[Music Playing] Lacey: You may have come across this question before: "Do you have any questions for the pharmacist?"

Maybe you're too put-on-the-spot or in a rush to ask your pharmacist anything.

Well, in this episode, we chat with Sarah Bush Lincoln Director of Pharmacy, Matt Clifton, about the common questions he gets as a pharmacist.

Lori: They're the ones who raise the bar, the ones dedicated to providing care in the most demanding of circumstances, the ones that understand the healing benefits of kindness and compassion.

They're the people of Sarah Bush Lincoln, and they set the bar high.

Sarah Bush Lincoln, trusted compassionate care right here, close to home.

Speaker 2: For over 50 years, Horizon Health has been keeping you and your family healthy, and although some things have changed, Horizon Health's commitment to meet the ever-changing needs of our community has remained the same.

Horizon Health, 50 years strong.

Speaker 3: Carle is redefining healthcare around you, innovating new solutions and offering all levels of care when and where you need it.

Investing in technology and research to optimize health care, Carle, with Health Alliance, is always at the forefront to help you thrive.

[music playing] Lacey: Thank you for joining us for this episode of Being Well.

I'm your host, Lacey Spence.

And today, we've got another new guest on the show.

We've got Matt Clifton, a pharmacist from Sarah Bush Lincoln.

Welcome to Being Well.

Matt: Thanks.

Lacey: Of course.

We're glad to have you; glad to have a new guest to the show.

We always love to get to know our medical professionals.

So if you could, can you tell us a little bit about your background and how you ended up here?

Matt: Sure.

Like you said, Matt Clifton.

I'm the Director of Pharmacy over at Sarah Bush Lincoln.

Started down that journey in pharmacy school.

I went to St. Louis College of Pharmacy, graduated there in 2008.

And then I came over to Mattoon, to work at Sarah Bush Lincoln as an inpatient pharmacist for a while.

Moved up to a lead pharmacist.

And about five years ago, became the director of pharmacy.

Lacey: Wonderful.

And you were telling me, before we started, that you are actually not from the area originally.

Matt: Yeah, right.

Yeah, I grew up actually...

I went all over the place.

I was born in Ohio, moved to New Jersey, then to Connecticut and back to New Jersey.

Lived most of my life though in Fort Myers, Florida.

And was there, went to high school, graduated.

My dad helped me pick what I was going to do for a living.

Through a whole lot of personality tests finally found out I was going to be in pharmacy.

Worked out well for me.

And so, yeah, he helped me pick out a school.

And St. Louis College of Pharmacy was a pretty good one.

And went with that one.

Lacey: And now you're here in the land of corn and beans.

And we're glad to have you.

Matt: Glad to be here.

Lacey: As we start our conversation today, I titled this episode, Ask the Pharmacist.

And I always picture, when I'm going through maybe a drive-through lane, or if I'm coming in person to a pharmacy, I will be asked, "Do you have any questions for the pharmacist?"

Nine times out of 10, I can't think of anything on the spot.

As we start this conversation, what do you think is maybe the most important thing that somebody asks of the pharmacist?

Matt: Sure.

There's a lot that can go into that.

And I know, like you, a lot of people don't have those questions right off the bat.

Usually, on your first time you're prescribed something, hopefully the pharmacist does take that opportunity to tell you the most important things.

But it really varies on the med.

But something that I like to think about is, how do you store the medication?

How do I take the medication?

Do I need to take it with food?

On an empty stomach?

Do I take it in the morning, evening?

Things like that.

Those are the important things.

Or, if it's not oral medication, if it's topical or whatever, just how you apply it.

Lacey: Those things kind of sound why it would be critical to communicate with my pharmacist.

Why are pharmacists important to my overall health?

Matt: Sure.

Behind the scenes, we're there for safety.

We're another double check.

As the doctor prescribes the medication, we're there to check for making sure the dose is correct, making sure there's no interactions between that medication and any other medications.

But like I said, education.

