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Taking Medicines
 Medicines and Your Body
Medicines can enter the body in many different ways. As drugs make their way through the body, many steps happen along the way. Understanding how medicines work in your body can help you learn why it is important to use medicines safely and effectively.
Medicines and Your Body - Drugs in the Body
Drugs are absorbed into the body when they travel from their point of entry into the blood. When you take medicines by mouth, they move through the digestive tract to the liver, the place where the body processes chemicals.
 When you take medicines in other ways -- getting a shot, using an inhaler, or applying a skin patch, for instance -- the medicine bypasses the liver and enters the bloodstream directly or through the skin or lungs.
The bloodstream carries medicines throughout the body in a process called distribution. Drugs often interact with many body organs. Side effects can occur if a drug has an effect in an organ other than its target organ.
After a medicine has done its job in the body, the drug is broken down through a process called metabolism. Drug metabolism is the chemical alteration of a medicine by the body.
Often, when a drug is broken down (or chemically altered by the body), it produces products called metabolites. These metabolites are not usually as strong as the original drug, but sometimes they can have effects that are stronger than the original drug.
Because most metabolites are broken down in the liver, scientists refer to the liver as a "detoxifying" organ. As such, the liver can be prone to damage caused by too much medicine in the body.
Once the liver is finished working on a medicine, the now-inactive drug enters the excretion stage and exits the body in the urine or feces. Age-related changes in kidney function can have significant effects on how fast a drug is eliminated from the body.
Quiz 1. Most drugs travel through the body in the bloodstream.
TRUE is the correct answer. Drugs are absorbed into the body when they travel from their point of entry into the bloodstream.
2. The heart is the place in the body where most medications are broken down, or metabolized.
FALSE is the correct answer. Most medications are broken down, or metabolized, in the liver.
3. Breakdown products of drugs, or metabolites, can have effects that are different than the original drug.
TRUE is the correct answer. Breakdown products, or metabolites, can have effects that are stronger or weaker than the original drug.
4. Metabolism is the final stage of a drug's life inside the body.
FALSE is the correct answer. Excretion, when a drug exits the body in urine or feces, is the final stage of a drug's life in the body.
Medicines and Your Body - Side Effects
While everyone needs to be careful when taking a medicine, older adults frequently take more than one medication at a time, and anyone taking several medications at the same time should be extra careful. Also, as the body ages, its ability to absorb foods and drugs changes.
As people age, the body's ability to break down substances can decrease, so that older people may not be able to metabolize drugs as well as they once did. Thus, older people sometimes need smaller doses of medicine per pound of body weight than young or middle-aged adults do.
All medicines have risks as well as benefits. The benefits of medicines are the helpful effects you get when you take them, such as curing infection or relieving pain. The risks are the chances that something unwanted or unexpected will happen when you use medicines. Unwanted or unexpected symptoms or feelings that occur when you take medicine are called side effects.
Side effects can be relatively minor, such as a headache or a dry mouth. They can also be life-threatening, such as severe bleeding or irreversible damage to the liver or kidneys.
Stomach upset, including diarrhea or constipation, is a side effect common to many medications. Often, this side effect can be lessened by taking the drug with meals. Always check with your doctor, nurse, or pharmacist to see if you should take a particular medication with food.
Here are some more tips to help you avoid side effects:
- Always inform your doctor or pharmacist about all medicines you are already taking, including herbal products and over-the-counter medications.
- Tell your doctor, nurse, or pharmacist about past problems you have had with medicines, such as rashes, indigestion, dizziness, or not feeling hungry.
Tips to help avoid side effects:
- Ask whether the drug may interact with any foods or other over-the-counter drugs or supplements you are taking.
- Read the prescription label on the container carefully and follow directions. Make sure you understand when to take the medicine and how much to take each time.
Tips to help avoid side effects:
- If you experience side effects, write them down so you can report them to your doctor accurately.
- Call your doctor right away if you have any problems with your medicines or if you are worried that the medicine might be doing more harm than good. He or she may be able to change your medicine to another one that will work just as well.
Tips to help avoid side effects:
- Don't mix alcohol and medicine unless your doctor or pharmacist says it's okay. Some medicines may not work well or may make you sick if taken with alcohol.
You should always be sure to tell your doctor and/or pharmacist about any and all medications that you take every day or even once in a while. Unwanted effects can occur when a drug interacts, or interferes with, another drug or with certain foods. These chemical interactions change the way your body handles one or both medicines.
