Medication Safety Articles


The 2019-2020 flu season is upon us. On average, 1 in 10 Americans get sick with the flu each year. Children are twice as likely to develop the flu than older adults, and children younger than 5 years are especially susceptible to serious flu-related complications. People 65 years and older, pregnant women, and people of any age with a chronic condition like asthma or diabetes are also at high risk of developing serious complications from the flu. 

Table 1 flu

The best way to protect yourself from the flu is to get vaccinated yearly. Yet, some people ignore the dangers of the flu and do not get vaccinated. Last year, 41% of adults were not vaccinated against the flu. Most were younger than 45 years. But even among older adults at high risk of flu-related complications, 1 in 4 said they did not plan to get a flu vaccine last year. This is unfortunate since the flu can affect even the healthiest among us and give us, at the very least, a miserable ride.

There are many reasons why some people don’t get vaccinated against the flu. But it often has to do with mistaken beliefs or myths about the flu itself and the flu vaccine. Here are the most common myths:

Myth 1: The flu is just a bad cold.

The flu causes some symptoms similar to a bad cold, like a sore throat, runny nose, sneezing, hoarseness, chest congestion, and cough. However, the flu is much more debilitating than a bad cold, causing additional symptoms like fever, headache, muscle aches, and extreme fatigue. Someone with the flu feels like they have a serious illness—and they do!

Myth 2: The flu vaccination can cause the flu.

The flu vaccination cannot cause the flu. Flu vaccines are currently made in two ways, neither of which can cause the flu:

• The flu virus has been inactivated (killed) and is therefore not infectious
• Only a single gene from the flu virus is used to produce immunity without causing infection

Some people report mild symptoms after the flu shot, such as soreness at the injection site or mild headache and muscle aches 1 to 2 days after vaccination. But this is not the flu. It takes 2 weeks after exposure to someone with the flu to cause symptoms. If you get the flu shortly after you get a flu vaccine, you most likely got exposed to someone with the flu 2 weeks prior to you receiving the flu vaccine and you were going to get sick anyway. If you get the flu more than 2 weeks after vaccination, you most likely caught a strain of the flu virus not covered by the vaccine. The Centers for Disease Control and Prevention (CDC) advises drug companies to make the flu vaccine every year based on the most likely strains to hit the US. It’s an educated guess, but sometimes a different strain makes its way into the US.

The flu vaccine can vary in how well it works. Some people who get vaccinated may still get the flu. But the symptoms are usually much less severe than without the vaccine.

Myth 3: I am healthy and have never gotten the flu, so I don’t need a flu shot.

Although some people are more vulnerable to getting the flu and flu-related complications, not even the experts can predict who among us will get the flu. Just because you have never gotten (or think you have not gotten) the flu, this could be the year. Strains of the flu virus are constantly changing and may make you sick this time. Additionally, we all interact with each other, including those who may not be as resistant to viruses as you think you are. We touch doorknobs, counters, office furniture, grocery carts, and other public shared surfaces. When you get the flu, you are contagious even a day before you have symptoms. In addition, 20% to 30% of people carrying the flu virus have no symptoms at all. Any hard surfaces that get flu virus germs on them can remain contagious for up to 48 hours. To be blunt, even when you don’t feel sick, you may be sick and can make others around you sick.

When you get vaccinated against the flu, you are not just protecting yourself. You are helping to protect everyone around you, including people who are unable to get the flu vaccination due to health reasons (e.g., those with a weak immune system, babies younger than 6 months).

Myth 4: I don’t need a flu vaccination this year because I got one last year.

Getting vaccinated yearly is important to make sure you have immunity to the strains most likely to cause a flu outbreak. Flu viruses often change each year, so this year’s flu vaccine is different than last year’s flu vaccine. Even if the flu vaccine has not changed since the previous flu season, yearly vaccination is still recommended for just about everyone 6 months and older. A person’s protection from the flu vaccine declines over time. So, yearly vaccination is needed to get the best protection against the flu.

Myth 5: It’s too late to get vaccinated after Thanksgiving.

The flu is unpredictable, so flu seasons can vary. Seasonal flu usually peaks between December and March most years, but illnesses may occur as late as May. If you have not been vaccinated by Thanksgiving, it can still be protective to get vaccinated in December or later. Even if vaccination doesn’t prevent you from getting the flu, it can greatly decrease the chance of severe symptoms.

Here’s what you can do: During this year’s flu season, take the necessary steps to stay healthy. Don’t let myths about the flu and flu vaccination get in the way of good medical care. Be sure to separate fact from myth when making a decision about whether to get vaccinated.