Talking to the patient; I think that's a big piece that we really like to get out there.

And we're the last line of, "Here's your medication" and the chance to actually talk to you on how to take that medication.

So, trying to hit those things like, "Okay, with this medication, these are the really things that you want to keep an eye on and how to take it" and things like that.

But also educating you on things like side effects.

What to expect that might pop up that isn't why you're taking the medication and maybe what to do to help with those side effects.

Lacey: And I like that you bring up that you are the last line of defense.

Because especially if somebody's going through something really major, if you've already gone through surgery, your follow-up with the doctor, trying to remember what the doctor said about, "Here's the dosing.

Here's when you're supposed to take it.

Don't take it with milk" or whatever, that's a lot to digest.

Matt: Oh yeah.

I agree.

And yeah, when you're in the hospital, so much is going on that, you hit the nail on the head, that you can't remember all of it.

Once you get to the pharmacy, you have that time.

And you've had a little bit of time to digest everything that's happened, and they can hit those points again.

Lacey: Let's try and ask some of the questions that might come up.

First off, what if a medication makes me sleepy?

Matt: Sure.

Yeah, that's definitely could be a side effect of the medication.

And just based on how meds work on the body, it may not be the intended effect, but it's something the med may cause.

And so, looking at that, a lot of times, maybe the med, it's new; your body's just getting used to it.

And maybe, after a couple weeks or something like that, you'll get used to it.

Another thing you can think about is if it's making you sleepy, just change when you take it.

It's easy to be, "It's the morning.

I'm going to take all of my medications."

You don't want to take it, if it makes you sleepy, in the morning.

That'll ruin your day.

So, move it to the bedtime.

Right before you go to bed, take that medication.

And if it makes you sleepy, maybe it'll actually help you go to sleep.

And then, if there's any issues: if you don't get used to it, if moving it around doesn't help you, it's always something you can discuss with your pharmacist or your doctor to say, "Hey, this is still an issue.

And what do I need to do to help with that?"

Lacey: Definitely.

Just to circle back.

If I'm someone who's taking this medicine that's been prescribed to me, it's probably pretty individualized.

But does it matter if I take my medicines in the morning or at night?

Matt: Yeah.

It's very dependent on the medication, really.

There's some medications, like I mentioned, with, if it makes you sleepy, it's good to take at night.

Some medications you have to take on an empty stomach because they're better absorbed then.

Or maybe it'll make you nauseous if you eat it on an empty stomach, so you have to take it with food.

Some medications, like cholesterol medications, they're ones that the idea's most of your cholesterol's made overnight.

And so, they like to give those to you before bedtime, because the idea is it'll help prevent cholesterol from being made.

Or maybe a medication might increase your urination, so taking that before bedtime's not a good idea.

And you'll be up all night up all night using the restroom, so you take those in the morning.

It is very dependent on what that medication might do and how it works.

And so, it's always good to have that discussion with the pharmacist, read the package and insert that comes with it.

I know it's a little boring; that'll help you go to sleep.

But you can read that, and it might give you some tips on when to take it.

Lacey: So, the instructions and those things on the side of the label, those are not a suggestion.

Matt: Yeah.

Yeah, correct.

Yeah, most of them are there for a reason.

It's not just, "Oh, take it with food because we thought that'd be fun."

There's a reason you're doing that.

And it's either absorbed better with that food.

Or, if you don't take it with food, it might make you nauseous.

So, those are there to as guidance, to really help you know when to take your medication.

Lacey: Now, can we talk about the expiration date?

Matt: Sure.

Lacey: There might be some folks who have heard maybe that they're just not as effective if they're past their due date.

But are there any real threats to taking something that's expired?

Matt: Yeah.

Yeah, just blanket statement: I can't really condone taking expired medications.

But yeah, to get into it, that's true.

Most of them, just that's what was studied by the manufacturer to say, "It is still good at this date."

So, the day after the expiration date, they're still going to be good.

