Self-prescribed drugs

First, a distinction must be drawn between prescribed drugs and self-prescribed drugs, a distinction which is important for two reasons. The first has to do with consumer sovereignty. Only the demand for self-prescribed drugs expresses the patient s freely decided willingness to pay. In the other case, it is prescribing doctors who initiate the demand, and they may not be perfect agents for their patients, either because they are subject to certain... 

Motola G, Mazzeo F, Rinaldi B, et al. Self-prescribed laxative use a drug-utilization review. Adv Ther. 2002 19 203-238. 

Long-term health effects from antidepressants include the increased risk of deliberate self-harm (DSH), which may occur more with the SRRIs than the tricyclic antidepressants. The self-harm may occur by overdosing with the prescribed drug, but is more frequently by other means. 

When evaluating an acute injmy of the cornea, the practitioner is sometimes tempted to prescribe a topical anesthetic for administration at home by the patient for relief of ocular pain. This practice is extremely dangerous, however, and in numerous instances has led to severe infiltrative keratitis and even loss of the eye from anesthetic misuse or abuse by the patient.Topical anesthetics must be used only for the pmpose of obtaining initial relief of ocular pain and never as part of a prolonged therapeutic regimen.The potential corneal toxicity of topical anesthetics precludes their use as self-administered drugs. 

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. 

Penicillamine. The primary healHi care provider will explain Hie treatment regimen and adverse reacHons before therapy is started. You must know which toxic reactions require contacting Hie primary healHi care provider immediately. Take penicillamine on an empty stomach, 1 hour before or 2 hours after a meal. If other drugp are prescribed, penicillamine is taken 1 hour apart from any other drug. Observe skin areas over Hie elbows, shoulders, and buttocks for evidence of bruising, bleeding, or break in the skin (delayed wound healing may occur). If Hiese occur, do not self-treat the... 

Monitoring and Managing Adverse Reactions The patient prescribed die female hormones usually takes diem for several months or years. Throughout diat time, die patient must be monitored for adverse reactions (see Ongoing Assessment ). These drugs are self-administered at home This makes patient education an important avenue for detecting and managing adverse reactions. 

The people who care most about pharmacovigilance results are patients. They want to use the most effective and safe drugs available. Many patients would like to believe that their prescribed or OTC drug is totally safe. Many patients seek and are given drugs for prophylaxis and mild self limiting disorders, when the risk from the disease is small or remote, and the risks of the therapy then loom larger in comparison. Certainly the risk perceptions of patients are enormously variable and certainly influenced by the disease they have. 

Clinicians should be aware that many of their patients may be taking alternative treatments either via self-care or prescribed by CAM practitioners. Inquiring about this should be routine because of potential side effects and drug interactions. A working knowledge of CAM treatments will allow child psychiatrists to give parents and patients advice about safety and effectiveness. Use of St. John s wort in children with unipolar depression may at times be appropriate, particularly in cases where more standard treatments are contraindicated or have failed. However, it should be used cautiously and with an appropriate explanation of its risks and benefits, as a competent clinician would do for any treatment. Use of St. John s wort for other conditions is not currently recommended given the lack of evidence for efficacy. Kava extracts may be used for anxiety, with similar provisos. There are much fewer data about the efficacy and safety of other dietary supplements and their use cannot be supported at this point. 

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