Sorting Pills

Emily Mackler, PharmD.
Emily Mackler, PharmD.

Download a Pain Diary [PDF] and/or Pain Diary Instructions [PDF]

New program helps patients get control of their medicine cabinets

Drug stores sell those handy pill boxes, some as big as tackle boxes, marked with each day of the week -- and sometimes the hours of the day. But those boxes are only as helpful as they are well organized. And the medication inside them is only effective if it's taken correctly.

It's easy to get confused when you have to take several medications each day. That's why the University of Michigan Comprehensive Cancer Center is launching a new Medication Management Program as part of its Symptom Management & Supportive Care Clinic. We talked with Emily Mackler, Pharm.D., a pharmacist with the program, about what patients should know about their medicine.

Q: What's the goal of medication management? Why would patients visit the clinic if they're already working with an oncologist?

A: Our team works in concert with U-M Cancer Center oncologists. I sit down as a pharmacist with patients and review each and every medication and nutritional supplement they are taking -- regardless of who's prescribing it. Often, there isn't time for this level of in-depth review of a patient 's medications during a typical visit in an oncologist's clinic. Many of our patients are managing multiple diseases as well as symptoms and side effects related to their cancer. By taking a look at the patient's whole medication profile, we can look for red flags.

Q: What kind of red flags?

A: Sometimes patients who are overwhelmed may not understand why they take a given medication. We've seen patients who don't realize that they're taking three different medications for the same thing, which is not necessary and may become a problem. Also, we check for drug interactions. Often, patients don't realize that a nutritional supplement they're taking to boost their immune system may actually interfere with cancer treatment.

Do you discourage use of nutritional supplements?

A: It depends which nutritional supplement is taken. We understand that many of our patients are seeking ways to make their bodies stronger. We help our patients understand how the different medications and supplements work in their bodies. Our ultimate goal is to ensure that everything patients are taking is benefiting them as much as possible -- whether that's by effectively killing cancer cells or helping to ease pain or some other side effect.

Q: What can patients do to ensure their medications are working effectively?

A: It's extremely important that patients follow instructions and take medication properly. We know it can be difficult to remember multiple pills at different times during the day. To help with that, we provide patients with a few tools. First, we type up a list of all medications a patient is taking along with the reason they are taking it and any important information about how to take it. For example, we note whether it should be taken with food and at what time of day. Second, we offer medication calendars to help plan their regimens. We also offer pain diaries to keep track of how pain medications are working. These diaries are useful to us in making adjustments to medications and maximizing the treatment of pain and other symptoms. Finally, we are available for frequent phone calls or office visits to assess how medications are working and discuss any necessary adjustments.

Q: What if it's difficult to swallow many pills in a day?

A: That's another benefit of working with a pharmacist in our clinic. For some patients, difficulty swallowing prevents them from taking the medication they need. Whenever possible, I work with those patients to try to find other formulations -- whether it be a liquid form or even a cream that could be applied to the skin -- to help them get the medication they need.

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Thrive Issue: 
Fall, 2010