MEDICINE CHEST ESSENTIALS
by Dr. Lesley Fernow
I am often called in the middle of the night by patients who have woken up with hives, a high fever or itching and don't have access to common remedies which are available over the counter. While there are some warnings for people as they age, for most people cautious use of these medications for short term use (less than 2 weeks) is safe and effective, and may prevent an unnecessary doctor’s visit.
The older you are, the smaller the starting dose you should use and the less frequently you should take the medicine. When in doubt about interactions with your prescription medications, speak to your pharmacist or medical practitioner.
Important medications for everyone to have:
1) Pain relievers and fever reducers: The two you need are acetaminophen (Tylenol) and any NSAID (non steroidal anti-inflammatory drug) which includes Aspirin, ibuprofen, Advil, Motrin, or Aleve. An IMPORTANT thing to remember is that while Tylenol is a pain reliever and fever reducer it is NOT an anti-inflammatory so for certain types of pain (tooth pain, acute back pain) an NSAID may be more effective. All NSAIDs have the potential to irritate stomach lining or cause bleeding, especially if taken often. They should not be used by people with ulcers, GERD, bleeding problems or on blood thinners. When in doubt, consult your medical practitioner. Tylenol has very important dose limits: no more than 3000mg in 24 hours. It is safe with proper usage, but it is deadly when overdosed.
2) Antibiotic ointment: For cuts and scrapes you should have a small tube of "triple antibiotic" or bacitracin in your medicine cabinet. First, clean simple wounds with soap and water, then apply one of the above topical ointments twice a day for a couple of days with a loose band aid. These should not be used longer than 1 week at a time.
3) Antacids for heartburn, upset stomach and bloating: Maalox and Mylanta or TUMS are good for quick relief. One of the H2 blockers like Zantac (ranitidine) , Pepcid (famotidine) and Tagamet (cimetidine) are also useful to have on hand, and you can take those along with Mylanta or Maalox. For a person taking multiple prescription medications, ranitidine or famotidine are preferred. A stronger alternative is a PPI such as Prilosec (omeprazole). This is very effective but has many long term effect including increasing risks for infections and possible interference with absorbing other medicines. As with any over the counter medication, prolonged use should be avoided and if symptoms persist you should check with your medical practitioner.
4) Anti-Allergy medications: Take advantage of the fact that these are now over the counter. The nonsedating antihistamines (Claritin (loratadine) , Zyrtec (cetirizine) should not make you tired and can work for most allergy symptoms. Seniors should avoid diphenhydramine and chlorpheniramine (too sedating). They should also avoid those with the ending –"D" which signifies decongestant, without checking with their doctor first, as these drugs are heart stimulants and can raise blood pressure.
This advice is in no way intended to suggest that everyone should take pills. There are many non-pill methods of healing mild ills and remaining well which are better and safer than medications. The advice is very simply to make it possible to care for minor, short-term problems at home without running to the ER.
I put this on its own because I think it's so important. Benadryl (diphenhydramine) does work for hives and itching from pretty much anything (poison ivy, animal allergies, medication allergies, food allergies). However, Benadryl’s main side effect of making you sleepy is also why it is often used for occasional insomnia. Unfortunately, this drug has many unwanted side effects in seniors including increased risk of falls and increasing confusion. It is on the Beers’ list of “do not take” drugs in the elderly. Remember Tylenol PM and Advil PM are just Tylenol or Advil with Benadryl. None of these can be recommended for seniors unless you have severe allergies or a severe case of poison ivy in which case you need someone around when you take it. It is on the Beers List of do not take medications in the elderly due to risks associated with falling!
Other things you should have in your medicine chest
5) Cold and cough:.
For a PRODUCTIVE cough where you are bringing up junk an expectorant like Robitussin (syrup) or Mucinex (tablet) (Guaifenesin) can work well to help you bring up that phlegm from your tight chest. If you need a cough suppressant, one of these with –DM on the end will usually suffice. For seniors I discourage the other endings –AC, -E, -PCE due to potential heart-related side effects. Cough drops often also work well-choose sugar free if you are diabetic.