Also, take these additional precautions during the flu season, even if you have been (or plan to get) vaccinated:

• Stay away from people who are sick.
• Cover your mouth and nose with a tissue when coughing and sneezing. If no tissue is available, cough or sneeze into your elbow instead of your hands.
• Wash your hands frequently with soap and water, especially when you are out in public; after blowing your nose, sneezing, and coughing; and before eating or touching your mouth or nose.
• Don’t share dishes, glasses, or eating utensils.
• Avoid direct contact with napkins, tissues, handkerchiefs, or similar items used by others.
• Eat healthier and stay hydrated.
• Disinfect surfaces often in your home and office.
• If you start feeling ill, minimize your contact with others. If you can stay home from work, do it and your co-workers will thank you. Staying home and resting is your best bet for a quick recovery.

One of the most frequent errors in the pharmacy is giving a correctly filled prescription medicine to the wrong customer. Recently, we received another report of this type of error. A parent of a 16-year-old teen picked up what was supposed to be an antibiotic to treat his acne, minocycline. The next month, when looking at the prescription label to call in a refill of the medicine, the teen’s mother realized the prescription medicine was for a different person, and the medicine dispensed was not minocycline. Instead, Xarelto (rivaroxaban), a medicine used to prevent blood clots after surgery or in people at risk of having a stroke, was listed on the label. Fortunately, the teen was not injured. However, the risk of bleeding from taking Xarelto in error for a month is certainly significant.

Here’s what you can do: An effective way to detect this error right away is to open the bag of medicine when picking up filled prescriptions at the pharmacy. Make sure the correct person’s name and the expected medicine, dose, and directions are listed on each bottle. Always provide your full name (or the name of the person the prescription is for) and date of birth when picking up medicines. Ask to speak to the pharmacist to review how to take the medicine. This can also help catch errors if the medicine, dose, or directions are different than you expect, or if the reason for taking the medicine does not match your needs. If the medicine is not what you expected, don’t be afraid to tell the pharmacist you do not think it is right.

The oral syringes that come with risperidone oral solutions are uniquely labeled and may cause confusion. Risperidone is a medicine used to treat certain mood disorders. Unlike other oral syringes, risperidone oral syringes have a barrel (the part that holds the medicine) that does not have any lines or numbers (markings). Instead, the markings appear on the plunger (Figure 1). To measure a dose, the plunger must be pulled back until the dose marking aligns with the flange (winged end) of the barrel. Even though these syringes are different than other oral syringes, the instructions do not provide detailed, clearly illustrated information on how to read the markings when measuring a dose. We recently learned about a man who may have taken too much risperidone due to confusion with the dose markings.

With birth control pills (e.g., Tri-Estarylla, Tri-Linyah), confusion is possible between the week 1 tablets that contain norgestimate and ethinyl estradiol and the week 4 tablets that do not contain any medicine. Different brands of these birth control pills have the same medicine and dose in the active tablets, but the tablet colors vary (Table 1).

A medicine commonly used to treat depression, sertraline (Zoloft), is available as a tablet or a concentrated oral liquid. The oral liquid form is very potent and must first be diluted in a specific beverage to make it easier to swallow. However, many healthcare providers and consumers are unfamiliar with the need to dilute this medicine before use.

Most prescriptions can be transferred between pharmacies in the US. You may need to do this for several reasons:

· You are moving to a new location

· You are looking for a more convenient pharmacy location

· You recently made changes to your health insurance that require you to use a different preferred pharmacy

· You need to obtain a temporary supply of your medicines because you did not bring enough with you while traveling

But take care, as errors have happened when transferring prescriptions between pharmacies.

Pharmacists from the Maryland Poison Center recently published several cases of what they refer to as “pill dumping.” An article in the American Journal of Health-System Pharmacy1 describes the term “pill dumping” for when patients use a spare medication vial to hold multiple medications taken from different labeled prescription vials.

Most people are aware of the need to keep medications out of children’s reach, but they don’t necessarily realize that similar rules apply when it comes to keeping pets safe. Pets can also get into medications that are not intended for them, which could cause harm. One case in point was recently reported.

A woman accidentally put ear wax removal drops (carbamide peroxide 6.5%) into her eye. This caused irritation and redness that persisted after rinsing her eye with water for 15 minutes. The bottle of ear wax removal drops (Figure 1) looks like a container used for eye drops. A warning that the drops are for the ears only is not on the front of the bottle (and carton) label. On the back of the carton, it says, “When using this product, do not get into eyes” in the Drug Facts table, but it does not stand out. This is mentioned on the side of the bottle, but the warning is buried in the middle of a paragraph in very small print.

Routine, recommended vaccines in the US currently offer some level of protection against 17 infectious diseases. One of these vaccines targets preteen boys and girls between 11 and 12 years of age—the human papillomavirus (HPV) vaccine. According to the 2017 Centers for Disease Control and Prevention (CDC) National Immunization Survey (NIS)-Teen, this vaccine is not widely used. Only 66% of boys and 67% of girls had received at least the first vaccine dose by age 15. Even fewer completed the full vaccine series of 2 to 3 doses—just 53% of girls and 48% of boys.

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