Medication stewardship

Added: 2026-05-31

[00:00:26]Hello friends good evening friends I am Doctor Sanjay Kalra you are friendly and familiar endologist and you are watching our baro buddies. We see you every Wednesday at Barrow Buddies.

[00:00:35]And we have a buddy. We have a friend, a friend, a companion, a companion who helps us navigate life with obesity. Arrow means wait and a warm welcome to Sapna Jain madam from Vellore. Tamil Nadu and also Ram ji Agarwal saheb. Hello everyone.

[00:00:52]Our topic today is From the Horse's Mouth. This is our ongoing series and today we will talk about medication stewardship.

[00:01:02]Now at Barrow Buddy, our job is to help make friends with people who are living with obesity.

[00:01:10]People who live with obesity. Most of the time when you live with obesity, some medicine or the other is required.

[00:01:14]You might be taking anti-obesity medications which are directly linked to weight loss. But more than that, and more frequently, we might be taking medicines that reduce complications or comorbid conditions. For example, if someone has blood pressure or diabetes, they also need medicines. Taking care of all this is medication stewardship.

[00:01:40]Now we can discuss medication study in different aspects.

[00:01:42]Firstly, whose responsibility is it?

[00:01:47]Who is responsible? And who has the second right?

[00:01:50]Whose rights are these? So who's responsibility is it and who's rights is medication counseling. Now it is everyone's responsibility. Everybody, the doctor who has prescribed, the pharmacist who has explained, the nurse who has counseled, all of these have the responsibility of counseling regarding medication.

[00:02:12]At the same time the person himself and herself. People who are taking medicines for obesity or complications have to be stewards for themselves. You have to take care of yourself.

[00:02:21]You cannot adjudicate all your responsibility for your body to other people. But sometimes the person living with disease like obesity is not able to manage on his own.

[00:02:33]A warm welcome to Tirupus another. So you need help of family members, friends, close ones. So it is everyone's responsibility. It is everyone's responsibility to help in medication counselling.

[00:02:47]Whose rights are these? Whose rights are these? They also belong to everyone. Of course the person who lives with the disease has a right to be counselled has a right to get stewardship. But also the family members, the people who he lives with, who she lives with, they also have a right. At the same time, doctors and nurses also have rights. They are also human beings. They also have their rights. So let's look at these rights and responsibilities again before we move on to exactly what medication counseling is.

[00:03:16]Now, it is the doctor's right that the patient listens carefully.

[00:03:23]Discuss, listen to what is said. But what happens sometimes in the OPD? We are talking about rights and resiliency. But there is a concept of reality as well. There are so many patients you want to explain what is to be done and you would like to do it in a more efficient and effective manner, so one right that the doctor and nurse have is that the patient should also cooperate, talk to them lovingly, do not speak angrily, do not talk rudely, do not talk sarcastically and many times when we say that you should bring the medicine, we explain to you how to take it, tell you how to take the vaccine, then the patient says no sir, I will buy it from such and such shop, I will buy it from any shop in my house.

[00:04:03]If so, you have a right to that. But then the shopkeeper who sold the medicine will tell you about medication counselling or medication stewardship. Then they will talk about the injection technique and how to take the medicines. But that is always not possible. This is the era of super specialties. There are so many medicines, so many vaccines. No single doctor, no single pharmacist, no single human being can know all the medicines. That is impossible, it is impossible. So one request to everyone is that if your doctor has prescribed any medicine, especially any vaccine, then you should bring it and along with that you should understand how to take the medicine and how not to take it.

[00:04:47]Despite this, sometimes mistakes happen and shortcomings remain. But if you expect someone to explain to you over the phone or WhatsApp how to take the vaccine, that is a sure shot way of making mistakes and getting into trouble. So it is the right of the doctor and nurse to bring the medicine and understand it well before leaving. The patient has the right that if the medicine is with him then we should explain it to him again and again.

[00:05:09]Once, twice, six times, that is your right. It is your right to ask before and after eating. You have the right to ask about tea with milk.

[00:05:18]Now sometimes it becomes too much that whether I take it in a copper jug, with water or in a steel jug. Now some questions are being asked just for the sake of being asked just to waste time. So please don't do this. And there is a theory of karma. There is the theory of karma.

[00:05:33]If you waste someone's time, it is possible that someone else may waste your time tomorrow.

[00:05:37]So there is a responsibility, there is a right, but you also have to look at reality.

[00:05:45]Now what is it that we need to know and Ram ji Agarwal sir asks which is the easiest medication? These general new diabetes medicines are very easy to use. There is not much difference between before and after eating. The medicines that we used earlier, 20-30 years ago, were given like this, 30 minutes before meals.

[00:06:06]Thyroid medicines are also easy to use. But we have to remember to take it with at least water and at least 30 to 60 minutes before breakfast.

