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Right Drug, Wrong Patient

by Andrea Rock

    As a rule, the pharmacy's proficiency and authority is little doubted. But the rate of pharmacy errors is much higher than people think. Imagine what would happen if the drug dispensed to you were not the proper one. The following article tells us more about pharmacy errors.

   At breakfast, seven-year-old Gabrielle Hundley took the first of two pills that would change her life. The new prescription that her mother, Peggie, had gotten filled at the Rite Aid in Rock Hill, S.C., was for Ritalin, a drug used to treat attention deficit-hyperactivity disorder.

   In an emergency room later that day, February 21, 1995, doctors discovered that the little girl hadn't taken Ritalin at all, but a high dose of Glynase, a diabetes medication. In court the next year, the Hundleys' attorney argued that the pills were incorrectly dispensed, and contained 16 times the normal starting dose for adult diabetics, causing Gabrielle's blood-sugar level to plummet so severely that she suffered permanent brain damage. The jury awarded the Hundley family $16 million. Rite Aid is appealing the verdict¹.

   Pharmacy transactions seem so straightforward. How often could they go awry?

   While there are no definitive national statistics, there is evidence suggesting that drug-dispensing mistakes are more common than you think. In a 1997 nationwide survey conducted by the trade publication Drug Topics, 53 percent of pharmacists admitted having made errors in the preceding two months. A June 1996 survey of 3361 pharmacists in California and Oregon revealed that errors occurred at an annual rate of 324 per pharmacy—nearly one a day.

   "Ten years ago, an acceptable error rate was considered one per year per pharmacy," says Ralph Vogel, president of the Guild For Professional Pharmacists, a union representing 2000 pharmacists. "What we're seeing today is the chaos that comes from understaffing² and other new stresses in the pharmacy. "

   The pharmacy industry insists that worries over error rates are overblown. Nevertheless, many state regulators, consumer advocates and pharmacists contend that a revolution in the retail drug business is causing problems by increasing workloads.

   They point to two factors: First, overall prescription volume keeps rising—up 30 percent between 1992 and 1997, according to IMS Health, a health care information company. Second, the percentage of prescriptions paid for by insurance or HMOs³ has risen from 28 percent in 1991 to 60 percent in 1997. These third-party payers are imposing ever-lower reimbursement⁴ rates on pharmacies, which must churn out a high volume of prescriptions to keep profit margins up. Even the Big Four chains—Rite Aid, CVS, Eckerd and Walgreens—are affected.

   Against this backdrop, too many people are taking the prescription transaction for granted. Indeed, for the past nine years, Americans responding to Gallup Polls have ranked pharmacists as the country's most honest and ethical professionals ahead of clergy members. No wonder so many people assume nothing can go wrong. "I had blind faith," says Peggie Hundley.

   Here's what you need to know to protect your family:

   You can't rely solely on your doctor. Most physicians get only one year of formal training in medical school on the use of prescription drugs. And, generally, continuing education on medications is not required.

   In contrast, many states require pharmacists to complete an average 15 hours of continuing education each year. And there's no dearth of homework: new drugs are pouring into the market, stimulated by a 1992 program shortening the FDA's⁵ drug-approval times. In the past two years, 92 new drugs hit the market—compared with 125 approved for the previous five years.

   So don't assume you would never leave your doctor's office with a problem prescription. Ruth Paxton, 44, of Dayton, Nev., trusted her doctor implicitly when she sought treatment for a sinus infection in July 1992.
    Years earlier, Paxton had experienced severe allergic reactions to the antibiotics penicillin and Keflex. Unaware of the severity of her past reactions, her doctor prescribed the antibiotic Ceftin, which can cause life-threatening allergic responses in people with extreme sensitivities to either of the other two drugs.

   Within 20 minutes of taking Ceftin, Paxton's throat began to swell, making it difficult to breathe. Swift self-treatment with an anti-histamine stopped the reaction.

   Nevada's board of pharmacy reprimanded Paxton's pharmacist, saying he should have warned her of the potential for allergic reaction.

    A white coat does not a pharmacist make. The burden of knowing about potentially dangerous drug reactions is one reason pharmacists must complete five or six years of academic training. Yet increasingly, the white-coated person who dispenses medicine isn't a pharmacist at all but a pharmacy technician. Depending on the state, such techs may have nothing more than a high school degree and on-the-job training.

   As pharmacy chains face squeezes on profit margins, the use of techs is growing. Why? Techs typically earn $5 to $12 an hour—compared with the average of $30 to $39 an hour for registered pharmacists.