But that's when they start probably degrading more.

And there are some.

There's a rare one, like tetracyclines, that actually get more potent after their expiration date.

And there's some maybe... What is it?

Nitroglycerine sublingual tablets.

After a certain amount of time, they're usually in a bottle with a bunch of little pills, and the med will go around between the pills.

So, you'll have some that are more potent, some that are less potent.

And so, really, the point is that it just muddies the water with when you're trying to see if a medication is effective.

So, if you take it after the expiration date, is it because the drug's not working, or maybe is your disease getting worse?

And it's hard to pinpoint what the problem is there.

And really, you should have another prescription for that medication; refill, something like that.

Why risk it?

Just get a new one.

And along those lines, I know a lot of people, they sometimes might keep pain medications or antibiotics like, "Oh, I have some that I didn't use.

I'm just going to put them in my medicine cabinet."

And with those, again, you should probably go to your medicine cabinet and routinely check for expiration dates.

And just get rid of the ones that are expired.

If you're expired, you're probably not using them.

And then, do you want to depend on them when they're a couple years old?

But especially with the antibiotics and pain meds, if you don't need them, just get rid of them.

Because really, they should be prescribed for a reason.

And you want to be having a conversation with a provider before you start taking those again.

But disposing of the meds, a lot of pharmacies have disposals, and you can find somewhere to do that.

Don't just flush them.

That can be bad.

Lacey: And I always think I hear of, with antibiotics, that you're supposed to make sure you finish the entire dose.

Don't stop just when you're feeling better.

Is that right?

Matt: That's right.

Yeah, and that's a good point.

When you're taking the medication, you may actually feel better before you're fully healed.

And so, there may still be bacteria in your body.

And while you're feeling better, if you stop taking that medication, just because you're feeling better, then, one, it's killed off the easy bacteria to kill, and you have the more resistant ones there.

So, when they come back, they may be more resistant to the antibiotic, and then it'll be harder to treat.

And then, two, then it's coming right back.

If you take the full course, for as long as they tell you to take it, it'll help minimize the chances of that coming back and will help minimize the chances of you having leftover antibiotics in your cabinet.

Lacey: Now, let's say we haven't heeded your advice, and we've accidentally had some older medicine in our cabinet; didn't realize it, took it.

If I start feeling bad, obviously I need to contact my doctor.

Is there any that I should be specifically worried about if I take?

Matt: Yeah.

I'm not sure there's any, other than the tetracyclines I mentioned that can be more potent.

But anytime you take a medication and you feel odd or something is not right, it's better to be more cautious and at least give a call.

You can always go to a walk-in clinic or go to an ER or something or just wait it out a little bit.

But yeah, in a pinch, some of those medications may be good.

But really, I can't think of an emergency where you need to take those expired meds.

So, I know it'll happen, but I'd avoid it usually.

Lacey: Definitely, definitely.

How is the best way to store my medicine?

Matt: Sure.

Yeah.

And I don't know if it's maybe a stereotype or a misnomer where a lot of people keep them in your medicine cabinet in the bathroom.

It's called a "medicine cabinet."

But usually in the bathroom, that's the humidity, so it's hot and humid.

That's actually bad for the storage of the meds, and that'll make them go bad quicker.

So, I always recommend keeping them somewhere that's more cool and dry.

Maybe a cabinet out and by your kitchen.

Not by the sink or whatever, but just somewhere more applicable there.

Or sometimes it's good, if you need to help remembering when to take your medication, sometimes you can keep your meds with something like your keys.

I always take them in the morning, and I'll put them by my keys, so I always remember them.

But the main one is, I'd avoid hot and moist climates.

Lacey: And was that recommendation the same for over-the-counter things and then also a prescription I would have filled?

Matt: Sure.

It depends.

Most of them are room temperature, is what it recommends.

Everyone will have a little bit of a different thing.

But most of them should be good in a cool, dry place.

One thing that you might consider though, is some of them they need to be refrigerated.