In some cases, the overall effect of an interaction is greater than desired. Combining aspirin with blood-thinning drugs such as CoumadinŽ, also called warfarin, can cause serious bleeding. Mixing ViagraŽ, also called sildenafil, and the heart drug nitroglycerin can cause blood pressure to plunge to dangerously low levels.
 A single glass of grapefruit juice can raise the level of some medications in the blood. This can occur with several types of drugs commonly used to treat heart conditions. Years ago, scientists discovered this "grapefruit juice effect" by luck, after giving volunteers grapefruit juice to mask the taste of a medicine.
Nearly a decade later, researchers figured out that grapefruit juice blunts the effects of an enzyme that breaks down drugs. This leads to higher levels of medicine remaining in the blood, which can cause health problems. Be sure to ask your doctor or pharmacist if it is safe to consume foods or beverages that contain grapefruit with the medication you are taking.
Mixing drugs also can cause effects that are less than what is desired. For example, calcium-rich dairy products or certain antacids can prevent antibiotics from being properly absorbed into the bloodstream. Ginkgo biloba can reduce the effectiveness of blood-thinning medications and raise the risk for serious complications such as stroke.
Learn what active ingredients are in the prescription and over-the-counter medicines you are taking. An active ingredient is the chemical compound in the medicine that works with your body to bring relief to your symptoms.
For example, over-the-counter pain relievers usually contain one or more of four different active pain relief ingredients.
- acetaminophen
- ibuprofen
- naproxen sodium
- aspirin
Many prescription or over-the-counter medicines intended for relief of multiple symptoms, such as cold and flu medications, also include these pain relievers as active ingredients.
Don't combine pain relievers, prescription drugs, or multi-symptom medicines that have the same active pain relief ingredient. This could result in taking too much of that ingredient, and too much of any one ingredient might damage your liver or lead to other serious health problems.
Also, it is a good idea to check what other active ingredients may be present in the over-the-counter medications you are taking. Some may also contain antihistamines, which can cause drowsiness. Caffeine, which is present in some over-the-counter medicines, can interact with certain drugs or with underlying conditions such as high blood pressure.
Quiz 1. Interactions only occur between different types of prescription medicines.
FALSE is the correct answer. Drugs can interact with other drugs, foods and beverages, vitamins, and dietary supplements.
2. Some side effects occur with almost all medicines.
TRUE is the correct answer. Nearly all medications have some type of side effects, although the side effects vary significantly between people. Most side effects are minor, but some side effects can be dangerous.
3. Grapefruit juice can affect the amount of medication in the blood.
TRUE is the correct answer. Grapefruit juice blunts the effects of an enzyme that processes drugs. This leads to higher levels of some types of medicines in the blood, which can cause health problems. Be sure to ask your doctor or pharmacist if it is safe to consume grapefruit-containing foods or beverages with your medication you are taking.
4. All medications contain a single active ingredient.
FALSE is the correct answer. Many prescription or over-the-counter medicines intended for relief of multiple symptoms, such as cold and flu medications, also include pain relievers as active ingredients. Don't combine pain relievers, prescription drugs, or multi-symptom medicines that have the same active pain relief ingredient. This could result in taking too much of that ingredient, and too much of any one ingredient might damage your liver or lead to other serious health problems.
Taking Medicines Safely
People age 65 and older take more prescription and over-the-counter medicines than any other age group. Older people as a group tend to have more long-term, chronic illnesses such as arthritis, diabetes, high blood pressure, and heart disease.
Because they may have a number of health problems or issues at the same time, it is common for older people to take many different drugs. To avoid risk and get the best results from your medicines, here are some tips on how to take medicines safely and manage them wisely.
Taking Medicines Safely - How to Take Medicines
There are two types of medications: drugs your doctor prescribes for you, called prescription drugs, and those you can get without a doctor's prescription, called over-the-counter drugs. It is important to realize that over-the-counter products include many different substances such as vitamins and minerals, herbal and dietary supplements, laxatives, cold medicines, and antacids.
 If your doctor prescribes a medication for your condition, make sure that you find out as much about it as you can and that you learn to take it properly. Ask the following questions and write down the answers before leaving the doctor's office.
Questions to ask about the medicine itself:
- What is the name of the medicine and why am I taking it?
- What is the name of the condition this medicine will treat?
- How long will it take to work?
Questions to ask about the medicine itself:
- How should I store the medication? Does it need to be refrigerated?
- Can the pharmacist substitute a less expensive, generic form of the medicine?
Ask your doctor, pharmacist, or nurse about the right way to take any medicine before you start to use it. Ask questions when you don't know the meaning of a word, or when instructions aren't clear. Here are some specific questions to ask:
Questions to ask about taking medicine:
- When should I take it? As needed, or on a schedule? Before, with, or between meals? At bedtime?
