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Scott Webb (Host): Most of us would love a few minutes with a pharmacist to ask them how to manage our medications, how and where to store or dispose of them and so much more. And today I'm joined by Dr. Joshua Jones. He's a Clinical Pharmacist at New Hanover Regional Medical Center. And he's going to answer all the most common questions that he gets asked.

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Scott Webb. Dr. Jones, thanks so much for your time today. As mentioned off the air, you know, most of us don't get a chance to kind of pepper a pharmacist with a bunch of questions, but that's what I'm going to do today. I'm going to ask you all the questions that most people have for pharmacists, but let's start here. Tell us a little bit about yourself and explain your role as a clinical pharmacist.

Joshua Jones, PharmD, BCACP: My name is Josh Jones. I'm originally from a small town called Ocala, Florida. Played basketball in college, a school called the Holy Cross, College of the Holy Cross in Worcester, Massachusetts. And then did my pharmacy school training and at East Tennessee State University in Johnson City, Tennessee. I ended up doing a residency actually here at New Hanover Regional Medical Center, where I have stayed on and worked ever since 2016. Here at New Hanover, I am one of our Clinical Pharmacists and my focus here is on patient transitions of care, as well as community pharmacy dispensing. So, I kind of have a dual role, which I think is really great and it keeps the day pretty interesting.

Host: Yeah, I'll bet. So, and I would love to tell you about basketball. My daughter's quite the hoopster herself. I would love to do a separate podcast and we can just talk about basketball.

Dr. Jones: That would be great.

Host: Yeah. But for today, let's talk about medications. And most of us like me, have multiple medications. So, how do we keep track of all that? How do we sort those out? How do we not get confused? How best to make sure that everything's in the right place and we take things that we should take, when we should take them and all that good stuff?

Dr. Jones: Well, that's a great question because this can really be difficult for a lot of people, not just people who manage their medications for themselves, but also those who manage medications for a spouse or a child or a loved one. And it can get really confusing, like you said, when you have two or three or four, even up to 10 meds at a time. The first thing that I would suggest is using pill boxes. Some pill boxes are made with the AM and the PM, and even like the midday spaces that can help you separate your meds and keep you on track. I also want to highlight where we are today in this age is 2021, almost everyone has a cell phone or a smartphone that has a capability to have alarms.

So, using alarms that you can schedule every day could be an extra reminder for you to, hey if you remember to take your medications. I know some people are more of a visual reminder people. So, using a chart, or a calendar could also be helpful, like putting a calendar, a chart on the counter or on the refrigerator. Somewhere, just to alert you to remember, to take your medications and then you can even check it off when you do it each day.

Host: Yeah. Those are all great suggestions. And I was thinking back when I was a kid, when I would stay at my grandparents’ house, my grandmother, every morning, she would put out two paper towels on the counter and there would just be these mounds of pills. I don't know if you're familiar with the mounds of pills. Yeah, and it just occurred to me, and I think back, I'm like, that's probably not how Dr. Jones would have recommended to manage their medications. And I think we all have these questions. This next one here, why does some medications need to be taken with food?

Dr. Jones: So there are typically two main reasons why we take medications with food. The first is, because some of these medications can cause GI or those stomach side effects. So, think of like diarrhea or nausea. So, taking these meds with food can help curb or blunt those side effects. So, drugs like antibiotics are the common ones that we think of that fall into this category. The second reason has to do with the way different drugs get absorbed into the body.

So, some medications like, for example, the Xarelto, a blood thinner, gets more widely absorbed in the body when you take it with a meal. This is obviously important because we want to make sure that all the drug is being absorbed and being used in the body so we get the desired clinical effect.

Host: Yeah. And of course, when we look at the label, when we get our prescriptions if anybody has a question, they can just ask Dr. Jones say, why do I need to take this with food? Is it because of the stomach effects or because it's more effective when I take it with food, people should just ask, right?

