Are you an expectant or breastfeeding mother? Are you looking after a small child or an elderly person? These are the “special categories” for whom extra measures are needed when taking or administering medication.
Here Consultant Physician Dr. Chamari Weeraratne who is also a Senior Lecturer at the Department of Pharmacology, Faculty of Medicine, University of Colombo, whose valuable insights are the basis for this series of articles, explains how to deal with these categories.
Expectant mothers –
Many are the times a woman who is expecting a baby is compelled to take some medication for a short term need such as a headache or vomiting or a long term illness such as diabetes or hypertension.
What needs to be remembered, cautions Dr. Weeraratne, is that there is a possibility of such medications taken by the mother being absorbed by the foetus. The first three months of pregnancy (first trimester), is the crucial period during which your baby’s organs develop and certain medications could cause abnormalities in the baby.
Even after the first three months, medications could affect the baby’s growth within the womb and rarely cause abnormalities. “The dosage suitable for the mother may become toxic to the baby,” she warns, stressing that you need to be extra careful what medication you are taking and never should you take them without consulting your doctor.
Referring to the categorization of medication, she says some should never be taken during pregnancy while others should never be taken in the first trimester. There are some drugs however that are deemed permissible during pregnancy, if the good effects outweigh the bad.
If you have been taking long-term medication before your pregnancy, it is important to inform your doctor before conception what those medications are and seek medical advice whether they should be continued during pregnancy, whether they should be changed or the dosage reduced or increased and what extra precautions need to be taken.
If you are suffering from long-term illnesses such as epilepsy, diabetes, asthma or heart disease, you should not stop the medication after conception, MediScene understands but consult a doctor immediately. If such long-term illnesses are not controlled, some harm may come to you or your baby.
If you are in the age group when pregnancy is possible, be careful of the medications you take as sometimes you may not even know that you have conceived for about two months and the drugs could have a serious impact on the foetus.
Breastfeeding mothers –
You need to be careful about the medications being taken at this time because these will enter the body of your baby through breast milk. Do not medicate yourself on flimsy excuses for body aches and catarrh.
As the aspirin that you may take for body aches may get into the baby through breast milk and result in bleeds or sores and antihistamines for catarrh may make the baby overly drowsy or cause changes in her/his sleep patterns, always seek medical advice before taking any medication, says Dr. Weeraratne.
Be alert for any side-effects such as difficulty in breathing, drowsiness, sores, itching and scratching or restlessness that your baby may suffer due to the medication that you are taking.
Children –
It is not only parents but also relatives, preschool or school teachers, day-care centre staff and staff at children’s homes who are called upon to give medicines to children.
What needs to be kept in mind is that a baby’s or child’s body is different, not only in composition but also in how it works, to that of an adult. As their bodies are in the process of growing and their organs are developing, medications have a major impact. The adult dosage is not suitable for children and it is important to get the dosage right, otherwise the medication can turn toxic or the expected outcome will not be achieved.
Don’t give over-the-counter medications, without a doctor’s prescription for ailments such as a cold, cough or fever, stresses Dr. Weeraratne, explaining that many cough and cold syrups have alcohol.
Beware of dosing your child with aspirin when she/he is having a temperature but give paracetamol, she says, adding that you should never give two types of medications which contain paracetamol at the same time. She cites the example of Panadol syrup and Calpol syrup both having paracetamol which together will give the child double doses of the same drug.
When a doctor prescribes medication to your child seek answers to these questions – What is the drug? What will be its effects – to bring down the fever, for cough or cure wheezing? Is it compatible with the medications that the child may be taking already? How should the medication be taken? For how long? If the child misses one dose what should be done?
How long will it take for the medication to have an effect? If it is an antibiotic for a bacterial infection, the fever should usually come down within 24-48 hours. What are the side-effects of the medication, how will you identify them and what should you do? Should you stop the medication as soon as the child feels better?
The side-effects could include diarrhoea, drowsiness, vomiting, bumps and itching and difficulty in breathing.
When buying the medication, check whether it is the medication prescribed by the doctor and whether the seal of the bottle is intact or the tablet pack looks yellowed. “Never buy it if the seal is broken or the pack looks old,” says Dr. Weeraratne. Before administering the medication, read the label and descriptive leaflet carefully.
The dosage is of importance and is calculated on the weight of the child, MediScene understands. Therefore, it is vital to take the chart containing the child’s birth and weight details as well as development chart when consulting the doctor. Use only the dispensers issued with the medication and never the tea or table spoon in your home.
You should also maintain a chart (and take to the doctor) recording not only the temperature but also the times when the medication was given. If two of your children are ill at the same time, two charts, clearly marked under each one’s name should be maintained.
If you have any reason to believe that your child is having side-effects, stop the medication immediately and go back to the doctor.
Elderly –
As you grow older, the chances of using more and more medication increase. At different times, some who are on long-term medication may also have to take additional drugs for other ailments.
When taking medication, the elderly will be more prone to developing side-effects than younger patients.
This may be due to the interaction between the long-term medications, the potency of the medications that are prescribed to deal with complex illnesses (eg: medications for mental illness,
to prevent blood-clotting, for heart disease or neurological ailments), the changes in the body and its workings as aging takes place (increase in body fat, decrease in the liquid content and digestion, liver and kidney function slowing down) and the fact that it may be difficult to keep track of the many medications that have to be taken at different times.
As you grow older, the absorption of medication through the digestive system reduces, the medication remains in the body for a longer period and the slow excretion of such medication may speed up the blood circulation to dangerous levels, says Dr. Weeraratne.
While keeping in mind that the dosage of a drug varies from a younger to an older person, it is also better to avoid taking a mix of prescription and non-prescription drugs as well as western and ayurvedic medicines, she adds.
In the elderly, it is more difficult to distinguish between the symptoms of a disease and the side-effects of a medication, MediScene learns.
The side-effects could occur soon after taking the medication or even weeks, months or years later and include severe lethargy and tiredness, constipation, diarrhoea, loss of appetite, puffiness of the stomach, changes in mental alertness, frequent falls, dizziness, feeling faintish and skin diseases.
The elderly could also face problems such as forgetfulness, difficulty in swallowing medication, poor eyesight, weakness in muscles and nerves which would cause difficulty in opening the stopper of a bottle of medicine, breaking a tablet to get the right dosage etc.
Even in the case of the elderly it is essential to keep a chart of all the doctors and the medications that he/she is on, so that every doctor knows what other medication the patient is on.
This is because certain drugs should not be taken together and the doctors need to evaluate the cocktail of medications the patient is on, adds Dr. Weeraratne.
(Next month: Final part on the use of insulin for diabetes and the inhaler for asthma) |
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