- How often should I take it?
- How long will I have to take it?
Questions to ask about taking medicine:
- How will I feel once I start taking this medicine?
- How will I know if this medicine is working?
- If I forget to take it, what should I do?
Questions to ask about taking medicine:
- What side effects might I expect? Should I report them?
- Can this medicine interact with other prescription and over-the-counter medicines -- including herbal and dietary supplements -- that I am taking now?
Taking different medicines is not always easy to do properly. It may be hard to remember what each medicine is for, and how and when you should take it. Here are some helpful hints about taking medicines:
- Check the label on your medicine before taking it to make sure that it is for the correct person -- you.
Helpful hints for taking medicines:
- Read and save any written information that comes with the medicine.
- Take the medicine according to the schedule on the label.
- Don't take more or less than the prescribed amount of any medicine.
Helpful hints for taking medicines:
- If swallowing tablets is difficult, ask your doctor or pharmacist whether there is a liquid form of the medicine or whether you could crush your tablets. However, do NOT break, crush, or chew tablets without asking a health professional first. NEVER break, crush, or chew a capsule.
Helpful hints for taking medicines:
- Get into the habit of checking the expiration dates on your medicine bottles, and throw away medicine that has expired.
- Try to set and follow a routine for taking your medicines.
Quiz 1. If your doctor asks you what drugs you are taking, you should mention only your prescription medications.
FALSE is the correct answer. The word "drugs" can mean both medicines prescribed by your doctor and over-the-counter medicines, which are the kind you buy without a doctor's prescription. Over-the-counter medicines can include vitamins and minerals, herbal and dietary supplements, laxatives, cold medicines, and antacids. Always talk with your doctor or pharmacist about any over-the-counter drugs you are taking.
2. When discussing medications with your doctor, it is a good idea to take notes.
TRUE is the correct answer. When discussing medications with your doctor, it is a good idea to write down your questions ahead of time and to jot down the doctor's answers to those questions. Taking a friend or relative with you to your doctor's appointment may also help you understand what the doctor said and remember what to do after you get home.
3. If you notice that the expiration date on your medicine bottle has passed, you shouldn't worry too much about it unless it has changed color or smells unusual.
FALSE is the correct answer. If the expiration date on the medicine bottle has passed, you should throw the medicine away. Check your medicines regularly to make sure they have not expired. Drugs that have expired may not look or smell any different, yet they may not work as well in the body.
4. If you have trouble swallowing tablets, it is okay for you to decide to crush the tablets first.
FALSE is the correct answer. If swallowing tablets is difficult for you, ask your doctor or pharmacist whether there is a liquid form of the medicine or whether you could crush your tablets. However, do NOT break, crush, or chew tablets without asking a health professional first.
Taking Medicines Safely - Managing Your Medicines
Keeping track of your medicines is very important. Making sure that they are stored properly, that they have not expired when you take them, and that prescriptions are refilled requires time and attention.
Also, taking many different medications at the same time is difficult. It can be hard to remember what each drug is for, when you should take it, and how you should take it. This is especially true for people with memory problems. However, there are simple strategies you can use to help you manage your medicines wisely.
 Keep a checklist of all the prescription and over-the-counter medications you take. For each medicine, mark the amount you take, the time of day you take it, and whether it should be taken with food. Store two copies of the list: one on the refrigerator door or where your medications are stored, and one in your wallet or purse. You may wish to print out the enlarged version of the chart on this page to help you.
Review your medicine record at every visit to the doctor and whenever your doctor prescribes new medicine. Your doctor may have new information about your medicines that might be important to you. Whenever possible, have your health care provider write down advice and instructions for taking the medication. Keep this information handy.
 Ask your pharmacist to provide your medicine in large, easy-to open containers with large-print labels. Keep medicines in their original containers, and never put more than one kind of medicine in the same container. Consider using multi-day dispensers that organize your medicines by the day and time that you should take them.
Ask your doctor or pharmacist and/or read the label to determine how a medication should be stored. Some medications must be stored in the refrigerator. Contrary to what you may think, your bathroom medicine cabinet is not a good place to store most medications due to the moist, warm conditions that can cause drugs to break down more quickly.
Don't stop taking a prescription drug unless your doctor says it's okay -- even if you are feeling better.
Get prescriptions refilled early enough so you won't run out of medicines. Running out could cause problems with your medicine schedule. Check expiration dates frequently and discard any medicines that are out-of-date.
Keep all medicines out of the sight and reach of children and away from pets. If children do visit your house, be extra cautious and write down the phone number of the nearest poison control center.
