• Remember that the term "natural" does not necessarily mean "safe."
  
  
• To stay safe, always tell your doctor, pharmacist, or other health care provider about the products you are taking, including:
  
  -- Herbal remedies,
  -- Non-prescription medicines, and
  -- Prescription drugs.
  
  This is especially important if you are taking "blood-thinning" drugs or have cancer, HIV, or other life-threatening conditions. Bring either a list or the products with you to your doctor's appointment.
  
  
• If you are taking a prescription medication, do not take an herbal remedy or dietary supplement for the same condition without telling your doctor.
  
  
• Only take the recommended amount listed on the label.
  
  
• Only choose products with labels that provide:
  
  -- Dosing advice,
  -- A lot number or expiration date (avoid products that are over one year old), and
  -- Manufacturer's name, address, and telephone number.
  
  
• Store products:
  
  -- In a cool, dry environment out of direct sunlight (not in a bathroom medicine cabinet or car's glove compartment), and
  -- Away from young children and pets.
  
  
• Herbal remedies should not be taken:
  
  -- By children without a physician's approval,
  -- By pregnant women or nursing mothers,
  -- With alcohol, or
  -- As a substitute for a balanced diet and proper rest.
  
  
• Ask your hospital or health-system pharmacist if you have any questions about this or other medicines.
  

• Infections are caused by two main types of germs--bacteria and viruses. Bacterial infections can be cured by antibiotics--viral infections cannot.
  
  
• Viral infections cause all colds and most coughs and sore throats. People recover from viral infections when the illness has run its course.
  
  
• Viral infections may sometimes lead to bacterial infections.
  
  
• Doctors and pharmacists in hospitals and health systems can tell you when antibiotics are needed. For example:
  
  -- Ear infections: There are several types; most need antibiotics, but some do not.
  -- Sinus infections: Antibiotics are needed for some long-lasting or severe cases.
  -- Cough or bronchitis: Antibiotics are rarely needed for bronchitis.
  -- Sore throats: Viruses cause most sore throats. Only "strep throat," which is diagnosed with a laboratory test, requires antibiotics.
  -- Common colds: Antibiotics have no effect on colds.
  
  
• Antibiotics are among the most powerful and important medicines known. Each time you take antibiotics, weaker bacteria are killed, but hardier ones may be left to grow and multiply.
  
  
• Most strains of antibiotic-resistant bacteria start in hospital intensive care units (ICUs). Therefore, untreatable and hard-to-treat bacteria are much more common in hospitals than in the community at large.
  
  
• Antibiotics are often used before and after surgery to protect patients from infection.
  
  
• Patients who are vulnerable to antibiotic-resistant bacteria include:
  
  -- Premature infants and children,
  -- The elderly,
  -- Burn victims,
  -- Bone marrow transplant patients, and
  -- Patients with weakened immune systems (i.e., AIDS, leukemia).
  
  
• Pharmacists in hospitals and health systems ensure that patients receive the right type of antibiotics. They also help create procedures to prevent the spread of antibiotic-resistant bacteria in hospitals and other health-care facilities.

While the U.S. drug supply supply is still the safest in the world, ASHP advises consumers to be particularly vigilant about their medications given the recent rise in counterfeiting.

According to the U.S. Food and Drug Administration (FDA), counterfeit drug investigations have quadrupled since 2000. Additionally, the World Health Organization estimates that fake medications currently make up seven to 10 percent of the world market. These products may be expired, contain incorrect ingredients or the wrong amounts of active ingredients, or be enclosed in packaging that doesn’t match the product inside.

In light of this new and growing danger, ASHP wants Americans to know that their best allies in receiving safe and appropriate drug therapy are pharmacists and physicians. 

“It is very difficult for patients to tell just by looking at a medication or its packaging if it is a counterfeit product,” said ASHP President Daniel M. Ashby, M.S., FASHP, noting the increasing sophistication of international counterfeiters. “However, that is not to say that consumers are helpless in the face of this new threat. They can do a lot by staying alert and following a few simple tips. And, when in doubt, always talk to your pharmacist.”

ASHP recommends that consumers follow a few simple safety tips when taking medication:            

1. Pay attention to your medicine, particularly the instructions on how you should take it, the correct dosage, and warnings about interactions with other medications.
2. Talk to your pharmacist if your medication is:

• Different than you’ve experienced before in shape, color, taste, smell, or feel
• Packaged differently, or
• Does not produce the expected results. This can be due to a number of reasons, including:

-- Your body’s response has changed over time (requiring a higher or lower dose),

-- An interaction has occurred among medications, vitamins, or herbal supplements you are taking or specific foods you are eating,

-- You have a new medical condition that changes the medication’s effectiveness, or

-- You have received a counterfeit product.

3. Be extremely careful when ordering medications on the Internet. To stay safe, only buy medications from pharmacy Web sites that post the National Association of Boards of Pharmacy’s VIPPS (Verified Internet Pharmacy Practice Sites) symbol.

