Medications self-prescribing

A 42-year-old woman had been admitted twice to hospital with hepatitis (4). No toxic agent could be identified during the first episode, but detailed questioning during the second showed that in both cases she had self-prescribed a commercially available medication of common celandine. Withdrawal of this herbal remedy was followed by an unremarkable recovery. 

Increasingly, patients are using herbal therapies to treat their diseases. Many of these patients self-prescribe and self-medicate without advice from a healthcare provider. Although patients may receive the desired therapeutic effect of herbal therapies, patients are exposed to the following risks ... 

Self-prescribed herbal therapies do not usually appear in the patient s medical records, risking the possibility that the healthcare provider will prescribe pharmaceutical medications that are contraindicated with the herbal therapy. 

Immunosuppressant medications suppress the body s ability to reject non-self-cells. These medications are prescribed to patients who have organ transplants. 

Significant deficiencies in the security and control of samples have been well documented. " " In fact, it has been estimated that just over half of samples actually reach patients. Samples may be used by prescribers and staff, or they may be diverted. Personal use of drug samples by physicians and other healthcare providers raises ethical concerns and is not without risk." Limaye and Paauw described three medical residents who self-prescribed antimicrobials and were subsequently diagnosed with Clostridium difficile infection." Tong and Lien reported self-medication with samples and distribution of samples to nonphysicians by almost 60% of pharmaceutical representatives surveyed at a Canadian family practice office. A contributing factor to some of these issues is that institutional or facility sample policy and procedures are often absent, or compliance is poor. One institution found only 10% compliance when the inventory of samples was compared with the required written documentation. Even after an educational program in which the policy was explained to the house staff, a second audit found only 26% compliance. " Poor compliance with policy and procedure may jeopardize patient safety, as well as put the institution at risk for JCAHO recommendations or Board of Pharmacy penalties. 

The self-medication by parents has formative effect, because children learn to follow a lot of the examples parents set. Thus, it can make a difference if parents only model drug use for the relief of physical or emotional discomfort based on a physician s prescription, or if they self-prescribe a variety of over-the-counter, natural remedy, and recreational substances to relax, reduce emotional distress, promote wellness, prevent problems, or increase sense of well-being on their own authority. 

Change lifestyle for recovering health Discuss current health problems 2. Visiting hospital for medical checkup Medical examination Prescribe the self-care treatment Physician in hospital... 

In general, with the exception of the central role that benzodiazepines play in the treatment of alcohol withdrawal, the use of medications that have been approved for alcoholism rehabilitation remains very limited. A survey of nearly 1,400 addiction physicians showed that they prescribed disulfiram to only 9% of their alcoholic patients and that naltrexone was prescribed for only slightly higher proportion of patients (13%) (Market al. 2003). These tesults contrast with findings for antidepressants, which were prescribed to 44% of alcoholic patients. Although neatly all of these physicians had heatd of both disulfiram and naltrexone, their self-reported level of knowledge of these medications was much lowet than that of antidepressants. 

Lejoyeux et al. 1998). Similar to opioid-dependent persons, these patients reported that they use benzodiazepines to self-medicate anxiety, insomnia, and alcohol withdrawal and, less commonly, to enhance the effects of ethanol. Approximately l6%-25% of patients presenting for treatment of anxiety disorders abuse alcohol (Kushner et al. 1990 Otto et al. 1992). Controversy exists concerning appropriate benzodiazepine prescribing in this population (Cir-aulo and Nace 2000 Posternak and Mueller 2001). 

Biologic response modifiers (BRMs) are indicated in patients who have failed an adequate trial of DMARD therapy.1 BRMs may be added to DMARD monotherapy (i.e., methotrexate) or replace ineffective DMARD therapy.22 The decision to select a particular agent generally is based on the prescriber s comfort level with monitoring the safety and efficacy of the medications, the frequency and route of administration, the patient s comfort level or manual dexterity to self-administer subcutaneous injections, the cost, and the availability of insurance coverage.23 In general, BRMs should be avoided in patients with serious infections, demyelinating disorders (e.g., multiple sclerosis or optic neuritis) or heart failure.21... 

Prescribers are advised to consult the package insert of any medication administered concomitantly with hormonal contraceptives, because some medications may decrease the effectiveness of these birth control products. Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. John s wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding while on oral contraceptives shortly after starting St. John s wort. Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John s wort. 

Ethanol (ethyl alcohol) has central nervous system depressant properties and is widely used to relieve anxiety and produce sedation. Although some medical practitioners occasionally prescribe an alcoholic beverage for relieving minor anxiety and inducing sleep, individuals frequently self-medicate with ethanol. Many individuals who abuse alcohol may have started using it to relieve symptoms of central nervous system disorders, such as anxiety and depression. 

Donovan et al. (1996, 1997) completed an open study evaluating the use of valproic acid (Depakote) in adolescent outpatients with marijuana abuse or dependence and explosive mood disorder (mood symptoms were not classified using the DSM FV Diagnostic System). Eight subjects were prescribed 1000 mg of valproic acid (Depakote) for 5 weeks, in addition to regular therapy sessions, but did not receive any other psychotropic medications. All subjects showed a significant improvement in their marijuana use (p <0.007) and their affective symptoms (p < 0.001), although both outcomes were measured only by self-report. The most common adverse events were nausea and sedation. No subjects discontinued because of these side effects, nor were there any reported interactions between the valproic acid (Depakote) and substances of abuse. 

---