Home medicine cabinet & medication expiry notes

Survival Manual/6. Medical/ c) General clinic/Medical & expiry notes

The home medicine chest (for when times are good)

What you need
•  A tube of antibiotic ointment for cuts and scrapes. If the tube touches an infected cut (especially one that’s full of pus), toss it and buy a new one.
•  A box of alcohol wipes. They’re much safer to have around than a bottle of rubbing alcohol, which is poisonous if swallowed. Use them to clean thermometers and the skin around wounds (stick to soap and water on open cuts,
since alcohol hurts).
•  Anti-diarrheal to relieve stomach upsets.
•  Antiseptic cream or liquid for cleaning cuts and  grazes.
•  Adhesive tape to secure bandages and dressings.
•  Aspirin/paracetamol/ibuprofen to relieve pain.
•  Cough formulas – chesty/dry/tickly.
•  Decongestants for stuffed, blocked nose.
•  Disposable gloves to protect against infection.
•  Hydrocortisone cream for bites & stings.
•  Mild laxatives to counter constipation.
•  Sharp scissors (with rounded ends).
•  Sun protection lotion (SPF 20 or higher).
•  Thermometer to monitor temperature (with sanitary sleeves).
•  Topical treatment for muscular pain.
•  Tweezers for removing foreign bodies
•  Anti-diarrhea medication. Your doctor may suggest this for mild cases of diarrhea.
[Photo above:  One of my two home medical cabinets, ca 2009.]

What to throw out:
By law, an over-the-counter medication must have an expiration date based on when it may have only 90 percent of its original potency. Check your medicine cabinet periodically, and discard pills in the toilet (not the bathroom trash can); pour liquids down the drain.
•  Any expired prescription drug (especially antibiotics  — some may be ineffective or even unsafe)
•  Any medicine that has changed color or developed a “funny” smell
•  Other products that may simply not work as well after their expiration dates: Painkillers, decongestants, cough suppressants, and other OTC medicines won’t be dangerous, but they may be slightly less potent.
•  Sunscreen should not be kept longer than three years (it can lose its effectiveness even earlier if regularly exposed to extreme heat).

Medication Expiration Dates
For further information on expiry dates read: <http://www.health.harvard.edu/fhg/updates/update1103a.shtml>
1.  A report of the American Medical Association (AMA) notes that the US Food and Drug Administration (FDA) and Pharmaceutical Research and Manufacturers of America (PhRMA) “were unaware of any comprehensive studies that addressed the clinical impact of pharmaceutical dates and no such studies were found in the peer-reviewed scientific literature” (AMA, 2008).
2.  In everyday terms, a medication expiration date is the point at which a batch of drugs has reached the end of the longest period of time the manufacturer has tested the continued potency and safety of
a medication. This process is known as stability testing.
3.  There are a couple of things to note here. First, the manufacturer is only required to provide testing results to the FDA for the duration at which it tested a drug; it is not required to test a drug until it is no longer viable. Say the company tests a drug’s stability at two years on the shelf and determines that the drug has no changes at this point. Then the FDA will require the company to stamp the packaging with an expiration date two years from the date of manufacture. Is the drug still good after that date? Well, it wasn’t tested — so no one can say for sure.
4.  What little I did find in the research journals all essentially referenced one long-term study conducted by the FDA at the request of the military. In 2000, Laurie P. Cohen in an article for the Wall Street Journal reported that between 1993 and 1998, the military had the FDA test more than 100 drugs –- both prescription and over-the-counter –- finding that 90% of these medications were safe and effective far past their original expiration date. In some cases, eight to fifteen years beyond their expiration dates. By 2008, the number of tested medications was up to 312.
5. 
As per Joel Davis, a former FDA expiration-date compliance chief, “most drugs are probably as durable as those the agency has tested for the military” (Altschuler in Kramer, 2003). Noted exceptions to this include nitroglycerin, insulin and some liquid antibiotics.
6.  “Wisdom dictates that if your life does depend on an expired drug, and you must have 100% or so of its original strength, you should probably toss it and get a refill, in accordance with the cliché, “better safe than sorry.” If your life does not depend on an expired drug –- such as that for headaches, hay fever, or menstrual cramps –- take it and see what happens” (Altschuler in Kramer, 2003). Pasted from <http://bipolar.about.com/od/medications/a/expir_when.htm>
7.  “In a study conducted by the FDA on a large stockpile of medications purchased by the military, 90% of more than 100 medications were safe and effective to use years after the expiration date. More recently, the FDA approved two-year extensions on expiration dates for a number of drugs, including the antibiotics Cipro (ciprofloxacin), penicillin, and tetracycline; the Tagamet (antiulcer/antireflux drug
 cimetidine); and Valium (diazepam), a tranquilizer. The drugs in the FDA study, however, were stored under ideal conditions — not in a bathroom medication cabinet, where heat and humidity can cause drugs to degrade”.

Note: You spend 90% of your health care dollars in the last year of your life. Insurance is something you buy that covers unlikely, but catastrophically expensive events.  End-of-life costs are not unlikely, they are inevitable. Tell your homeowners insurance company that you will have a fire that consumes your home within the next 10 years and then try to price that insurance.

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