That is another one that you want to discuss with your pharmacist or read the insert or whatever, is that they'll tell you if they need to be refrigerated or if there's specific storage that's specific to the med.

Lacey: I'm not familiar with any.

Can you just throw out maybe one or two that are typically refrigerated?

Matt: Sure.

Insulin's a big one.

It can be good out of the fridge for 28 days.

But typically, when you first get it from the pharmacy, you keep them all in the refrigerator.

It keeps them good for longer.

Lacey: Sorry if it's a dumb question, and feel free to tell me what to move on but- Matt: No, you're fine.

Lacey: ... with insulin, what does keeping it cold do?

Matt: It just keeps it better, longer.

Lacey: Just fresh.

Matt: Yeah.

Yeah, exactly.

When you take it out of the fridge, it starts breaking down.

Usually the storage requirements have to do with the stability of the medication.

And so, if it's some you don't want to put in the fridge, because it breaks down quicker.

Not usually in the home, but some need to be in the freezer until they're ready to be used and you take them out.

Because once they're at room temperature, they'll break down much quicker.

So that's why.

If you do take them out, then sometimes they have dates with them that you want to put a date on them and say, "Okay, well they're good for 28 days from this point."

Lacey: Gotcha.

Well, let's see.

I think something that probably happens to a lot of folks: you get in a hurry, or you get tired, and you fall asleep, and you forget to take your dose of medicine.

What do you do now?

Matt: Sure.

Yeah, and it'll happen.

Oh yeah, we're all human.

We'll forget that.

Again, I'm going to be a broken record: depends on the med.

But I usually use the half rule, the rule of halves.

So, halfway between your scheduled doses.

If it's a daily medication, I'd go halfway between that time and the next time you need it.

Or if it's twice a day, halfway between those two doses.

Use that as your rule.

And if you're up to that point, the halfway point, you can take your missed medication.

And if you're after that point, I would just skip it and move on.

But something to consider also is, don't double your dose.

Like, "Oh, I missed a dose this morning, so I'm just going to take two doses at night."

Unless you're specifically told to do that by your provider or your pharmacist, I would avoid doubling a dose.

Because when you do that, you can just put your chance of higher chance of side effects and things like that.

But remembering your dose, I mentioned it, where you put it by your keys or something.

But finding a schedule and a time and a place that works for you is really important because set a reminder on your phone, use a daily pill planner, things like that really help you remember, so you lower the chances of forgetting it.

There are some meds out there, like some blood thinners or anticoagulants, where, if you miss a dose, you have a very high chance of clotting.

The reason you're on the medication is to prevent a clot.

And then you miss one dose by a couple hours, and you're automatically at risk again.

Or there's some blood pressure medicines where, if you miss a dose, it'll actually throw you into hypertension, high blood pressure.

Rebound hypertension, is what that's called, where your blood pressure actually spikes higher than it would otherwise, which is also bad.

That's why it's important to try not to miss a medication and do things to prevent that from happening first.

And then, if it does happen, and we're all human, try to use that half rule.

Lacey: And don't let your pride get in the way.

Even if you're in your thirties, twenties, whatever, young, get the pill box if you need it.

I feel like they're so stigmatized.

But if you need something like that, just to remind you and say, "Hey.

Oh, it's still full.

I didn't take it today."

The visual reminders are invaluable.

Matt: Oh yeah, I agree.

Lacey: Well, let's move on to something that maybe folks might not want to talk about as much.

But bathroom habits.

Why can some medications maybe upset your stomach a little bit more?

Matt: Sure.

Yeah.

Bathroom habits, that's a big one.

And a lot of meds can do that, whether it's increasing or decreasing your urination or causing diarrhea or constipation.

There's a lot that goes into it, and it really depends on the medication.

And just how it works versus it may be part of how it's working.

Or maybe it's a side effect of just because of how it works.

And so, common one would be things like diphenhydramine or something like that.