The National Association of Boards of Pharmacy has developed the following list of drug products that have been counterfeited in the past.  Consumers should be especially cautious if taking:

• Diflucan®  (fluconazole)
• Lamisil® (terbinafine)
• Lipitor® (atorvastatin)
• Sustiva® (efavirenz)
• Procrit® (epoetin alfa)
• Zocor® (simvastatin)

ASHP is working on a number of fronts to address the issue of counterfeiting, including partnering with the FDA in providing rapid alerts to ASHP members and U.S. hospital pharmacy departments about counterfeit drug incidents. The Society also maintains an online Drug Shortage Management Resource Center that provides health care providers with timely updates on product shortages and therapeutic alternatives.

ASHP recommends that consumers be aware of their medication needs as they prepare for any emergency. Following the tips below can help you be ready:

• Keep a list of all your medications in your wallet (include lists for your immediate family members, and drug name, strength, dosage form, and regimen).

• Wear your medical-alert bracelet or necklace.

• Store 3-5 days of medications that are important to your health.

• Include any medications used to stabilize an existing medical condition or keep a condition from worsening or resulting in hospitalization, such as medications for asthma, seizures, cardiovascular disorders, diabetes, psychiatric conditions, HIV, and thyroid disorders. Carry these with you, if possible, in a purse or briefcase in labeled containers.

• Don't store your medications in areas that are susceptible to extremes in heat, cold, and humidity (e.g., car or bathroom). This could decrease the effectiveness of the medication.

• Use child-resistant containers and keep your purse or briefcase secure.

• Rotate these medications whenever you get your prescriptions refilled to make sure they are used before their expiration date.

• Refill your prescriptions while you still have at least a 5-7 day supply of medications left. Keep in mind that some sources, such as mail-order pharmacies, have a longer lead time to refill.

• If your child takes medications, talk to your school system to find out their emergency preparedness plans.

• If you are being treated with a complex medication regimen, talk to your physician or pharmacist to create appropriate emergency preparation plans.

• Such regimens include injectable medications, including those delivered by pumps (e.g., insulin , analgesics, chemotherapy, parenteral nutrition), medications delivered by a nebulizer (e.g., antibiotics, bronchodilators), and dialysis.

Pharmacists in hospitals and health systems play an important role in preventing medication errors. To make sure you use medicines safely and effectively, ASHP recommends that you:

• Keep a list of all medications that you take (prescribed drugs, nonprescription medicines, herbal supplements, home remedies, and medical foods) and medicines that you cannot take due to allergic reactions, and share those with your doctor or pharmacist.
  
  
• Tell your health care provider how you actually take your medication, especially if this is different from the originally prescribed directions.
  
  
• Learn the names of the drug products that are prescribed and given to you, as well as their dosage strength and schedules.
  
  
• Ask if you should avoid certain foods, beverages, other medicines, or activities while you are taking the drug.
  
  
• Ask for any written information available on the drug product.
  
  
• Question anything you don't understand or that doesn't seem right. Be especially alert to unexpected changes, such as receiving a prescription refill that seems to have a different strength or appearance from your original prescription.
  
  
• Show that you understand how to use your medication by repeating information about your prescription back to your doctor or pharmacist.
  
  
• If you're too ill to follow these suggestions, ask a friend or relative to help.
  
  
• Remember that when you're in a hospital or health system, you can always ask to speak to the pharmacist if you have questions about your treatment or medications.

Seniors

Seniors who take multiple medications are at increased risk for accidental poisonings.  Older patients have complex medication regimens, often involving multiple medications prescribed by several physicians, that make them vulnerable to accidental poisonings.

Patients should:

• Keep a list of your medications.  A written record of the medications you are taking, including drug name, dosage, and frequency, is an important tool to have during physician visits and in case of an emergency. 
• Communicate. Inform your doctor and pharmacist of all the medications you are taking, including non-prescription medications and dietary supplements; this will help reduce the chances of an interaction.
• Learn about your medications.  Ask your doctor or pharmacist to explain why you are taking the medication you have been prescribed, the food and medicines you should avoid, and possible reactions and side effects. 
• Use one pharmacy. Many seniors receive prescriptions from more than one doctor, making drug interactions more likely. By using one pharmacy, all of your prescriptions are consolidated and your pharmacist can check for possible interactions between medications.
• Keep a journal. Make note of all symptoms, especially after taking your medications. Painful or unexpected side effects may signal a need for adjusting your medication regimen.
• Maintain a schedule. Holding to a routine can decrease your chances of missing dosages or taking more than needed.

Patients should immediately contact their physician if they experience an adverse reaction to their medicines.  If the physician is not available, contact the local poison center using the toll free number (800) 222-1222.   Eighty percent of directors and half of all staff members at poison control centers are pharmacists, health care professionals who are trained and highly educated on the complexities of today's medications.

Children

Did you know that many of the creative methods parents and caregivers use to get children to take their medicine can actually contribute to accidental poisonings?

