Medication Management - Part II
Stan, Clarence, Barry, and the Health Chatter team chat with Dr. Ronda Marie Chakolis-Hassan, President of the Minnesota Board of Pharmacy, and Dr. Ai-Ja Jackson, pharmacist, about Medication Management—and explore the central question: “Should we just medicate?”
Dr. Ronda Marie Chakolis-Hassan, PharmD, MPH, exemplifies the intersection of clinical expertise and public health advocacy in pharmacy practice. An alum of the University of Minnesota College of Pharmacy and School of Public Health, her diverse career spans 15 years in Pharmacy Benefit Management and over 5 years as a Medication Therapy Management pharmacist in community practice. Her commitment to healthcare equity shines through her work addressing infant mortality, opioid abuse prevention, and her service on the Minnesota Department of Human Services Drug Formulary Committee, where she helps shape medication access policies across the state.
Join us for an enlightening discussion about when medication is the right solution—and when it might not be.
Join the conversation at healthchatterpodcast.com
Brought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.
More about their work can be found at https://www.huemanpartnershipalliance.org/
Research
EG Weight Loss Drugs (GLP-1)
Glucagon-like peptide-1 (GLP-1) agonists are a class of medications utilized to treat type 2 diabetes mellitus (T2DM) and obesity. More recently, the FDA has approved several GLP-1 agonists for weight loss in people with obesity who do not have diabetes.
- GLP-1 receptor agonists mimic the GLP-1 hormone that is naturally released in the gastrointestinal tract in response to eating.
- GLP-1 triggers the release of insulin from your pancreas. Insulin helps usher glucose (sugar) out of the bloodstream and into your cells, where it can be used for nourishment and energy.
- These drugs also act in the brain to reduce hunger and act on the stomach to delay emptying, so you feel full for a longer time.
- These effects can lead to weight loss, which can be an important part of managing diabetes. GLP-1 agonists have been used to treat type 2 diabetes for about two decades.
Obesity rates declining
The obesity rate dropped to 37% of U.S. adults this year, down from a high of 39.9% three years ago, according to the survey.
- In the US alone, usage jumped a staggering 700% between 2019 and 2023.
- In the US, about 1 in 8 adults report having used a GLP-1 medication like Ozempic, Wegovy or Mounjaro, according to a 2024 survey by the Kaiser Family Foundation.
- Since the drugs have come on the market, declines in obesity rates have been higher among those between ages 40 and 64, correlating with a higher reliance on GLP-1 medications for that age group.
- Use of the medications is highest among those ages 50 to 64, for example, and in that cohort, obesity rates dropped 5.0 points to 42.8%. Similarly, the survey found more women take the drugs, with corresponding greater weight loss compared with men too.
Kinds of GLP-1’s
Side Effects of GLP-1
"Ozempic face" is often known as a side effect of GLP-1 drugs, though the term is misleading because this can be a side effect of any GLP-1 drug or any other cause of rapid weight loss.
Gastrointestinal symptoms — nausea, vomiting, diarrhea, and constipation — are by far the most common side effects of GLP-1 drugs.
- Nausea can be managed by avoiding strong smells and eating crackers, mint, or ginger-based food or drinks about a half hour after taking a GLP-1 drug.
- Vomiting can be managed by staying well hydrated and having more frequent meals in smaller amounts.
- Diarrhea can be managed by drinking plenty of water and avoiding dairy products and high-fiber foods until symptoms go away.
- Constipation can be managed by getting enough fiber in your diet and drinking plenty of water.
Less common but more serious side effects of GLP-1 agonists include:
- pancreatitis, an inflammation of the pancreas that causes abdominal pain
- gastroparesis, in which movement of food out of the stomach is slowed or stopped
- bowel obstruction, a blockage that keeps food from passing through the intestines
- gallstone attacks and bile duct blockage.
Polypharmacy
Polypharmacy is the medical term for excessive or unnecessary use of medications and is commonly seen in the older adult population (ages 65 and older).
- Often, polypharmacy is defined as taking at least five medications regularly
- A study found that an older adult taking seven or more medications was at a 2.5 (approximately 145%) increased risk of frailty over 8 years.
- Frailty is a state of increased vulnerability and has been associated with an increased risk of poor outcomes in older people including disability, falls, hospitalization, institutionalization and even death.
Consequences of Polypharmacy
- Adverse drug effects (such as nausea, confusion, and bleeding)
- Drug-drug interactions (when a medication changes the effect of other medications that a patient is taking)
- Medication nonadherence
- Decreased mobility and falls
- Increased health care use (including visits to a clinic or emergency department and hospitalizations)
- Higher out-of-pocket costs
How can the risk of polypharmacy be decreased?
- Bring an up-to-date list of prescription and over-the-counter medications, or all your medication bottles, to each medical appointment. Also report if you take dietary supplements—these products can interact with prescription medications.
- Talk with a doctor or pharmacist before starting any over-the-counter medications or dietary supplements that you plan to take on a regular basis.
- When a new medication is recommended, ask the doctor or pharmacist how long you should expect to take it.
- Talk with a doctor or pharmacist if you are taking a medication longer than planned, to determine if it is still needed.
- Review with your doctor or pharmacist all medications that were prescribed after discharge from a hospital because some may be needed for only a limited time.
- If possible, obtain all medications from a single pharmacy so the pharmacist can verify that new medications are safe to take with current medications.
Deprescribing
Deprescribing is the medically supervised process of decreasing or stopping medications that are no longer needed or may be causing harm.
- The benefits and risks of medications can change as people get older, so medications that have been taken for many years may need to be adjusted or even stopped.
- Sometimes an alternative medication that is safer or a nonmedication lifestyle change may be recommended to manage a health condition.
- Deprescribing can benefit patients by decreasing medication side effects and drug-drug interactions, reducing nonadherence to medications, lowering out-of-pocket costs, and improving health.
Tips for managing medications
Medication is only one part of your treatment plan - Taking medication as directed is important, but it’s not the only action needed. Lifestyle changes, such as following a heart-healthy diet, not smoking and getting physical activity, play a key role in getting your health back on track.
- Take your medication as directed.
- Keep your medication organized.
- Take your medicine even if you don’t have noticeable symptoms.
- Continue taking medicine even if symptoms seem to have “gotten better.”
- Tell your health care professionals and pharmacists about all the medications you are taking.
- Make sure your health care professionals and pharmacists know about other supplements or over-the-counter drugs you may be taking.
- Be aware of any food interactions.
- Be aware of potential side effects.
References
https://www.heart.org/en/health-topics/consumer-healthcare/medication-information
https://www.sciencedirect.com/science/article/pii/S0029646517300580?via%3Dihub
https://jamanetwork.com/journals/jama/fullarticle/2808052