Dr. Jones: Exactly, easy question to ask. And for the most part, very easy for us pharmacists to answer for you.

Host: Yeah, definitely. And when you talked about pill boxes and things like that, and I mentioned my grandparents, and their mound of pills, but really how should medications be stored? What's the best way, the best place for us to store our medications?

Dr. Jones: So, typically most medications that come in that tablet or a capsule form should be stored at room temperature, in an area free of moisture, that's not subject to temperature fluctuations. So, think of like, not in bathrooms or even in those cabinets above the stove where the temperature can be affected by steam when you're cooking. So, we try to avoid those places. Medications like insulins or other injectable meds used for diabetes should typically be stored in the refrigerator when they're not being used. So, it's important more for drug integrity, but there's also a safety component. So, we want to try to avoid storing medications out in the open, where they're easy to be seen by children or other adults. So, you don't want to leave them in your car or on kitchen counters or even in persons or bags. Ideally, you want to store these meds in higher places out of the reach of children. And that's just more for the safety side of it.

Host: You know, I was thinking back to my wife and I've had many conversations about expired meds, you know? She's of the opinion that they, they put those dates on there because they have to, but they don't really expire necessarily. Let's put all that to rest, Doctor. Do medications really expire, and if they are expired, let's say for a short period of time, maybe six months or a year, are they still safe for us to take?

Dr. Jones: So, I would say as a pharmacist, I would say, no, not safe to take. And it's just because those medications have, because it's past the expiration date, they may not be as potent. They may not work as well for you. So, we want to avoid running into any issues like that. And also the medications haven't been studied past those, identified expiration dates. So, we can't with any confidence, say this is going to work, or this is going to happen, if you take this medication.

Host: I think we've all been through this, where we are used to getting a particular medication from a particular manufacturer, and then we go to the pharmacy and it gets filled by something else, by another manufacturer or a generic drug equivalent, if you will. Are generic drugs, the same as their name brand counterparts?

Dr. Jones: This is a really great question. So, generic drugs have the same active ingredients as those brand name counterparts. They may differ in the process that they're made or in their active ingredients, or even in the drug formulation. But something to keep in mind, I would say, is that here in the US, even generic drugs still need to go through the same testing by the manufacturer and the FDA before they can actually gain approval. So, they are still safe to take.

Host: Yeah. And if people have some sort of side effect that they're not used to because the drug was changed out, well, then they can reach either back out to the pharmacist or their primary and let them know, hey, I don't think that this generic is working for me. Could we try something else, right?

Dr. Jones: Exactly. That's always an option. And one of the things I will add, is that generics, I even tell like my, not just my patients and my family as well, generics are typically usually preferred by insurance companies, prescription insurance companies. So, they will come with a cost savings that you don't always see with those brand name drugs. So, that could be another reason to for some of these take the generic over the brand.

Host: Yeah, that's definitely been my experience. The generic is always a whole lot cheaper. Yeah. So doctor, if I forget to take my medication in the morning, let's say, can I still take it at lunch or later in the day? Or should I wait and then sort of recycle the next day?

Dr. Jones: Gotcha. So, that's going to vary depending on what the drug is and the frequency. So, as a general rule for most medications, if you forget the dose and then you don't remember until the next time that dose is due, just skip the missed dose and take whatever dose that you should be on at that time. So, essentially, don't double up or try to include your missed dose. Now, if this is like a one daily medication and say you forget to take your medication at eight o'clock, but you remember at 10 o'clock just two hours later, at that point, it's typically okay to take that dose, but your pharmacist is usually just one call away. That's an easy phone call to make, and an easy question to ask, and they can kind of direct you specifically based on the drug that you're on.