   Of course, pharmacists are supposed to check technicians' work. Failure to do so was cited as a major cause of dispensing errors by nearly a third of pharmacists in the Drug Topics survey.

    You could get the right drug, but the wrong dose. Hazel Van Hattem of Crete, Ill., says there were two pharmacists and three technicians on duty on May 30,1995, when she picked up a refill of Coumadin, a powerful blood-thinning medication, for her husband, Ernest. "At the trial, they said they couldn't be sure who filled the prescription," says Hazel, referring to her lawsuit against Kmart. Her attorney argued that whoever filled the prescription did so with pills containing 5 mg. of Counmadin rather than Ernest's usual 2 mg.—an overdose that caused massive bleeding and led to his death. A jury levied an $810 000 judgment against the pharmacy. A Kmart spokesperson says the company is appealing.

   Some dispensing errors can be attributed to unreasonable workloads. Three medical studies conducted over an 11-year period found a correlation between pharmacists' workloads and error rates :"There does appear to be a greater risk of errors when a pharmacist is expected to fill more than 24 prescriptions per hour," says Elizabeth Allan Flynn of Auburn University's School of Pharmacy. Increasingly, pharmacists say, pushing beyond that rate is not unusual.

    The safety net has holes. Most pharmacies rely on computer setups that are supposed to be updated regularly with information about new drugs or new risks for existing drugs. But these systems don't always work.

   In a study reported in the Journal of the American Medical Association in 1996, Raymond Woosley, chairman of the department of pharmacology at Georgetown University Medical Center, and his colleagues presented two prescriptions for the same patient to 50 pharmacists in the Washington, D.C., area. One was for the antihistamine Seldane; the other was for the antibiotic erythromycin.

   Since 1992 the FDA and the drug manufacturers have issued warnings that mixing the two drugs could be fatal. Still, 32 percent of the pharmacies filled the prescriptions. Of the 48 pharmacies using computers to flag adverse interactions, 29 percent had programs that failed to issue an alert. In some cases, Woosley says, pharmacists had shut down the systems or overridden them.

   And what about the patient information leaflets stapled to prescription bags at most pharmacies? These are also designed to give added protection against drug interactions or side effects. They usually aren't prepared by pharmacists or physicians—but by commercial vendors. And they're often vague or out-of-date.

    Little watchdog oversight exists. Most state boards don't require pharmacies to report dispensing errors. And national error-reporting programs such as one run by U.S. Pharmacopeia (a nonprofit group that sets drug-manufacturing quality standards) are voluntary.

   Drug chains, however, usually require pharmacists to submit error reports to management. But even those internal reports don't always prevent future errors.

   Malvina Holloway, 59, of Mobile, Ala., received a bottle filled with Tambocor, a dangerous heart-rhythm-altering medication, rather than the breast-cancer drug Tamoxifen that her oncologist had prescribed. Holloway didn't discover the mistake until five months and two refills later.

   Luckily, she did not experience any adverse reactions to the heart drug, but Holloway was distressed that her cancer treatment was delayed. She sued⁶ Harco Drugs, Inc., the regional chain where the mistake was made. Her attorney presented 233 incident reports that had been submitted to Harco management, the majority involving dispensing errors at their stores over the preceding three years. Holloway won a $255 000 jury award.

   Such awards have motivated chains to improve internal procedures on error reports. But Carmen Catizone, executive director of the National Association of Boards of Pharmacy, which represents state licensing boards across the country, argues for greater oversight: "We are proposing that each individual pharmacy be required to report serious dispensing errors to the state board."

   The ultimate responsibility of protecting himself, though, rests with the consumer. In most states, pharmacists are required by law to counsel customers about new prescriptions. Nevertheless, most customers turn down offers for a "show and tell."

   Says Stephen Giroux, a pharmacist in Middleport, N.Y. "If people understood the harm that could be done to them by a dispensing error, they wouldn't treat going to a pharmacy like going to a fast-food store."

How to Protect Yourself

    * Take notes: At your doctor's office, write down the generic and brand names of your prescribed medicine, along with its purpose and the dosage. That way you can double-check the medication the pharmacist hands you.

   * Inform Everyone: Remind both your doctor and your pharmacist of any drug allergies you have, as well as any other medications you're taking. Include over-the-counter pain or cold remedies, vitamins and herbal supplements.

   * Check Refills: Make sure the pills are the same color and size you usually get. If they're different, assume they're wrong until a pharmacist examines them.

