Heed the Warning Signs

Be watchful for signs of misuse. Caution employees about interactions and side effects that can compromise safety.

• By Fred Elliott
• Apr 01, 2005

OVER-the-counter medications can be "the right stuff" for colds, allergies, first aid, fevers, headaches, and pain in general. They're relatively inexpensive and readily available--all too readily, considering the ease and potential risks of ordering and refilling via online sources.

OTC meds are an essential part of most Americans' lives, and this undoubtedly holds true for American workers as a whole. They are medications that can be bought without a prescription, relieve minor ailments, and are considered safe if users take care to follow their warnings and directions. But OTC medications can be harmful if they are overused, incorrectly used, or mixed with alcohol or some other prescription or non-prescription drugs. Especially when taken regularly, OTC meds can reduce or mask symptoms that warn of a more serious medical problem. National organizations and federal agencies routinely issue reports and warnings about drug interactions, misuse dangers, and medication error rates.

* On Jan. 6, 2005, the Centers for Disease Control and Prevention launched a new series of print and radio announcements to raise public awareness about proper use of antibiotics by children and adults. Some of the new ads were aimed at Spanish-speaking listeners and readers.

CDC began its campaign during the winter, when respiratory infections rise. Get Smart: Know When Antibiotics Work is part of a national campaign started one year earlier by the U.S. Department of Health and Human Services, CDC, the Food and Drug Administration, national health organizations, and state and local health departments with the goal of changing the public perception that "antibiotics cure everything." Get Smart is supported by the American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, and the Council for Affordable Quality Healthcare, among others.

"Taking antibiotics when they are not needed can cause some bacteria to become resistant to the antibiotic," said Dr. Richard Besser, Get Smart's director. "The fact is these resistant bacteria are stronger and harder to kill. They can stay in your body and cause severe illnesses that can't be cured with antibiotics. It's so important to get smart about antibiotic use and work with your doctor to get the right remedy."

* The National Council on Patient Information and Education, located in Bethesda, Md., recently issued "Prescription Pain Medicines: What You Need to Know," a 12-page brochure spelling out the risks associated with these powerful medications.

* The United States Pharmacopeia reported in December 2004 that computer entry errors have steadily increased and represent 11.5 percent of all hospital and health system medication errors reported to its MEDMARX system from 1999 through 2003. USP, a Rockville, Md., nonprofit standard-setting organization concerned with safe and proper use of medications, said most of the computer entry errors occurred in the transcribing/documenting phase or dispensing phase of the medication use process.

"It would seem logical that applying computer technology to the medication use process would have a significant positive impact in preventing medication errors," said Diane Cousins, R.Ph., vice president of USP's Center for the Advancement of Patient Safety. "Yet, depending on the computer's design or user competence, new points of potential errors can emerge. Health care providers need to be focused and vigilant in their use of computers."

Safe Use of Pain Medications
Aspirin and other non-prescription pain medications, such as acetaminophen and ibuprofen, can relieve minor pain. Even these present some risk: Acetaminophen can cause liver damage when taken chronically, in large doses, or in combination with alcohol or other drugs that harm the liver. Ibuprofen should not be taken in combination with aspirin or acetaminophen, and those using it should not drink alcohol.

Basic safe practices are essential when using pain relievers:
1) Take them exactly as directed.
2) Consult your doctor or pharmacist before taking them and discuss all other medications you are using.
3) Tell your physician if you have liver, heart, or kidney disease, high blood pressure, or are pregnant and intend to take these medications.
4) Report side effects if they occur. Labels on ibuprofen-containing products, for example, bear warnings that they may cause allergic reactions including hives, asthma, facial swelling, and shock.
5) People taking ibuprofen may become drowsy and should not drive or operate machinery if they are drowsy.

Stronger, prescribed medications for more serious or more lasting pain, classified as opioids, can cause serious problems. This group includes morphine and oxycodone. The problems include possible addiction; a risk that high doses of an opioid will cause the user to stop breathing, particularly if he or she is drinking alcohol; and tolerance, according to the National Council on Patient Information and Education's "Prescription Pain Medicines: What You Need to Know" (available for purchase at www.talkaboutrx.org/index.jsp). Taking the proper dosage of these medicines is essential, according to the council, which advises, "If there is anything you do not understand about what the doctor is saying, keep asking until you do understand. The more you know, the better you will be able to use the medicine effectively."

Management's Role
The council's advice is sound for all types of medications, including OTC meds. Workers in normal circumstances aren't asked to report what kinds of OTC medications they are using, but managers should be watchful for signs of misuse and also should caution employees about interactions and side effects that can compromise safety.

You can tell them, Be informed consumers. Know what and how much you are taking--not just the product's trade name, but also its active ingredients and the cautions and directions listed on each medication's package.

Remind them to consult your doctor or a pharmacist whenever they use over-the-counter medications, to read the labels carefully, and to follow the directions they find there.

Warn them about drug-drug interactions, which occur when a drug interacts or interferes with another drug. Unexpected side effects can occur, or the effect of one or both drugs may be more or less than desired. Healthfinder, a service from the U.S. Department of Health and Human Services, notes that both aspirin and blood-thinners help to prevent blood clots, but they can cause excessive bleeding if used together. Some antacids can prevent antibiotics and other types of medications from being absorbed into the user's bloodstream, preventing them from working as intended.

"What are some of the most common symptoms of a drug-drug interaction? The worst feared is a potentially deadly drug-drug interaction, such as one which results in a dangerous drop in blood pressure, a fast-paced, irregular heart beat, a buildup of toxins that damage the heart or liver, etc. However, most drug-drug interactions are considerably less severe. Some of the more common symptoms of drug-drug interactions include nausea or stomach upset, headache, heartburn, and dizziness. However, if you experience any reaction--after taking prescription or over-the-counter medicine--that seems out of the ordinary, you should consult your local pharmacist and make him or her aware of all of the medicines you're taking. In the case of a serious reaction, you should not hesitate to seek medical treatment. Drug-drug interactions can have serious consequences," the service cautions.

While regular training can tell workers they must seek help if their use of OTC medications is causing problems, self-reporting is highly unreliable in the real world. You'll be wise to watch for signs of trouble yourself, at the same time ensuring your employees know the risks of these highly useful modern "wonder drugs."

Precautions When Taking OTC Medications
It's a good idea to read labels carefully before taking any medication. Teach workers to follow these practices when they buy and use over-the-counter meds.

• Examine the ingredients. Are you allergic to anything in this product?
• Read the list of limits on taking the medication and listed side effects.
• Avoid certain foods, beverages, herbal products, or dietary supplements while taking it, if so advised.
• Check for a list of symptoms that should alert you to stop taking the medication.
• Check the dosage level and instructions.
• The label may recommend that you avoid driving or operating heavy machinery while taking the medication. Follow this advice.
• Check for the date indicating when the medication expires.

This article appeared in the April 2005 issue of Occupational Health & Safety.

This article originally appeared in the April 2005 issue of Occupational Health & Safety.