Abbreviating Med Lists

People who regularly take medicine should know what we’re taking.  To me, this seems obvious, but there are always those who need everything stated explicitly.  People taking prescriptions, vitamins, herbs, and any other treatments should know what’s being taken and why.

It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available.  If you need medical assistance (for instance, if you’re in a car wreck, or if you suddenly get sick and are taken to the emergency room), it’s great to have that list ready to hand the medics or emergency physician.

In the beginning, my list was the basic:

I thought it was efficient to adopt standard medical abbreviations.  I’ve discovered, however, that certain assumptions accompany those abbreviations.  There are 24 hours in a day, and it makes no sense to me that “qd” means “every day” but is assumed to be “every morning.” I’m told that it does.  Why that is, nobody has explained.  One doctor told me that if you choose to take a medicine in the evening, you’d abbreviate that q pm.  Given the similarity between the way “r” and “n” run together when typed, I’d be inclined to use capital letters to avoid any chance of confusing prn/pm.

Do people ever misinterpret your meds list?  In an attempt to remove the ambiguity, I now write, “with dinner” instead of “qd” since my once-a-day prescriptions are taken with my evening meal.  I suppose, if I were travelling, I’d change that to “with supper” to avoid confusion in those parts of the country where dinner is eaten at noon.

I also added a column explaining the purpose of the medicine, and another column indicating whether the medicine is by-mouth (po), subcutaneous (sq), or a topical ointment (ung).

I discovered a great bonus to taking once-a-day medicines with supper instead of with breakfast.  Some medical procedures require fasting.  Doctors try to balance their need for you to have an empty stomach with their desire for you to take your medications as prescribed.  If they don’t know what time of day you take your prescriptions, instructions end up being the equivalent of, “Nothing to eat or drink after midnight because it’s very important that you have an empty stomach, except you should take your dinner-time meds with a tiny sip of water at breakfast-time.”

Abbreviations are great when everyone agrees on what they mean.  With med lists, I suspect we’re better off being as clear as possible.

Methotrexate in the Hospital

The young woman who’d so cheerfully introduced herself as my nurse when I was admitted to the hospital returned to my room about ten minutes later.  Now looking afraid, she stopped hesitantly only a few steps into the room and explained that there would be a different nurse assigned to me since she was expecting a baby and I was taking methotrexate.

Methotrexate, unlike tons of other prescription medications, comes with a black box warning.  Patients are told to be careful to avoid infections because one could be deadly, and are given a host of other instructions.  There are apparently some things they never tell us about this medication, though.

More than once I heard people talking at my door stop as they were about to enter, then one would tell the other, “Uh-oh.  Someone else will have to take this room.”  Apparently people taking methotrexate are worse than lepers.

Later I discovered that my hospital room had this sign on the door:

Part of me thought, “This is ridiculous.  It’s not like I’m exuding the stuff through my skin.”  Another part of me wondered why they were so concerned about methotrexate, but not about Cimzia.

It turns out that although methotrexate doesn’t ooze out the pores, it can be found in bodily fluids for 72 hours after a dose is given.  Since medical people deal with blood, vomit, urine, and the like, they really do have to be careful when patients are taking methotrexate.

Had I known that, I might have been able to alert people from the very beginning:  “I’m taking mtx; please make sure my caregivers are people who aren’t trying to have a baby.”

Women expecting a baby try to do everything possible to have a healthy baby.  Seeing the look on that poor nurse’s face, I imagine she was beside herself.  She looked to be about eight months along, and spending the next month worrying what she might have done to her baby couldn’t be good for either of them.  It wasn’t until a few days later that I learned what the concern with mtx is, and I asked my nurse if she could track the other nurse down and let her know that my last injection was beyond the 72 hours, so she and her baby were in the clear.

That should never have happened.  Had I known that it was an issue, I would have told them from the start.  Wouldn’t we all do that?  Shouldn’t we all do that?

A stranger’s baby shouldn’t suffer birth defects due to the medicines I’m taking.

I’m adding a note to my cell phone (where I keep my meds list):  Cytotoxic agents.  If there’s ever a next time, that information will be among the first provided.

Injectable Methotrexate

It’s great having few side effects from methotrexate.  I recall how nervous I was about starting this medication, and how sick I was the first couple weeks (despite a low dose).  Thanks to AF’s RA support board, I’d already known that side effects can be minimized by taking pills at bedtime (which lets you sleep through the majority of the nausea).  It was great to discover first-hand that it’s true when they say that side-effects diminish over time – your body gets used to the med and it doesn’t continue to make you sick.  What a relief!

I started taking methotrexate as tablets.  My starting dose was four pills (10 mg).  Then I increased to six pills (15 mg), then to eight (20 mg).  Now my rheumatologist has again increased the dose and also switched me to injectable.  25 mg equals 1 cc in the syringe.

I thought, being experienced with the injectable biologics, that injectable mtx would be the same.  It’s not.

Injectable mtx is stable at room temperature, so it can be kept in the cupboard, unlike biologics that need to be stored in the refrigerator.  Since my refrigerator always seems to have way too much stuff in it, it’s nice to keep the mtx in my cupboard.  A bonus benefit is that this should make the mtx easier to take along on trips, should the need ever arise.

Unlike the huge space-eating boxes that biologics come in, the vials of mtx are small.  Two of the 2 ml vials fit into a regular sized prescription bottle.  Even the 10 ml vial is about the size of a standard prescription bottle.

A large part of the difference is that my biologics have all come in pre-filled syringes with an attached hypodermic needle.  I open the box, remove the medicine, let it warm up briefly, then give the shot.  It’s quite simple.  In contrast, injectable mtx comes in a little vial with separate syringes/needles, and I have to draw it up myself.  It’s not difficult.  My pharmacist was kind enough to give me a demonstration and then let me practice (with a vial of plain water) instead of sending me home to figure it out on my own.

Appearance of the medication is different, too, and I think this is where I’m running into problems.  My biologics have all been clear, looking a bit like water:  familiar, harmless.  Injectable mtx, on the other hand, is bright yellow.  BRIGHT YELLOW!!!  Really, I’m supposed to put that in my body?!  I’m having a little trouble wrapping my head around this one.

In some ways, the injections are even easier than the pills.  Pills are supposed to be taken on an empty stomach, but injections can be done any time of day, without regard to when you last ate.

I also read somewhere (sorry, no link), that sometimes injecting a medicine (bypassing the stomach) can make it easier on your liver.  My liver needs to last many years yet, so I’m in favor of making things easier on it.

Another advantage is that bypassing the stomach is supposed to make the medication more effective.  Who could object to that?

I’m open to tips if anyone has ideas on getting past the concept of injecting that bright yellow stuff into my stomach.

Thank you for reading.

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 *With needles, a bigger number means a smaller needle diameter.  A 27 gauge needle is 0.01625 inches (0.4128 mm).  A 25 gauge needle is 0.02025 inches (0.5144 mm).  Not a huge difference, but definitely noticeable when that thing is poking through your skin!