[00:06:16]Try not to take any other medicine four hours before or after thyroid medicine. The new medicines for obesity and diabetes that have come, GLP One Scepter N Vaccine, it is very easy to administer, it is very simple, but now there are so many companies in the market, the medicine may be the same, Tapetite and Semagltite, but the number of delivery devices is mind-boggling, all of them have different types of pens, different types of syringes, so even the chemist and the doctor will get confused if you ask theoretically how to use it, if you bring the medicine which is prescribed and show it to the doctor or the nurse, they will happily teach you whether it is a disposable pen and a reusable pen, whether the pen has got single dose and multiple dose, it is flexi dose and fixed dose or prefilled syringe.

[00:07:06]So when the thing is lying in front, the delivery device is lying there, then there is no difficulty in using it.

[00:07:14]Some medicines, such as oral semaglutide, also need to be taken before meals. 30 to 60 minutes before the first meal with maximum 100 ml of water i.e. half a glass of water. But overall, medicines have become much easier to use compared to two and three days ago.

[00:07:32]Now let's talk about specific medication counseling. The obesity medicines available in Nairobodies are mostly injections.

[00:07:40]You can have once a week injection or once a day injection. The once weekly injections are tezepatide and semaglutide.

[00:07:48]As we said, there are many different types of pens. Delivery devices are syringes and vials. So please bring the medicine learned from the nurse and doctor before going home. In case you are not comfortable with a particular delivery device or you do not like the pen, vial and syringe are also available. If you don't like vial and syringe, pen is available. Some pens will come with a dose of only 2 mg.

[00:08:15]Some will come with a dose of 15 mg.

[00:08:17]So there are different types of pens. But be aware that the number of delivery devices is so much. No chemist can stock all the medicines. This is not possible even for a chemist. They simply wo n't have enough space in their shop or refrigerator to stock all the different types of delivery devices. So whenever you take medicine, take only that medicine which is easily available and your doctor may be prescribing two or three different brands. He must be writing well.

[00:08:46]All Are Of Good Quality. All are approved by DCGI. And it is a matter of pride for us that our Indian medicines for obesity are approved even in a place like Canada.

[00:08:57]So, in medication counselling, you should understand that you should bring the medicine but if you are very uncomfortable with the delivery device, do talk to your doctor and say that I would prefer this is true and true a delivery device is available and chances are he will tell you yes, we will change your brand and this thing is available for you. Doctor Noor Agha will salute Danish and Eid Mubarak Doctor Sahib, Doctor Danish has locked in from Kabul, Eid Mubarak to you and pray for peace and prosperity across the world, we are celebrating Eid tomorrow in India.

[00:09:27]So we are celebrating Eid tomorrow.

[00:09:30]Eid Mubarak to our fellow citizens a day in advance. And to Dr. Danish today.

[00:09:36]Akshay Aadi ji asks do I need to maintain four hour gap between thyroid medicine and pantoprthol? The Answer Is Yes We Do Need To. 50-60 minutes if possible but otherwise ideally four hours is what is suggested. With antibiotics there won't be too much of an issue. Even 30 minutes will be fine. Vinayak Sharma ji also join us in wishing and Eid Mubarak to Doctor Danish and good evening Vinayak it is good to have you with us so we are talking of medication counselling we said we understood that the rights and responsibilities of all are not only of the patients but also of the poor doctors and nurses all that we request is human human behaviour and we request that you bring the medicine so that we can explain to you only the theoretical explanation you should get it done in the OPD and then take the medicine from the chemist later. That doesn't work. Ok? Now we are talking about anti- obesity medication. The delivery devices for the injections need to be taken care of. By a delivery device which your doctor has prescribed and which is available. If your doctor has prescribed it. It is his and her responsibility to make it available in the near by chemist shops. But the doctor cannot take responsibility for a shop that is located 50 and 100 km away. Away Even 10 km. Away.

[00:10:53]Some are also injections once a day like Lira Glutide this was used earlier but now it is not used so frequently because the once weekly drugs are more effective and more economical as well now we do have capsules usually used in obesity this is also not used so frequently but we do use it in adolescents so the dose is 60 to 120 mg to be given 30 to 60 minutes before a meal usually 30 minutes before meals and with this comes yellow colour stool.

[00:11:25]Now that we do medication counseling, We Should Talk About Black BLAC's B for Benefits. What are the expected benefits? So when you take antiobesity medicine, your weight will reduce and waste will reduce.

[00:11:39]And you can also tell the expected time duration. So with the same gluteal effect, you may feel less hungry in a few days in a week and so on. You will start feeling lighter in two weeks.

[00:11:51]The stomach will go inside. The waist circumference will come down and weight will also start to decrease within three to four weeks. Even if it doesn't happen for four to one week, do n't worry. We will increase the dose. That is B for benefits. L is for limitations.