   * Shop Off-Peak: Avoid getting prescriptions filled on a Monday, traditionally a pharmacy's busiest day. Call in refills a day or two ahead to lessen chances that your prescription will be filled during busy hours. If you get your prescriptions by mail, order them at least two weeks before you need a refill. Most importantly, if you feel sick after taking a newly prescribed drug, call your physician immediately.

─ A.R.

(1645 words) TOP

课文一

药对了，病人错了

安德里亚·洛克

    通常，药房的职业水平和权威是很少受到怀疑的。然而，药房的出错率比人们所想的要高得多。想一想，要是药房给你开错了药会出现什么后果？下面这篇文章将会告诉我们更多有关药房错误的事情。

    在吃早餐时，7岁的加布里埃尔·亨德黎服下了将会改变她一生的两粒药中的第一粒。新处方上开的药是利他林，这是她母亲佩吉在南卡罗来纳州洛克山的日特爱德药店配的药，一种用来治疗注意力缺失/过动症的药。

    当天，即1995年2月21日的晚些时候，在急救室里，医生们发现小女孩服用的根本不是利他林，而是大剂量的格里纳斯,一种治疗糖尿病的药。次年在法庭上，亨德黎的律师论证说，药物没有正确配发，其剂量比成人正常初服量高出16倍，使得加布里埃尔血糖急遽攀高，从而导致她脑部永久性损伤。陪审团判决赔偿亨德黎家１600万美元。日特爱德药店提出了上诉。

    药房交易看上去非常简单明了。它们的出错率有多高呢？

    尽管没有确定的全国性统计数据，还是有证据表明配药错误比人们想象的要更常见。1997年，行业刊物《药学信息》在全国范围内进行的一次调查表明，53%的药剂师承认在前两月里发生过差错。1996年6月对3361位加利福尼亚和俄勒冈的药剂师的调查显示，出错率为每家药店每年324次——将近每天1次。

    “十年前，可接受的出错率为每家药店每年1次，”拉尔夫·沃格尔说。他是专业药剂师协会的主席，这家协会拥有2000名药剂师。“我们今天看到的却是由于人员配备不足以及配药业出现的一些新的压力所造成的混乱局面。”

    配药业坚决认为，对出错率的担忧被过分渲染。不过，有许多州的管理者、消费者权益维护者和药剂师们认为，由于工作量增加，一场零售药业的革命正在引起诸多问题。

    他们指出了两点：一、处方总量在不断增长——1992年到1997年增长了30%，这是卫生保健信息公司“IMS Health”所调查的结果。二、由保险公司或卫生维护组织支付的处方百分比已由1991年的28%增长到1997年的60%。这些第三方付款者使配药业得到的付还率持续走低，这必然造成为保持利润增长而大量配药。甚至四大连锁药房——日特爱德公司，CVS，爱克德以及沃尔格林斯——也受到了影响。

    在这种背景下，有太多的人想当然地看待配药交易。实际上，在过去的九年里，美国人在回答盖洛普民意测验时，都将药剂师列为本国最诚实最有职业道德的专业人员，位于牧师之前。难怪为数众多的人以为，根本不会出什么差错。佩吉·亨德黎说：“我盲目地信任了他们。”

    为了保护您的家人，您需要了解以下知识：

    不可完全依赖您的医生。大多数医生在医学院只接受过一年的有关配方药使用的正式培训。而且，一般说来，不要求他们再接受药学方面的继续教育。

    相对而言，许多州政府要求药剂师每年平均完成15小时的继续教育。而且，额外的准备工作也不会少：1992年，由于美国食品和药物管理局缩减了药品批准时间，新的药品就如洪水般涌入了市场。在过去的两年里，92种新药涌进市场，而在此之前的五年里只批准了125种。

    因此，不要以为自己从不会拿着有问题的配方离开医生的办公室。来自内华达州达顿的44岁的路斯·帕克斯顿，在1992年7月请自己的医生治疗窦炎，当时，她对他信任无疑。

    此前几年，帕克斯顿曾经因为使用抗生素盘尼西林和基弗莱克斯而发生过严重的过敏反应。在对她的过敏史不了解的情况下，医生开出了抗生素西福辛。对于使用以上两种药中的任何一种都极度敏感的患者来说，这种药可以引起致命的过敏反应。