You take a antihistamine for allergies.

A lot of times, those will... Well, one, they'll make you drowsy, like we mentioned earlier.

But some of them are used to dry you out, for allergy season.

And when it dries you out, just because of how it's working, it's also going to decrease your urination or could cause constipation, things like that.

Sometimes more in the elderly than... And then, things like strong pain medications.

Things like hydrocodone, is one.

They're called opiates.

And the way they work, they bind to some stuff in your gut, that essentially they can, especially at higher doses or longer therapies, really cause some constipation.

And it's just a side effect of how it works.

Or another big one that a lot of people are familiar with, and I kind of touched on earlier, is water pills.

Hydrochlorothiazide is one.

It's a blood pressure medication.

And how it works is it's trying to decrease the amount of water in your blood to decrease the pressure in your body.

And by doing that, it filters it out through your kidneys and out through your urine.

So, by lowering your blood pressure, it's also increasing your urine.

And that's another one, like I mentioned, you'll see the increased urination.

And people on that med, they'll know it increases your urination.

So, you always want to take it in the morning to help prevent being up all night.

Lacey: Gotcha.

Well, is that the perfect instance to ask the pharmacist?

If you're aware that there's some sort of side effects?

Because I feel like my pharmacist is pretty knowledgeable to say, "Well, you might experience this.

But to combat it, you can maybe, in the stomach instance, take fiber or things like that."

Is that a good time to ask you questions?

Matt: For sure.

Yeah, and on multiple points with side effects, they're the right ones to ask.

Because as I mentioned, maybe it's something that's just short-term.

You just started taking the medication, and it's going to resolve itself.

Maybe give it a week.

So, you don't really have to do anything about it.

"Okay, yeah.

That's due to timing.

Let's move the timing of that."

Or maybe it's because it's interacting with another medication; let's separate those a little bit.

Or what's happening with your diet?

Let's move something around there.

Things like that.

Or maybe it's because the drug's not working or something like that.

There's a lot that's going on and why you're on a medication, that just having that conversation really helps to find the problem.

And there may be some probing questions, after that, of, "Well, let me see how you're doing this."

But they're the ones best to be able to look at what other meds you're taking; look at what time you're taking that medication.

In a retail pharmacy, they're right next to over-the-counter medication.

Some they can look at what you're doing there and help give a good recommendation.

Lacey: And what might you say to someone who's a little bit intimidated to ask the pharmacist?

Because I think, if you're looking through the window, and you see everyone zipping back and forth in the pharmacy, and you're, oh, I don't want to bother them.

They're busy.

But that's what you're there for.

Matt: That's right.

No, that's a hundred percent right.

And to be honest, especially in retail pharmacy these days, they are very busy.

And I know it's rough because they're trying to keep up, and they're doing all of their safety checks and everything behind the scenes.

But I mentioned going to pharmacy school.

That's one of the biggest things we're taught there, is education.

And how to educate patients and how to be relatable to patients.

And that's what we're there for.

We are that last line to the patient, before the med gets to the patient.

And so, that's our job.

That's why we're there and why we're readily accessible.

And we should be more accessible than the physician.

You don't have to give a call.

We're right there.

You're already picking up your meds.

So, go ahead and ask us.

Lacey: Make that conversation.

Before we hit one of our last topics, in our last couple of minutes here, a lot of folks might wonder why there are two different names for their medicine that they're trying to pick up.

Can you walk us through that a little bit?

Matt: Sure, yeah.

Sometimes I think it's just the manufacturer's trying to make it really confusing for us, but- Lacey: Ah, love that.

Matt: But for real, the reason is: when a drug is manufactured, they discuss it with the FDA, and they come up with the generic name.

The generic name is closer to a kind of chemical name.

It's not really the chemical name, but the one decided upon by the FDA.

And there's usually some things in common with other medications in the same class, the same indications.

There's things like, I mentioned, cholesterol medications.

We call them "statins" because they all end with "astatin."

