Do you know side effects of the newest drugs?
Increasingly, patients are demanding specific drugs but are unaware of potential side effects. Often, patients will ask their family doctors for drugs that have been advertised heavily. Later these same patients may show up at your ED with unexplained symptoms resulting from side effects, says Robert Knies Jr., RN, MSN, CEN, clinical nurse specialist for emergency services at HealthSystem Minnesota in St. Louis Park.
Because hospitals are being pressured by managed care organizations not to order the newer, expensive prescription drugs, ED physicians may not be familiar with the side effects of those medications, stresses Knies.
As a result of intense marketing campaigns, patients are asking for specific drugs, but not getting the information they need about side effects, warns Knies. Examples include over-the-counter stimulants such as No-Doz (Hoechst Marion Roussel, Kansas City, MO), Allegra (for allergies, manufactured by Hoechst Marion Roussel in Kansas City, MO), and Meridia (a weight loss drug manufactured by Knoll Pharmaceutical Co., in Mount Olive, NJ).
The classic example is Wellbutrin (Glaxo Wellcome, Research Triangle Park, NC), which helps you quit smoking, says Knies. "People don’t realize it’s a psychotropic and close to an selective serotonin reuptake inhibitor [SSRI]," he says. "So, patients may not realize that they may not be able to take certain over-the-counter medications or increase or abruptly stop intake of alcohol, since these can increase their seizure threshold."
Giving patients what they want
Physicians and managed care organizations want to provide good customer service and meet demands of their patients. "This trend goes back to the increased demand for antibiotics," says Knies. "Patients go to providers wanting antibiotics and do not want to leave without a prescription." Likewise, patients are demanding drugs such as antidepressants seen in advertisements, he explains.
Many patients are taking psychotropics without the corresponding recommended psychotherapy, warns Knies. "You can’t do one without the other, but health insurance companies won’t pay for therapy sessions, so often the patient has to pay out of pocket," he says.
The patient may stop taking the antidepressant because they feel better, then feel side effects or exacerbation of their symptoms. "They don’t feel right, but patients are. usually just treated for symptoms, not to find the causation," says Knies.
In the ED, you may not have time to do an in-depth evaluation to determine causation of the patient’s symptoms, Knies notes. "Symptoms will be very similar to gastrointestinal problems or generalized malaise — nothing that is totally specific to SSRI withdrawal."
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