    在服用西福辛二十分钟之后，帕克斯顿的咽喉肿胀起来，并随之呼吸困难。由于迅速用抗组胺药自救才中止了这种反应。

    内华达配药业委员会对帕克斯顿的药剂师进行了批评，认为他应该警告病人此药有可能导致过敏反应。

    穿白大褂的未必是药剂师。了解药物潜在的危险反应这项重任，是药剂师们必须完成五或六年专业培训的原因之一。不过，越来越常见的现象是，穿着白大褂配药的人根本不是药剂师，而是药店的技工。根据各州的情况，这样的技工或许只有高中学历，仅仅受过在职训练。

    配药连锁店由于利润幅度紧缩，使用的技工越来越多。为什么会这样呢？技工每小时的酬金为5-12美金，比较而言，注册药剂师每小时的酬金则达30-39美金。

    当然，药剂师应当核查技工的工作。《药学信息》的调查认为，将近三分之一的药剂师犯配药错误主要是由于没有核查。

    拿到正确的药，但剂量不对。伊利诺斯州克雷特的海泽尔·凡·哈特姆说，1995年5月30日，她去为丈夫恩尼斯特配强效治疗血管收缩的药香豆定时，有两位药剂师和三名技工当班。“在审讯时，他们说拿不准是谁配的这张药方，”海泽尔在谈到诉讼卡马特的案件时说。她的律师论证说，无论是谁配的这张药方，他确实配了含5毫克香豆定的药剂，而不是恩尼斯特的正常用量2毫克——剂量过大引起大出血而导致了他的死亡。陪审团判决药店赔偿81万美金。卡马特的发言人说公司将提起上述。

    某些配药错误可归咎于不合理的工作量。三项持续11年之久的医学研究，发现了药剂师的工作量与错误率之间的关系：“在人们想让药剂师每小时配的药方超过24张时，发生错误率的风险确实要高，”奥本大学配药学院的伊丽萨白·艾伦·福林说。药剂师们说，配药超过那个速度越来越常见，并不是什么稀奇事。

    安全网络有漏洞。多数药剂师依靠电脑装置，他们以为有关新药或现有药品的新危险的内容会被定期更新。然而这些系统并非总是发挥作用。

    1996年《美国医学会杂志》报道了一项研究，乔治镇大学医学中心配药学系的主任雷蒙德·伍丝尔利和他的同事们向华盛顿市区的50位药剂师展示了为同一病人开出的两张药方。一张是抗组胺药塞尔岱，另一张是抗生素红霉素。

    从1992年起，美国食品及药物管理局与药品制造商就已经发布警告说，将这两种药混用会产生致命的后果。但仍然有32%的药剂师配发了这两张药方。在48家使用计算机指明副作用的药店中，有29%的药店的程序没能给予警告。伍丝尔利说，在有些情况下，是药剂师关闭了系统或者使它们失效。

    那大多数药店里钉在处方袋上的病人须知单又是怎样的呢？这些单子同样是为了进一步防止药物的相互作用或副作用而设计的。一般它们不是由药剂师或医生——而是由商贩们提供的。而且，往往要么是含糊不清要么就是已经过时。

    存在小的监督疏漏。多数州政府委员会不要求药店汇报配药错误。而像美国药典会（制定药物生产质量标准的非营利性组织）主持的国家错误汇报项目，也只是自愿执行的。

    不过，连锁药店通常要求药剂师向管理者呈交错误报告。然而，即使内部报告也不总是能避免将来的失误。

    59岁的来自亚拉巴马州莫比尔的玛尔维纳·霍罗威拿到的是一瓶泰布考（一种改变心脏节律的危险药物），而不是肿瘤医生为她开出的治疗乳腺癌的它莫西芬。霍罗威在五个月后，又配了两次药后才发现了这个错误。

    幸运的是，霍罗威没有因这种心脏药发生任何不良反应，但她因耽搁了癌症的治疗而十分沮丧。她起诉了造成错误的地区性连锁店哈克药品公司。她的律师出示了曾上交给哈克管理部门的233次事故报告，其中大部分事故是有关前三年间这个药店发生的配药错误。霍罗威获得了陪审团判决的255,000美元赔款。

    诸如此类的赔偿推动了连锁店改进汇报错误的内部管理程序。然而，国家配药业委员会协会（全国各州许可委员会的代表）的负责人卡门·凯狄左恩则要求进行更严厉的监督：“我们提议要求每一家药店向州立委员会汇报严重的配药错误。”

    不过，保护自己的最终责任还在于消费者。在大多数州，法律要求药剂师必须向消费者提供新处方的咨询。不过，多数客户谢绝这种“展示和介绍”的好意。

    纽约米德尔泼特的一位药剂师斯蒂芬·吉洛克斯说：“倘若人们懂得配药错误可能引起的危害，他们就不会认为去药店和去快餐店一样方便了。”

