Friday, December 30, 2016

Medicine Cabinet/What to have on hand/Getting rid of expired meds


Topic of the week:

What's in your medicine chest?
How to get rid of expired medications?
(Flushing them is NOT the correct action)
If you or your child becomes ill in the middle of the night, that 3:00 am visit to the local pharmacy may furnish you with some interesting anecdotes about the odd folks lurking in the aisles, but generally it is something you want to avoid. Try to have some basic medications on hand ahead of time. A little preparation goes a long way.
Here are some suggestions of items to keep on hand.
Fever reducers/Pain relief
Acetaminophen and Ibuprofen are the most common medications used for this.
Remember that you never want to give actual aspirin to a child.
Acetaminophen/Tylenol Infant and Children's Liquid are the same concentration so they are actually interchangeable, but the infant bottle comes with a nifty little measuring system and a spill proof bottle which is safer.  For those of you with older kids, yes you are right, they used to be different products, but that changed several years ago.
Acetaminophen also comes as a suppository, which is great for a child who is vomiting or resisting medication by mouth. Keep those in the fridge. Mushy suppository??? Enough said.
Ibuprofen is also known as Advil or Motrin. This medicine also comes in a more concentrated infant form. The infant and child dose are not the same. Make sure you understand your child's proper dose. 

Antihistamines
Benedryl and/or Zyrtec are the ones we most commonly use.
The generic name for Benedryl is Diphenhydramine HCL. There is no special liquid specifically for infants. Most of the bottles have a caution not to use for children under 4. In our office, we do use it for younger patients if indicated. I do not recommend giving it  to a young child without speaking to your health care provider.
These antihistamines would be given for general allergic reactions, itchy skin rashes or insect bites.
While Benedryl will make most kids (and adults) very sleepy, it also can cause a few patients to be jittery.
My favorite allergist, Dr. Fast counsels against giving Benadryl if you are worried about an anaphylactic reaction. The ensuing sleepiness might make it hard to figure out if it is a reaction to the medication or a further complication of the anaphylaxis.
.Zyrtec (Cetirizine) also comes in a liquid. Zyrtec typically has a more even response, with less likelihood of either sedation or the jitters. Claritin also comes as a liquid. It is fine for sneezy allergies, but perhaps not quite as effective for itchy rashes.
It is probably worth having both Benadryl and Zyrtec on hand. Dr. Hurd has a slight preference for Benedryl when treating her younger patients. There are many times when that sleepiness is a bonus.
Tummy issues
Pedialax or glycerin suppositories are worth having on hand If your child is prone to constipation. If days have gone by without a poop and diet enough hasn't helped to get things moving, these are often the next step. If  it is the wee hours of the morning and you have a miserable, grunting and straining kid, getting the poop out is a good strategy.
If your child is vomiting, you will be glad to have an oral rehydration solution in the house.  Options include:
Breast milk is also great for that, but not everyone is lucky enough to always have it on hand. Pedialyte is the one you most likely have heard of. It seems to have recently become a bit more palatable. It also comes in popsicle form, which is great for older kids. Drip Drop has been on the market for several years and tastes a bit better. Some Walgreen's carry it, but alas it is not always easy to find. This is where planning ahead will help you out. You can get it from Amazon. It comes as a powder which you mix with water.
Pediavance is newer product. It comes in a pre-dosed concentrated liquid that gets mixed with water. These would also be handy to take along on a trip. I haven’t gotten reports about the taste yet. Drip Drop and Pediavance are both great travel options.
Dr. Hurd also counsels that it is worth having a box of saltines in the pantry just in case.
Colic
If you have an infant, have some colic remedies on hand (blog post) My favorite is anything with Simethicone!

Mouth sores
If you child is prone to mouth sores or irritations, I find Glyoxide very helpful and seems to help things heal up pretty quickly
Tip: With any of your medications, put a strip of masking tape on the side of the open bottle and sign and date your doses.
This will avoid the common incident of parents double dosing their babies. This also will help you keep track for yourself when you are sleep deprived. I get plenty of frantic calls from parents who have inadvertently overdosed their kids by giving the medications too often. If there is a concern your first call should be to Poison Control.
1-888-222-1222   (California)
Tip: Have a syringe or dropper on hand for much more accurate measuring.