Atorvastatin, lovastatin.

There's some blood pressure medications; they all end in "pril," like lisinopril.

Or metoprolol.

A lot of meds end in "lol."

And that helps you classify them.

"These are beta blockers or ACE inhibitors."

And that's the generic name.

And that one will usually follow the drug for its life.

As long as it exists, it'll have that generic name.

And then, the brand name; that one's more decided upon by the manufacturer.

And they do marketing, and they look into things.

And it's usually a catchier name.

They have Zs and Xs or Ys in there.

It sounds cool.

Lacey: Color scheme.

Matt: Yeah, exactly.

Lacey: The whole nine.

Matt: Yes.

Yeah, they're really marketing it to make it catchy, memorable, so that the patient can ask for it.

And those ones are limited to just the manufacturer who has a patent on it.

So, when they first develop a medication, they do get a patent on it for a number of years.

And while that patent is out, they're the only ones allowed to sell that medication.

And they sell it under the brand name.

And the idea behind that is, they spent a lot of time and money in the research for developing and testing this medication.

And that allows them time to recoup that money.

And then, after that patent wears off, that's when other manufacturers can come in.

They can actually make the medication.

And they release it under the generic name, without that brand name.

When they release those generics though, they're still going through the FDA.

They're testing them, making sure they're good.

And so, if you have the choice, really, generics are tested to be just as good as the brand names.

And they're usually significantly cheaper.

Lacey: That is good to know because I know I've been through just... you look at them side by side, and you're, "Oh gosh, I don't want to spend the extra money.

Is it worth it?"

So, thank you for clearing that up.

Matt: Yeah, no problem.

Lacey: In our last couple minutes here, pharmacists do more than prescribed medicine.

And so, vaccinations.

Can we talk briefly about what types of vaccinations you can get through your pharmacist?

Matt: Sure.

Yeah.

A lot are available through the pharmacy.

And some key ones: there's Shingrix, which is for shingles.

There's Pneumovax, a pneumococcal vaccine.

Your flu vaccine, which everyone should be getting every year.

Lacey: Subtle plug.

Matt: Yeah, right?

Yeah.

Yeah, every age.

And then, your COVID vaccine.

Those are your big ones.

There's probably some others out there, but those are your big ones.

And a lot of them depend on age and things like that.

So if you're over 50, you're eligible for the shingles vaccine.

Over 65, you can get your Pneumovax and flu vaccine.

Like I said, everyone should be getting that.

But you're at higher risk when you're you're older.

And if you're over 65, there are some higher dose concentrations or ones available for you that help boost your immune response.

And then, COVID vaccines, as we're all aware of.

And those, I think we're up to two boosters now, if you're over 50.

So, there's a lot of options out there.

And really, vaccines, they're all proven to help with your immune response.

And with elderly people, you're at higher risk for being admitted to the hospital and things like that.

And yeah, we should be getting those vaccines to help prevent the significant disease.

Lacey: All right.

Well, you heard of here from pharmacist, Matt Clifton: get your shots.

Well, thank you for coming on our show today.

We appreciate it.

Matt: Yeah, no problem.

Thanks for having me.

Lacey: Of course.

And we hope our viewers will join us for our next episode of Being Well.

Speaker 3: Carle is redefining healthcare around you, innovating new solutions and offering all levels of care when and where you need it.

Investing in technology and research to optimize health care, Carle, with Health Alliance, is always at the forefront to help you thrive.

Speaker 2: For over 50 years, Horizon Health has been keeping you and your family healthy, and although some things have changed, Horizon Health's commitment to meet the ever-changing needs of our community has remained the same.

Horizon Health, 50 years strong.

Lori: They're the ones who raise the bar, the ones dedicated to providing care in the most demanding of circumstances, the ones that understand the healing benefits of kindness and compassion.

They're the people of Sarah Bush Lincoln, and they set the bar high.

Sarah Bush Lincoln, trusted compassionate care right here, close to home.

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