    如何保护自己

    *做笔记：在诊室里，记下所开药的通用名及商标名，并写下用途与用量。这样，你便可以对药剂师交给你的药品进行复核。

    *提供信息：提醒你的医生和药剂师有关你药品过敏的情况，以及你正在服用的其它药品。这包括止痛药和感冒药、维他命以及草本补给品等非处方药。

    *检查再配药：确保药片与你通常所取药片的颜色及大小一致。倘若不同，就认定药品是错配，直到药剂师对其进行验证。

    *在药店非高峰期配药：避免在周一配药，周一通常是药剂师最忙的一天。提前一、两天电话预约再配药，以减少在高峰期配药的机率。倘若是通过邮递配药，你至少得在需要配药前两周预定。最重要的是，倘若在服用了刚刚配好的药之后感到不舒服，必须立即联系自己的医生。

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Text 2

Hidden Dangers of Over the Counter Drugs

by William Fcenbarger

    When the 18-year-old staggered into the emergency room, she was wild-eyed and gasping for air. Her air passages were swelling dramatically. Quick-acting doctors in that Midwestern hospital managed to regulate her breathing with an emergency tracheotomy and intravenous drug treatment⁷. She was admitted to the respiratory intensive-care unit for follow-up treatment and eventually recovered.

   The young woman's nearly fatal experience was brought on by an allergic reaction to aspirin. She knew she was allergic to aspirin, but she had taken it inadvertently⁸. How?

   At the onset of a headache, she had reached for a common over-the-counter (OTC) drug that she thought contained acetaminophen⁹. It did—but had she bothered to read the label closely, she would have seen the small print that said it also contained aspirin.

   A near-death experience with an OTC drug is, thankfully, uncommon. But the young woman's mistake—failure to read the label—is all too common. A survey by the American Pharmaceutical Association last year found that 47 percent of adults did not always read the labels on OTC pain relievers, fewer than 40 percent consulted a pharmacist before taking these products, and 43 percent were unaware of the potential risks associated with taking these remedies along with prescription medicines.

   The dangers can be considerable. The remedies we buy for allergy, headache, upset stomach and other common ailments are drugs. And they must be used responsibly. If you are taking prescription medications, be sure to consult your doctor or pharmacist. Consumers who disregard warnings on the labels and the package inserts before they swallow, spray, sip, inhale, insert or smear one of the 100 000 OTC remedies now on the market are taking a risk.

   Here are some of the pitfalls:

Overdosing

    "There is the idea that if one doesn't work, I'll try two," says Joe Graedon, a pharmacologist and author of The People's Pharmacy book series. That is not a good idea.

   Earlier this year a 45-year-old truck driver showed up at the Houston Headache Clinic complaining of excruciating¹⁰ headaches. The pain would throb and pulsate, waking him out of a sound sleep and making him nauseated.

   It didn't take long to find the problem. The man had been swallowing about 200 Excedrin Migraine tablets weekly for nearly a year. The label warns users not to take more than eight tablets per day and not to use the medication for more than 48 hours. Each tablet contains 250 grams of acetaminophen, 250 grams of aspirin and 65 grams of caffeine.

   "This is the classic rebound headache," says Dr. Ninan T. Mathew, clinic director. "As the pain got worse, he took more and more painkiller, thinking this was a safe product. We took him off all daily pain medication, introduced a relaxation and stress-management program and gave him drugs to prevent migraines. He is progressing well. "

   While no definitive studies have been done, Mathew estimates that between two and three percent of the population—as many as eight million Americans—may be overusing OTC headache remedies.

   Many OTC products are merely lower-dose versions of drugs that can only be obtained with a prescription. For example, the painkiller Orudis KT is a version of the prescription drug ketoprofen, which can cause ulcers and severe stomach bleeding if taken in high doses or for an extended period.
   "Habitual and chronic use of pain relievers that have more than one active ingredient may be risky," warns Dr. William Henrich, chairman of the National Kidney Foundation's public-policy committee. "This could lead to kidney damage and a reduction in kidney function." Some experts, though, say an association between kidney disease and use of combination analgesics has not been proved. In any case, these drugs are considered safe when used as directed.