Host: One of the things I want to ask you is about drug interactions. And I worry about that sometimes. Not that I, I question my primary's judgment or expertise, but sometimes when you start layering on a drug after drug and you're taking a couple of things, I wonder, whether my primary has really studied how those drugs interact with each other and then, likewise do pharmacists? Do you look at, okay, well, patient Scott is taking this and this and this, and now his doctors added this well. These, all these all go together. How does that work? How do you make sure that there aren't drug interactions, negative drug interactions for people?

Dr. Jones: That's a great question. So, there are actually a systematic defenses that are in place to help prevent those drug interactions from happening. A lot of doctor's offices use electronic medical record systems to prescribe and order those meds. And within those systems, there are alerts that will notify doctors, or any kind of healthcare provider, of an interaction that might happen. But very similarly, all pharmacies have a similar type of electronic medical record system. And so the same way, the doctor's office would catch a drug interaction, a pharmacy would as well. But I often tell people to make sure you keep a list of your medications on you. So, just in case you have a primary care doctor and then maybe a cardiologist or a pulmonologist who may use different types of systems. By keeping that med list on you and showing it to each doctor that you see, that'll help make sure that everyone that's involved in your medical care is on the same page in regards to your medications.

Host: Oh, that's such a great suggestion. I know my mom does that because she has a regular doctor and a heart doctor and a knee doctor and so many doctors. So good to know she does that for a fact, she keeps all of her medications, you know, or a list of that with her or in her phone, however she does it. So, that's a great suggestion. And, maybe it's still too early in the process, but are you aware of any interactions, negative interactions between the COVID-19 vaccine and let's say the more common medications that we all take?

Dr. Jones: You're right. It is pretty early in the process. As of right now, no, we don't think that there should be any interaction with the COVID-19 vaccine any of them that are out now, with any typical medications that people may have. Without knowing each medication a person is on, it's kind of tough to specifically say that there will, or won't be an interaction, but in general, where vaccines are concerned, they usually don't get approved if there's a chance that there could be a drug interaction. With that being said, it's really important, especially with this COVID-19 vaccine for patients to have that conversation with their providers, just in case there is something out of left field that they're on or something that the doctor is concerned about. They can have that conversation with their patient.

Host: We have something where I live, where we can bring expired medications to the police station. And there's like a little mailbox in there and you bring your expired prescriptions in and you drop them in the mailbox. And then they dispose of them. I don't know if that's common across the country, but how do you recommend that people dispose of unused or expired medications?

Dr. Jones: No, I think that's a great option. I'm glad you had that in your area. And most areas do, whether it be the police station or even the Sheriff's department in their County, they have those drop boxes. I always tell people, it looks like those old library drop boxes almost. You can just go anonymously, drop those medications off. Here, where we're located in Hanover County in North Carolina, our outpatient pharmacy actually here at this hospital, we have a Dropbox in our pharmacy. And a few of our local pharmacies, like a CVS and our Walgreens have in their lobbies as well, just to make it more accessible for patients to get those meds out of their home if they're not being used or if they're expired.

Host: As we wrap up here, Doctor, anything else you want to tell people about your role, about medications, about managing them, side effects? Anything else? Any final sort of take home point?

Dr. Jones: Well, I feel like I'm going to toot my own horn or all of our pharmacists horns with this, but pharmacists are the medication experts, and we're local and we're accessible members of your healthcare teams. So, if you ever have a question, please, don't hesitate to call. You heard the saying there are no stupid questions and that's especially true when we think about medications and things that affect our body like that. So, please reach out. We'd be happy to help you out and answer any questions you have.

Host: Yeah, I absolutely believe that. And so great speaking with you. Hopefully we'll get to talk again some other time about basketball and some other things, but for today, hopefully we answered everybody's questions. Great to have your undivided attention for this podcast. So, really awesome. Thank you so much. And you stay well.

Dr. Jones: Thank you. You too. It's been great.

Host: And if you have any questions about your medications, talk to your prescribing doctor or your pharmacist. For more information about medication disposal options, visit nhrmc.org. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Scott Webb. Stay well.