A March 2005 ASHP consumer survey found that almost half of parents and caregivers said they have pretended to take their child's medication or called it "candy" to convince the child to take the medicine. These methods are extremely dangerous and could lead to an overdose, according to pharmacists. 

The Centers for Disease Control and Prevention reports that approximately 9 of 10 accidental poisonings occur in the home. Sixty percent of these victims are children younger than age six, and close to half of poisonings in children of this age group involve a misuse of medicines.

• Avoid taking medications in the presence of children, as they often try to imitate adults.

• Don't call medicine "candy."

• Use child-resistant closures on medicine and other products.
  
  
• Keep all medications (both prescription and nonprescription) in their original child-resistant containers.

• Always turn on the light when giving or taking medicine.

• Check your medications periodically for expiration dates. If the medication is not dated, consider it expired six months after purchase.
  
  
• Avoid putting medications in open trash containers in the kitchen or bathroom because many adult medications can be deadly to small children and pets.

• Be aware that vitamins, particularly those containing iron, can be poisonous if taken in large doses. Children are especially suspectible to adverse effects from vitamin overdosing.

In cases of poisoning, ASHP recommends that consumers immediately call 800-222-1222, the national phone number for poison control centers. Eighty percent of directors and half of all staff members at poison control centers are pharmacists, health care professionals who are trained and highly educated on the complexities of today's medications.

Whether you are traveling domestically or internationally, you won't want an illness to disrupt either your vacation or business plans. This means planning well, managing your medications wisely, and consulting your physician or pharmacist about proper precautions to take before you leave home:

• Many medications can cause "photosensitivity," or increased sensitivity to sunlight. Even if you don't usually sunburn, taking medications that cause this reaction could greatly increase your chances of getting a bad burn. Your pharmacist can advise you about whether your medication can cause photosensitivity and recommend the right SPF (skin protection factor) for your skin type.
  
  
• If you are flying, keep your medications in your carry-on luggage so that you have access to them during your flight and will not lose them in the event that your luggage gets lost. Plus, keeping your medications with you helps prevent exposure to extreme temperatures in the baggage compartment, which can alter the drug's effectiveness. Keep in mind that airport security requires that your medications be transported in their original, labeled containers.
  
  
• If your medication requires you to use a syringe - insulin, for instance - you may need to carry your prescription with you to ensure that you can pass through airport security. The American Diabetes Association recommends that people with diabetes be prepared to provide airport security personnel with copies of prescriptions for diabetes medications and supplies as well as complete contact information for the prescriber.
  
  
• Make sure that you carry your prescriber's and your pharmacy's phone numbers with you when you are away from home. In case you lose your medications, you may need a new prescription. You should also keep on hand a list of all your prescriptions.
  
  
• If you are traveling through several time zones, consult with your physician or pharmacist to work out a specific plan for adjusting the timing and dosage of your medications. This will prevent you from taking too much or too little.
  
  
• If you are visiting a foreign country, beware of buying "over-the-counter" medications. Many medicines that are available by prescription in the United States are available "over the counter" in other countries. Some of these medications could have different ingredients, and may not undergo comparable quality control. Buying these medications could put you at risk for allergic reactions, drug interactions, or other problems.
  
  
• If you are visiting a hot, humid climate, be sure to keep your medications in a cool, dry place out of direct sunlight. Never store medications in the glove compartment of your car. Also, because of the heat and humidity that build up in a bathroom, it is the worst place to store medication whether you are at home or on the road.
  
  
• Take along more medication than the number of days you've planned to be away. This will allow you to be prepared for unexpected delays.
  

For Children

Pediatric vaccines are important tools in the fight to prevent and eradicate disease. Because of this, parents should follow federal childhood immunization schedules. For more information, contact the National Immunization Hotline at 800-232-2522, e-mail your questions to nipinfo@cdc.gov, or click here.

For Adults

Influenza

Yearly flu shots can help Americans prevent many of the complications caused by influenza viruses. Click here for more information.

Pneumonia

• Pneumococcal disease (including pneumonia) is a bacterial infection that can be life-threatening and can cause:
  
  -- Lung infections, such as pneumonia, or
  -- Invasive infections such as bacteremia (bacteria in the blood) and meningitis (infection of the brain lining).
  
  
• Approximately 40,000 people die annually in the United States from pneumococcal disease. About half of these deaths could be prevented through the use of pneumococcal vaccine.
  
  
• Americans at highest risk-seniors age 65 and older and people with long-term illnesses, such as heart, lung, kidney, or liver disease, diabetes, or cancer-should receive the vaccine.
  
  
• Pneumococcal vaccine is typically a one-dose treatment and can be given any time of the year. A second dose of the vaccine is sometimes required.
  
  
• If you are currently age 65 or older and received your first pneumococcal vaccine five or more years ago (and were younger than 65 at that time), ask your health-care provider if you should be vaccinated again.
  
  
• Ask your hospital or health-system pharmacist if you have any questions about this or other medicines.
  
  

Material prepared with support from Merck Vaccine Division