Interaction

   Medical authorities urge anyone taking a prescription medicine, especially those with a chronic illness, to consult with a doctor or pharmacist before taking any OTC drug. Millions of Americans, for example, take Tagamet HB, a popular remedy for heartburn, acid indigestion and other minor stomach problems. But if they're also taking the widely prescribed drug Coumadin (used to prevent blood clots), they're at risk. Tagamet HB and Coumadin can interact in a way that, in severe cases, may cause internal hemorrhaging and bleeding from the mouth, nose, rectum and urinary tract. The warning about this interaction is present on the Tagamet label, but the reference is to warfarin, the generic name for Coumadin. (The package insert, though, refers to both the brand and generic names. )

   Anti-depressants are now among the most widely used drugs in America. Prozac, for example, is America's fifth most often dispensed drug. "People on medication for depression have to be careful about using cold remedies," notes Grant Shetterly, a fellow at the Center for Proper Medication Use in Philadelphia.

   A common ingredient in many cough suppressants, dextromethorphan, may interact with an anti-depressant such as Prozac or Paxil to produce a serious, though infrequently reported, problem called serotonin syndrome. One 51-year-old victim was vomiting blood, sweating, shaking, confused and having trouble breathing. His blood pressure was elevated, and his pulse was 122 beats per minute. The man, who had a pre-existing vascular disease, recovered after some time in intensive care.

   Cold remedies also can interact dangerously with another class of anti-depressants called monoamine oxidase inhibitors (MAOIs). Most OTC cough and cold products, like Sudafed, warn specifically against this reaction.

Cancellation

    Consumers need to be aware of another potential pitfall: one drug can cancel or reduce the effects of another.

   Because it provides relief from high blood pressure, Vasotec is one of the most frequently dispensed drugs in America. It is not unusual for someone with high blood pressure to be taking ordinary aspirin as a preventive against heart attacks. "But aspirin may reduce the effectiveness of Vasotec," says pharmacologist Graedon. The same interaction could occur with other widely prescribed heart and blood-pressure drugs—known as ACE inhibitors—such as Accupril, Prinivil and Monopril. People who take these drugs should not avoid aspirin, especially if it has been prescribed by a physician, but should have their blood pressure carefully monitored.

   Many people with high blood pressure also have arthritis. Combining certain prescription drugs for the former and too much of an OTC drug for the latter may reduce the effectiveness of their blood-pressure medication. For example, people on beta blockers should consult their doctors before taking nonsteroidal, anti-inflammatory painkillers (known as NSAIDs), such as aspirin, Advil, Aleve, Motrin and Nuprin.

   Grant Shetterly also cautions that the active ingredients in many antacids, including Rolaids and Tums, can reduce the absorption of certain antibiotics. In some cases they can totally negate the effects of the antibiotics and inhibit the curing of major infections. People should ask their physicians whether they should take both drugs.

Alcohol

    When Antonio Benedi caught the flu from his sons, he relieved his symptoms with Extra-Strength Tylenol, the No. 1 best-selling OTC product. Later, when the ambulance came for him at his suburban Washington home, he was in a coma with liver failure.

   Benedi's liver was destroyed by a toxic reaction to acetaminophen, Tylenol's main ingredient. His habit of drinking two or three glasses of wine with dinner had made his liver more sensitive to the drug. A last-minute liver transplant saved his life.

   A study published in 1997 found that overuse of acetaminophen was the leading cause of admission for acute liver failure at Parkland Memorial Hospital in Dallas, Texas, and that heavy drinkers were especially vulnerable11. The American Liver Foundation recommends that regular drinkers use less than the normal dosage of OTC acetaminophen products.

   Combining alcohol with many popular OTC pain relievers can be dangerous. Under a new FDA regulation, all pain-relief and fever-reducing products will carry labels warning anyone consuming more than three drinks per day to consult a doctor before taking the product.

   Medical and pharmaceutical professionals urge consumers to read the label of every OTC product they buy and to ask a doctor or pharmacist about it. They add these precautions:

   * Find out for sure whether taking the medication will affect your ability to drive.

   * Don't assume that all products under a given brand name are the same. For example, there are at least 11 different OTC products with the name Sudafed. Some contain only pseudoephedrine, and others include acetaminophen, guaifenesin and dextromethorphan. Some contain alcohol; others contain caffeine.

   * Read the label every time you purchase an OTC product, not just the first time. Companies can change the ingredients.

   * Be extremely cautious if you crush, chew or break a medication before swallowing it. Sometimes OTC drugs have a coating that keeps them from dissolving as they pass through the stomach; sometimes these drugs are designed to release medications slowly over time—a goal that can be frustrated by not taking them whole.

   Help for consumers is on the way. New FDA rules approved earlier this year will make nonprescription drug labels easier for consumers to read and understand. There will be larger type, more white space, a standard format and simpler language to explain side effects, interactions and when to consult a physician.