Respiratory
If you child has a history of wheezing, now is the time to make sure you have asthma medications available. Please check the expiration date and see when they were opened. Many of those are light sensitive so you should always mark the package when you open them. If your child uses a nebulizer, the tubing should be replaced every 6 months.  If you or your child use an inhaler, it should be rinsed out at least once a week. If it hasn't been used for more than a week it may need to be primed. Check the directions on your specific medication. Pro Air, which is one of the more popular inhalers, needs to have 3 extra puffs to clear it if it hasn't been used in 2 weeks.
Flovent and Qvar are others that need to be primed if they haven’t been used recently.

Topical creams/ointments
  • Triple antibiotic ointment for cuts or scratches
  • Anti fungal cream for yeasty rashes or fungal infections
  • Arnica for bruises
  • hydrocortisone cream for mild itchy irritations
HC cream comes is a variety of strengths. You can get the weakest ones over the counter.
It is also worth having a basic barrier cream for diaper rash.
If you call the nurse team to ask about a rash, chances are good that we are going to play “paint by numbers” with a combo of the above ointments.
Please pay attention to this rather disgusting factoid:
It is easy for tubes of ointments to get contaminated. Think about it. If the tip comes in contact with bacteria from a finger or directly from the body...there you go. Yuck! One study that I read suggested that more than half of the tubes of creams and ointments that people have laying around are contaminated with Staph. The best way to avoid this is to make sure that you don't directly touch the tip to anything. Try to keep it sterile. Squeeze the desired amount onto a spoon and then use whatever applicator you want (clean fingers are usually fine.)

BASIC FIRST AID
I particularly like the self adhesive gauze popular brands Coban/Co-flex. They come in lots of colors and are pretty inexpensive.
The advantage of these is that not only do they not hurt when you take them off, Your child can’t pull them off without help. Also, your little one can’t eat the band-aid..
Having a baggy with some gauze, neosporin and a roll of Coban would be a good addition to your diaper bag.
Invest in child friendly ice pack that you can keep in your freezer. There are loads of adorable ones on Amazon. Holding a soft little penguin or bunny against the booboo might elicit a bit more cooperation.
Keep a bag of Epsom salts on hand. They come in handy for all sorts of things.

Have a working thermometer that you have tested for accuracy before someone actually has a fever. As long as your baby is over 2 months, I am not one who is going to focus too much on the exact degree of the fever, but we do want to get a sense of how high it is.

Make sure that all your medications are stored in a safe, childproof location (a steamy bathroom is possibly not the best place.) Don't underestimate the ability of a climbing child who knows where the gummy vitamins or yummy medicine is stashed. Even older kids can catch you by surprise at times. This year we had a 7 year old with mystery tummy aches. He finally confessed to being in the habit of sneaking handfuls of gummy vitamins daily.

Do a routine check for expired medications. Even though I try to stay on top of this I can be occasionally stunned by the old stuff that I find lurking in the back of my own medicine cabinet (it runs in my family.)
Please don't randomly toss expired medication down the drain or flush it in the toilet. Medicine can pollute the bay and ocean, or be accidentally misused or abused. Wastewater treatment plants are not designed to remove medications or other chemicals in waste-water, so after traveling down your drain, medicine may affect our environment.
.Here in SF you can take your expired medications to:
http://sfenvironment.org/article/safe-medicine-disposal-for-residents
When you visit one of the pharmacy sites, simply deposit your medicine in the green drop-box. If you visit a police station, take your medicine directly to the window.  At police stations, you may be asked for your name and address. You are free to decline to give them that information.
We are also looking into being part of a pilot project called Mail-back med project. http://www.med-project.org/
This project will supply us with postage paid envelopes that you can pick up from us and use to mail back acceptable expired meds.
I will update this post on the blog when that goes into effect

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