Finally, the pharmacist is a good source of information about your medicines. In addition to answering questions and helping you select non-prescription medications, your pharmacist keeps records of all the prescriptions you get filled at that drug store.
Because the pharmacist keeps these records, it is a very good idea to have the same drug store fill your prescriptions whenever possible.
Quiz 1. Keeping a checklist of all your medications can help you
A. remember all of the medications you are taking.
B. stay on schedule when taking your medicines.
C. remember how much of each medication to take.
D. all of the above.
D is the correct answer. Taking many different medications at the same time is difficult. It can be hard to remember what each drug is for, when you should take it, and how you should take it. This is especially true for people with memory problems. A checklist can help you remember all your medicines and when to take them.
2. You should always store your medicines
A. in the freezer.
B. in a drawer.
C. according to the label, or where your doctor or pharmacist says.
C is the correct answer. Medicines have different storage requirements, and these are usually written on the label or the box the medicine comes in. For example, some medications must be stored in the refrigerator. If you cannot locate the written instructions about how to store a particular medicine, contact your doctor or pharmacist.
3. It's a good idea to have your prescriptions filled
A. at a single pharmacy.
B. at various pharmacies.
C. at a convenience store.
A is the correct answer. A pharmacy usually keeps records of all the prescriptions you get filled at that particular drug store, so it is a very good idea to have the same drug store fill your prescriptions whenever possible. This way, the pharmacist can alert you to possible interactions with other drugs.
4. If you start feeling better after taking your medication, you should
A. stop taking it.
B. continue taking it as prescribed by your doctor.
C. give it to someone else to take.
B is the correct answer. Don't stop taking a prescription drug unless your doctor says it's okay -- even if you are feeling better. Also, never share prescription drugs with anyone else.
Testing Medicines
Testing potential new drugs in people is done through a process known as clinical trials. A clinical trial is a research study with people to find out if a new drug or treatment is both safe and effective. This type of medical research has led to treatments for many diseases, such as Hodgkin's lymphoma, arthritis, heart disease, and childhood leukemia.
Testing Medicines - Developing Medicines
The Food and Drug Administration, or FDA, is the federal agency responsible for making sure that foods and cosmetics are safe, and that drugs and medical devices are safe and effective. Clinical trials are a key part of drug discovery and development, and the FDA requires that new drugs be tested in clinical trials before they are put on the market.
Clinical trials are sponsored or funded by pharmaceutical companies, federal agencies like the National Institutes of Health, foundations, individuals, and voluntary groups. Trials can take place in a variety of locations, such as hospitals, universities, doctors' offices, or community clinics.
Along with seeking new therapies, researchers sometimes perform clinical trials to compare existing drugs. This way, they can see which medication or combination of medications is the safest or most effective for treating a particular ailment.
Both prescription drugs and over-the-counter drugs are tested in clinical trials before they become available to the public. However, according to a 1994 law, ingredients used in dietary supplements no longer have to be tested like drugs before they go on the market, so they are not tested in clinical trials. Also, there are no regulations that govern the way these substances are manufactured.
 Scientists usually do years of experiments in the laboratory and in animals before they can even consider testing an experimental medication in people. Most of this early research occurs at universities and medical centers across the country. The National Institutes of Health funds much of this basic research.
According to the Pharmaceutical Research and Manufacturers of America, most of the medicines tested in scientists' laboratories fail in laboratory or animal studies. On average, only 5 out of every 5,000 potential medicines actually make it to clinical trials. And only one of these five is eventually approved for use in patients.
In 2003, the Tufts University Center for the Study of Drug Development found that a pharmaceutical company typically spends $802 million over 10 to 15 years to bring a new medicine from the laboratory to your local pharmacy.
It is true that developing drugs is a time-consuming and expensive process. Yet, clinical trials are the only way doctors can know for sure whether medicines are both safe and effective in people.
Enrolling in a clinical trial offers benefits and risks. If you choose to participate in a clinical trial, you may get therapies not yet available to most patients. Also, patients in clinical trials are watched very closely, and they typically benefit from a high standard of care.
Importantly, scientists who wish to test drugs in people must follow strict rules that are designed to protect those who volunteer to participate in clinical trials. Special groups called Institutional Review Boards, or IRBs, evaluate all proposed research with humans to determine the potential risks and expected benefits.
The goal of an IRB is to make sure that the risks to humans are minimized and that they are reasonable compared to the knowledge researchers expect to gain by doing the study. Clinical studies cannot go forward without IRB approval.