   Nevertheless, all the warnings in the world won't help if you don't read them.

(1531 words)  TOP

课文二

非处方药的潜在危险

威廉·弗斯恩巴捷

    18岁的她跌跌撞撞地走进急症室，两眼圆睁，大口大口地喘着粗气。她的气管极度肿胀。那家中西部医院的快速反应医生们，成功地用紧急气管切开术及静脉注射药物治疗来控制她的呼吸。她又被呼吸科特护处接纳进行随后的治疗，并最终康复了。

    这位年轻女士近乎致命的经历，是阿司匹林的过敏反应造成的。她知道自己对阿司匹林过敏，但是却粗心大意地服下了药。怎么会发生这样的事情呢？

    在刚刚出现头疼症状时，她去取一种普通的非处方（OTC）药，以为这种药里含有醋氨酚。药里确实含有醋氨酚——但倘若她费心认真地阅读一下标签，她就会看见上面有小字说明它也含有阿司匹林。

    幸亏，由OTC药引起的走近死神的经历并不常见。但是这位年轻女士的错误——不读标签——是太常见了。美国药学会在去年进行的一场调查发现：47%的成人有时不阅读非处方止痛药的标签，不到40%的人在服用这些药品之前咨询药剂师，43%的人不了解与配方药同时服用这些药品的潜在危险。

    这些危险会相当严重。我们买来用于治疗过敏、头疼、胃不舒服以及其它一些常见病的东西是药品。必须负责任地使用它们。你在服用处方药时，一定要向医生或药剂师咨询。消费者不看标签上以及夹在包装里的警告而吞咽、喷洒、吮吸、塞入或涂抹目前市场上10万种药品中的某一种药，就是冒险。

以下列出的是一些误区：
　

剂量过大

    “人们常有这样的想法，一片不行，我就吃两片，”药物学家，《人民配药业》系列丛书的作者乔·格雷登说。那不是个好主意。

    今年初，一位45岁的卡车驾驶员出现在豪斯顿头痛诊所，抱怨自己头疼欲裂。这疼能疼得钻心，让他从熟睡中疼醒，呕吐。

    没费多少时间就找到了症结所在。这个人近一年来每周大约吞服了200片Excedrin止头痛药。标签上警告使用者每天用量不要超过八片，而且使用期不要超过两天。每片药含有250克醋氨酚，250克阿司匹林，以及65克咖啡因。

    “这是典型的复发性头疼，”诊所主任尼南·T·马休医生说。“随着疼痛的加剧，他服用了更多的止痛片，还以为那是安全的药品呢。我们让他中止服用所有的日常止痛药，而进行了一种休息与控制紧张的治疗程序，让他使用防止偏头痛的药品。现在他恢复得不错。”

    虽然尚未有确定的研究，但马休估计2%到3%之间的人口——相当于8百万美国人——可能在过量使用OTC头疼药。

    许多OTC药品仅仅是那些只有凭处方才能取到的药品的小剂量版本。比如说，止痛药奥诺迪斯KT是处方药酮络芬的一种翻版，倘若长期高剂量地服用这种处方药，可以引起溃疡和严重的胃出血。

    “习惯性以及长期性的使用具有一种以上活性成分的止痛药可能是在冒险，”国家肾病基金会的公共政策委员会主席威廉·亨瑞奇医生警告说。“这会导致肾损伤并引起肾功能衰退。”不过，有些专家说肾病与使用化合止痛剂的关系尚未得到证实。在任何情况下，只有当按照指示的方法服用时，这些药品才能被当作是安全的。

相互作用

    医学权威人士敦促使用处方药者，尤其是慢性病患者，在使用任何OTC药之前都要向医生或药剂师进行咨询。比如说，数以百万的美国人服用治疗心痛，胃酸过多以及胃部其它小毛病的常用药泰格米特HB。但是，倘若他们同时服用经常开出的处方药香豆定(防止血块的药)，那就危险了。泰格米特HB会与香豆定发生相互作用，情况严重的话，可能会引起内部大出血，以及口、鼻、直肠和尿道出血。泰格米特的标签上注有关于这种相互作用的警告，但它提到的是华法令——香豆定的通用名。（不过，在包装内的说明中商标名与通用名都被提及。）

    目前在美国，抗忧郁药是最广泛使用的药物之一。比如，普罗扎克在美国最常被开出的处方药排行中名列第五。“依赖药物治疗忧郁症的人在使用感冒药时必须当心，”费城正确用药中心的职员格兰特·谢特利强调说。