6) Hydrocortisone cream: A 1% topical hydrocortisone cream is useful for relieving itching and inflammation from many skin lesions. You will see many variations of this cream at a pharmacy with different names, with or without aloe, etc. You just need the 1% hydrocortisone cream. Use it to help you with any skin issue that ITCHES: bug bites, poison ivy or any contact dermatitis (an allergic skin reaction from something that touched you).
7) Antifungal: Clotrimazole (Lotrimin) cream or powder or miconazole, (Zeasorb-AF) is very useful for the occasional red fungal rash on feet, or in the groin, under breasts or armpit. This rash usually comes from moisture, so the powder is often drying and helpful. Remember, if it does not seem to work after a few days you should check with your doctor.
8) Diarrhea: Immodium (Loperamide) is your best over the counter option.
There are many anti-nausea drugs that require a prescription but Dramamine over the counter tablets will work well. As you know you can also use them for prevention of motion sickness so they are good to have on hand. It is very sedating, and carries the same risk for seniors as Benadryl. (Ginger root or Ginger ale may work just as well) Use only for emergencies then lie down.
There are many effective medications for constipation not helped by a diet rich in fiber, bran, prunes, apples, etc. Stool softeners simply soften the stool. Senna in many forms including tea is a mild stimulant and is quite gentle. Fiber such as psyllium is available to mix in juice (Metamucil, Konsyl, Citrucel), and is very helpful in bulking the stool, softening it and making it easier to pass. Stronger laxatives such as bisacodyl, Milk of Magnesia are also available. Prevention with drinking enough fluids, a good diet and exercise is preferable to medications, but if you are constipated, having one of these on hand is helpful.
11) Sterile gauze: Sterile gauze (in either pad or roll form) and medical tape are for injuries that require something bigger than an adhesive bandage. Use them to apply pressure to a bleeding wound, or apply to wounds with a little antibacterial ointment . Non-stick pads like Telfa can be helpful if skin is very delicate and to avoid pulling scabs off, but may not be as absorbant. To dress a wound with the gauze and tape combination, first cut a piece of the material to fit the size of the wound or wrap gauze around it from the roll. Then secure the material in place with the tape. Remember to change the bandage if the bandage gets wet or dirty -- and if the gauze sticks to a scab or part of the wound, soak the area in warm water to loosen things up.
12) Paper or silk tape. Silk adheres betted, but paper is better for sensitive skin. Available in pharmacy.
13) Thermometer. Throw away the old mercury thermometer. There are now good inexpensive digital ones.
14) ACE bandage. The most useful size is 3” or 4” width. This can be used for sprains, swelling in the legs, or to hold ice packs in place.
15) Adhesive bandages: Adhesive bandages come in a variety of shapes and colors, from clear to camouflage, and there should be a stash in your medicine chest.
16) Muscle rub: Having a muscle cream, balm, self-heating wrap or heating pad on hand to soothe sore muscles or ease lower-back pain is a must. Tiger Balm is an important and effective relief for any aches and pains you may feel. It consists of different herbs and ingredients that are known to be effective. In a recent study, anti-inflammatory skin cream reduced soreness by 45 percent in the 48 hours after exercise over pain reliever pills [source: WebMD]. The ingredients in topical creams and adhesive patches like Icy Hot and Bengay are absorbed through your skin into your bloodstream, meaning you should be stingy with how frequently you apply them. Many contain an ingredient called methyl salicylate which is similar to aspirin, and just like aspirin, it can be toxic in high doses. Be safe -- use anti-inflammatory treatments in moderation.
17) Tweezers: A pair of fine-tipped tweezers will remove things lodged under your skin like splinters or ticks.
18) Artificial tears: Many brands and generics. Very useful for soothing sore, itchy, tired eyes from dust, excess drying, computer work, etc. Safe to use every 4 hours if needed one drop. Not the same as Visine which is not an artificial tear.
19) Tea Tree Oil - If you prefer to use more “natural remedies” it is essential to have some of this oil on hand, because it is known to heal skin cuts, burns, and even infections. It acts as an antiseptic and is antifungal. It can be used for acne or athlete's foot. It is also been reported to reduce the symptoms of dandruff. It may take the place of many of the items listed above