken in the liver, so do the drugs. The kidney’s role is to filter the blood with the ultimate benefit of washing away toxic chemicals in the form of urine. Since the liver and kidney are involved in regulating the amount of drugs in the body, patients with a defect in these organs may fail to regulate drug levels appropriately hence high levels of drugs in the body ultimately toxicity. Therefore, patients with a history of kidney or liver dysfunctions should communicate to physicians or pharmacists about their problem this helps those professionals to tailor medicines to fit their condition to avoid toxicity. 

(iii) Drugs-to-drugs and drug to food interactions.

Drug-to-drug interaction is the negative effects that occur to the patient when two drugs are co-administered (taken up) at the same time thus bringing unintended side effects ranging from minor discomforts, permanent disability to extreme effects such as coma and death. When drugs are co-administered tend to influence each other to either level of one become too high or too low than expected therefore toxicity or ineffective treatment, respectively.

The internal human body is too complex, despite drugs being too specific to their target, they still interact with off-target in their pathways and the aftermath is something which is not always desired. Recall, drugs are foreign substances whose level has to be precisely regulated by being cleared away out of the body. Also, the drug should be at optimal levels, too much drug amount than therapeutic range causes toxicity. Similarly, when the drug’s level is too low than the therapeutic range leads to ineffective treatment (no therapeutic effect). Hence when two drugs co-administered may cross-talk their clearance pathways.

 Suppose there is drug A and drug B that share their pathways, due to the inherent nature of each one leads one to become more favored in clearance, let say drug A is favored in clearance than drug B, in the time frame drug B accumulate to surpass the upper therapeutic limit, the result of that is toxicity. Alternatively, drugs may influence each other by enhancing clearance, suppose drug A favors clearance of drug B, the ultimate result is drug B level becomes too low level than therapeutic range thus no therapeutic effect.

Drug to food interactions!

Perhaps you’ve heard that some drugs should not be taken along with alcohol or grapefruit juice and many other types of food, how is that true? and why ?

Well, just like a drug-to-drug interaction, the same applies to food. Food may affect drugs at uptake level in the intestine or clearance from the body. It is worth noting that foods are made up of diverse chemical compounds like sugars which may significantly affect the level of drugs in the body.

Example 1: grapefruit juice interacts with many drugs, remarkably Blood pressure regulating drugs e.g. Nifedipine (Procardia) and lovastatin (used to control cardiovascular diseases, side effects include damage of kidney).

Example 2: Alcohol interacts with many drugs e.g. warfarin used to reduce the risk of a heart attack when administered along with alcohol puts the patient at a high risk of bleeding. 

3. The common households’ misuse and malpractice of medicines and their rectifications for effective health.

1. The Practice of not finishing the prescribed dose of medicine in the specified time.

This behavior not only develops the drug resistance in the pathogens since pathogens are not killed completely but also sets up the platform for a virulent comeback of the disease.

Rectification: Finishing the prescribed dose of medicine in the allocated time. When no relief has been attained by the patient it is important to communicate with an immediate physician for assessing the situation perhaps with alternatives such as suggesting stronger and effective medication or a higher safe dose of the same medicine. Reusing the same medication without contacting a physician, with the same dose which hasn’t shown medical relief may not always be the effective strategy.

2. Overdose or underdose of prescribed medication.

Recall, for a particular medicine to be effective, it should be administered such that the drug level in the blood should be in the therapeutic range, hence drug level in the blood higher than therapeutic range leads to toxicity, conversely drug level less than therapeutic range leads to ineffective medication (no medical benefit is obtained).

Rectification: patients should adhere to the physician's recommendations on the dose and the time interval that the dose should be taken.

(3)   Polypharmacy

Polypharmacy is an act of taking multiple medications (at least more than 3 medications) at once, usually, medications are taken from different sources with the health professional being uninformed by a patient that has other medications. Although this practice is quite common among older adults it is still common among teenagers and middle-aged adults. Polypharmacy may also be practiced in the form of taking processed medications (western medicine) those which are administered at hospitals along with herbal medicine (traditional medicine). Additionally, another subtle form of polypharmacy is taking drugs along with alcohol, this is harmful only for the incompatible drugs with alcohol which may produce drug to alcohol reaction as seen earlier. Some herbal medicine is risky compared standardized drugs because their chemical contents are not well known and their quantities are not standardized.

Rectification: In the case when polypharmacy is inevitable, the patient should inform the health professionals so that they can tailor multiple medicines with a low risk of the drug to drug interactions to harm the patient.

(4)   Use of leftovers along with poor storage of medicines

Generally, drugs have a specific period of shelf life and necessary storage conditions thus any violation can lead to medication poisoning. Therefore, if drugs are not stored in the conditions as recommended by the manufacturer tend to undergo chemical transformation to form other substances which are no longer drugs but most likely to be toxic substances. Therefore, it is important to adhere to storage conditions recommended by the physician to avoid drug poisoning. It should not have been misunderstood that all leftover medicines are unhealthy rather only those leftover medicines with either instruction from the manufacturer that leftover medicines should not be used or have expired for human uses.

Rectification: it’s important to follow the manufacturer or health professionals’ recommendation on the proper usage and storage conditions of medicines.

4.     IMPORTANT THINGS FOR A PATIENT TO COMMUNICATE WITH PHYSICIAN OR PHARMACIST BEFORE PRESCRIPTION OR TAKING MEDICINE

q.1. History of medicines that patients have used (both worked best and those with serious consequences), hence it is important to have a personal medical history notebook.

 2. Communicate if a patient had/ have any kidney, liver, or mental disorders.

3. This will help the physician to tailor specific doses or medication to avoid serious drug reactions or overload.

4. The patient should know the correct dosage and how to take the medicines that have been prescribed.

5. Report any polypharmacy (having more than one prescription from more than one source), this will help the pharmacist to tailor medicines that have a low risk to the patient.

6. Patients should get informed on how to store prescribed medicines, this will help to effectively administer correct medicine without poisoning the medicine.

7. patient should ask a physician about foods and other drugs which are incompatible with prescribed medicine.

8. Patients should become aware of any contraindications and uncomfortable experiences associated with the prescribed medicine. 

Oooh yeah! congratulations on making a long way to this far. it is my desire to see societies use drugs effectively.  Is there any misuse other than the mentioned ones that you have experienced or seen ? along with questions, opinions, and additions are welcomed in the chat box. 

Get better, live stronger and safely !

Masota, M. A.