    许多止咳药中含有的常用成分右甲吗南，会与诸如普罗扎克或者Paxil之类的抗忧郁药相互作用，从而造成一种严重的然而很少报道的所谓血色素并发症的问题。一位51岁的受害者出现了吐血、出汗、发抖、昏迷、呼吸困难的症状。他血压升高，脉搏每分钟达122次。这个人患有先天性血管病，在接受了一段时间的特护之后才恢复了健康。

   感冒药也会与另一种抗忧郁药单氨氧化酶抑制剂(MAOIs)发生相互作用。多数OTC咳嗽和感冒药，如苏得法得，会对这种作用提出特别警告。

抵消药效

    消费者需要知道另一个潜在的误区：一种药可以抵消或降低另一种药的疗效。

    因为沃热泰克可以缓解高血压，它成为美国开药率最高的药品之一。高血压患者服用普通的阿司匹林来防止心脏病，是常见的现象。“但是阿司匹林会降低沃热泰克的效果，”配药学家格雷登说。同样的相互作用也会见诸其它被广泛开出治疗心脏与血压病的药物——通常称为ACE抑制药——诸如阿克普瑞，赖诺普利和福辛普利。服用这些药物的患者不用回避阿司匹林，如果是医生开出的更不用回避，但是必须认真监控自己的血压情况。

    许多高血压患者也患有关节炎。服用某些处方药治疗前者、大量使用某种OTC药治疗后者，这种结合治疗的办法会降低血压药的疗效。譬如说，服用受体阻滞药的病人在服用诸如阿司匹林、艾德威、Aleve、异丁本丙酸和纳普林等非固醇的消炎去痛片(通常称为NSAIDs)之前，应该向医生咨询。

    格兰特·谢特利还提醒说，包括Rolaids和Tums在内的许多抗酸性药物当中含有的活性成分可以减少某些抗生素的吸收。在某些情况下，它们可以彻底抵消抗生素的作用，抑制严重感染的治疗。病人应该向医生咨询，自己是否可以同时服用两种药物。

酒精

    安东尼奥·拜尼蒂被儿子传染上流感后，服用了销售量最大的OTC药强力扑热息痛来缓解自己的症状。后来，当救护车赶到他在华盛顿郊区的家中时，他已经由于肝功衰竭而昏迷了。

    拜尼蒂的肝脏由于对醋氨酚的中毒反应而损伤，醋氨酚是扑热息痛的主要成分。每天在用餐时喝两、三杯酒的习惯使他的肝脏对这种药更加地敏感。生死关头的肝移植手术才挽救了他的生命。

    1997年发表的一份研究报告认为，在得克萨斯州达拉斯的帕克兰德纪念医院里，过量使用醋氨酚是导致严重肝功衰竭的首要因素，而酗酒者的肝脏更容易受到伤害。美国肝脏基金会建议，常喝酒者使用的非处方醋氨酚类产品的剂量应少于正常的剂量。

    将酒精与许多种常用OTC止痛药混合使用是危险的。根据FDA的新规定，所有的止痛以及退烧药品上将附有标签，用以提醒每天喝三杯酒以上者在服用前需向医生咨询。

    医学和配药学的专家们敦促消费者阅读所购买的每一种OTC药品的标签，并且向医生或药剂师就有关问题咨询。他们又提出了下列警告：

*确认服用此药是否会影响自己开车的能力。

*不要以为所有冠以同一既定商标的药品是一样的。譬如，至少有11种不同的OTC药品的名称为苏得法得。一些药里只含有假麻黄素，而另一些药里则含有醋氨酚，愈创本酚甘油醚与右甲吗南。一些药含有酒精，而另一些则含有咖啡因。

*每次购买OTC药品时都要阅读标签，不要仅仅在第一次购买时这样做。公司会改变药物成分的。

*吞咽药片之前，如果将之碾碎、咀嚼或者分开，必须极其小心。有时，药上有一层防止药物在经过肠胃时融化的护层；有时，这些药被设计成可长时间缓慢释放药物成分——这个目标会由于没有整体服用而得不到实现。

    为消费者提供的帮助正在进行之中。美国食品药品委员会（FDA）在今年初通过的规定，将会使消费者更容易地阅读和理解非处方药的标签。标签将会更大，有更多的空白处，以标准的形式及简洁的语言来说明副作用、相互作用，并告知何时应该向医生咨询。

    不过，世上的任何警告，倘若你不去阅读它们，都不会起作用的。

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