Quiz 1. Clinical trials help scientists find new treatments for a variety of health problems.
TRUE is the correct answer. After testing potential drugs in the laboratory and in animals, researchers have to see how drugs work inside the human body. Researchers sometimes perform clinical trials to compare existing drugs, so they can see which medication or combination of medications is the best possible treatment for a particular ailment. Treatments for many diseases are found through this important type of research.
2. Most drugs tested in clinical trials eventually become available to the public.
FALSE is the correct answer. Most of the medicines tested in scientists' laboratories fail in laboratory or animal studies. On average, only 5 out of every 5,000 potential medicines actually make it to clinical trials. And only one of these five is eventually approved for use in patients.
3. The Food and Drug Administration monitors the safety and effectiveness of foods, drugs, and dietary supplements.
FALSE is the correct answer. The Food and Drug Administration, or FDA, makes sure that foods and cosmetics are safe, and that drugs and medical devices are safe and effective. However, according to a 1994 law, ingredients used in dietary supplements no longer have to be tested like drugs before they go on the market, so they are not tested in clinical trials. Also, there are no regulations that govern the way these substances are manufactured.
4. Strict rules protect people who participate in clinical trials.
TRUE is the correct answer. Special groups called Institutional Review Boards, or IRBs, evaluate all proposed research with humans to determine the potential risks and expected benefits. The goal of an IRB is to make sure that the risks to humans are minimized and that they are reasonable compared to the knowledge researchers expect to gain by doing the study.
Testing Medicines - Clinical Trials
People in clinical studies must agree to the terms of a trial by participating in a process called informed consent and signing a form, required by law, that says they understand the risks and benefits involved in the study.
Throughout a study, patients are kept informed about anything that may affect their willingness to continue. Clinical trial patients may withdraw from a study at any time, even after signing the consent form.
Scientists conduct clinical trials in three steps, called phases I, II, and III. Each phase provides the answer to a different question about a potential new drug: Is it safe? Does it work? Is it better than the standard treatment?
Phase I studies test a drug's safety in a few dozen to a hundred people and are designed to figure out what happens to a drug in the body -- how it is absorbed, metabolized, and excreted. Phase I studies usually take several months.
Phase II trials test whether or not a drug produces a desired effect. These studies take longer -- from several months to a few years -- and can involve up to several hundred patients.
A phase III study further tests how well a drug works, as well as whether it is better than current treatments. Phase III studies involve hundreds to thousands of patients, and these advanced trials usually last several years.
Many phase II and phase III studies are randomized, meaning that one group of patients gets the experimental drug being tested while a second, control group gets either a standard treatment or a placebo. A placebo often comes in the form of a "dummy" pill or injection. The use of placebos helps researchers compare the effects of a given treatment against no treatment.
Usually, phase II and phase III studies are "double-blinded" -- neither the patients nor the researchers know who is getting the experimental drug. This helps to prevent bias on the part of the researcher or the patient.
Finally, once a new drug has completed phase III testing, a pharmaceutical company can request approval from the Food and Drug Administration to market the drug. Once a drug goes on the market, it undergoes a period called phase IV, or "post-market surveillance."
During this time just after a new drug becomes available, uncommon and unexpected problems with a new medicine may occasionally occur. This is because rare problems, which range from mild to severe side effects, can only surface when hundreds of thousands to millions of people begin taking the medication.
To find out more about participating in a clinical study, talk to your doctor or search on-line for the clinical trials that are available. For more information visit the federal Web site: ClinicalTrials.gov.
Quiz 1. Testing drugs in people usually takes a few months.
FALSE is the correct answer. Scientists conduct clinical trials in three steps, called phases I, II, and III. The entire process usually takes several years.
2. The first step in the clinical trial process determines whether a drug is safe for use in humans.
TRUE is the correct answer. Early clinical trials, known as phase I studies, test a drug's safety in a few dozen to a hundred people and are designed to figure out what happens to a drug in the body -- how it is absorbed, metabolized, and excreted.
3. Your doctor can enroll you in a clinical trial without your knowing about it.
FALSE is the correct answer. Participating in a clinical trial is completely voluntary. People in clinical studies must go through a process called informed consent and sign a form, required by law, that says they understand the risks and benefits involved in the study. Patients can withdraw from a trial at any time, even after they have signed the consent form.
4. In randomized clinical trials, study patients receive any of several different types of medicines at random.
FALSE is the correct answer. In randomized clinical trials, one group of patients gets the experimental drug being tested while a second, control group gets either a standard treatment or a placebo. The use of placebos helps researchers compare the effects of a given treatment against no treatment.
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