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General Approach to Medications

Paul Auerbach, M.D.

Better life through pharmaceuticals, or so it seems. As a wilderness medicine doctor, indeed as a physician in general, I receive many questions about medications. Without dwelling on any particular drug, there is a general approach to the use of medications that seems sensible to me. Over-the-counter (“OTC”) medications are often sufficient for simple medical problems (like minor skin irritations or symptomatic relief of diarrhea), but fall short for serious problems (like an allergic reaction or rapidly progressive infection caused by bacteria. For instance, for a severe allergic reaction, you may need epinephrine (also known as adrenalin) in injectable form, and for the infection, you may need an antibiotic(s). Both of these categories of drug require a doctor’s prescription, at least in the U.S.

In my opinion, an excellent way to acquire these medications is to bring a list of what you intend to carry to your personal physician. Explain that the medications are being used to supply a medical kit, and ask your doctor to explain each medication to you in terms of indication(s), dose, duration of administration, and side effects. Be certain to learn if a drug is part of a particular “class” of drugs. For instance, acetazolamide (Diamox) is used to prevent and treat acute mountain sickness is a “sulfa” drug, so a person allergic to that class of drugs should probably be advised to not use it. If your doctor doesn’t have time to provide the explanations, then obtain this information from a pharmacist. Write everything down. Don’t carry medications if you don’t understand what they are and their appropriate use. Also, you should know the shelf life of each medication, so that the drugs can be replaced when they are outdated. Furthermore, you should know which drugs lose potency in extreme temperatures, if you will be exploring in very hot or cold environments. Finally, encourage each member of your traveling party to carry his or her own prescription medications, and to inform you where they are kept so that you will have ready access in a medical emergency.

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1 Comments:

  • At Tue Nov 14, 06:08:00 PM 2006, Blogger Jeremy Joslin, MD said…

    A simple suggestion to your readers would be to somehow contact your doctor before your visit to allow him/her some time to check on the current recommendations for your particular destination or activity.

    You might be surprised but many non-wilderness-medicine-oriented physicians might be hard-pressed to fill you in on the use of Diamox or Decadron at altitude.

    A simple note, fax, or email to your doctor in reasonable advance will give them time to gather the best advice and be more comfortable writing that prescription for you. Those of us on the East coast go alooooong time between scripts for Diamox and such so keep this in mind before asking for them as an "oh, by the way..." on your way out the door.

     

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