[00:12:08]When we give the medicine Dr. Noora Ask About Same Glotide. It will not replace diet and exercise. It is an add on. It is a complement to diet and exercise. So the limitation is that the drug is not going to replace diet and exercise.

[00:12:25]A is for adverse events. What adverse events can occur? Adverse events may be in the form of nausea, loss of appetite, fullness of the stomach. So this can happen. It can last for three, four, six, eight days. Then it will be fine. If so, these are the medicines you can take. These Are the Folk Remedies You Can Follow. Like in our part of the country we will if you are full, constipated, take a sweet soda.

[00:12:51]Sodium bicarbonate half a pinch in the morning, afternoon and evening and that will help you. Doctor Noor Ask About the Maximum Dose of Semaglutide. So in South Asia the maximum dose of oral ceclotide is 14 mg a day. But international studies have been done on 50 mg a day as well. But for us 14 is the maximum. Injectable 2.4 mg once a week is the maximum dose for us but abroad they have done studies up to 7.2 mg what are to be kept in mind while prescribing GLP one RA a doctor myth said doctor Bharat Praveen ask so we are talking about counselling black pl a ck let's just complete this first so B is for benefits we have to explain l for limitations a for adverse events c for cost what is the cost of the therapy and k for knowledge what is the knowledge required to take the medicine the knowledge required to take the medicine is that we should rule out all the contraindications a common contraindication would be diabetic gastroparesis in which there is already stomach jam sa rehti hai not a good idea to start GLP one RA first first you fix the gastroparesis another contraindication is medullary thyroid carcinoma but this is Very rare I have not been diagnosed in the past 25 years that does not mean it does not exist but it is rare and the third contra indication would be frequent pancreatitis.

[00:14:18]Apart from this any woman of child bearing age who is planning pregnancy she can take GLP one earlier to reduce weight but not while she is planning actively so these drugs are contra indicated when you are planning pregnancy.

[00:14:33]With Semagaltite you don't need to change the choice of contraception. But if someone is taking tergepetite and you increase the dose of tergepetite then you have to either add a barrier contraception and you have to shift to intrauterine contraceptive device. The reason for this is that the bioavailability of oral contraceptives decreases with dyspepsia. Another thing to be kept in mind is that if you are starting active Tetracycline or Semaglutide in a lady patient and she has a history of premenstrual syndrome then you might as well wait for the follicular phase. Let your periods come.

[00:15:11]After that start the medicine so that acceptance is higher. We will also talk about meditation. Ram ji Agarwal sir is asking. We will talk about what we have spoken in the past and later on we will also talk about meditation. Not only medication but meditation. A warm welcome to Dr. Pradeep Rawal from Ujjain and Madhya Pradesh. Akshay Aadi ji asks Sitaglipin and Medfmin 50 plus 1000 combination causes weight loss. So this does n't happen usefully. It is weight neutral. But 1000 mephamin twice a day is quite a heavy dose to take. It becomes quite heavy. This may be accompanied by loss of appetite. Hello to Sartaj Singh ji also. Sat Srilal Adab for being with us. It's great being with you. So we're talking about medication counseling for the person living with obesity. Medication isn't it is a part of life. Medication is of no use unless you take it properly.

[00:16:04]That is what medication counseling or medication stewardship is. So we explained how to take the medicine. Lack benefits, limitations, adverse events, cost and knowledge were explained. We teach how to take the injection. Now if adverse events come then how to handle them.

[00:16:24]For someone on semaglotide and you might wish to take if vomiting occurs, Onase mouth dissolving tablets or Prochlorperazine mouth dissolving tablets. If someone has gas or gastritis feeling then you may wish to add Rebazol and Pantoprol.

[00:16:41]If there is prominent constipation or prominent diarrhea, the medicine will be changed. But all these things get cured in a few days.

[00:16:48]Some people may have only nocturnal diarrhea for one to two days in a week. This has to be explained that the body is gradually adjusting to the drug. And this too will be fine in a week or two. Many doctors, many people like taking probiotics and pre- probiotics, they call them synbiotics.

[00:17:05]And in this also there are different brands which are there for constipation predominant and for diarrhea predominant patients.

[00:17:17]This is Medications Towards from the Doctor's Point of View from the Health Care Professional's Point of View. From the person's point of view, try to be errant, try to be persistent. Do not skip the medicine.

[00:17:28]Take it at the right time. If you see that the medicine is about to run out, then buy it in advance.

[00:17:32]Depends upon where you are living in the country. How much electricity is there, how much is not there, how many power cuts occur.

[00:17:39]No Need To Buy Lots Of Injections To Store In Your Fridge When You Know That You Won't Have Uninterrupted Electricity. It's better than to buy fresh supplies from the ah chemist. At the same time it is possible. You may be living far away from the city. There's rain, there's fog, there's storm and then you want to stock up. Maybe we live in the Himalayas and we want to stock up before winter. So take medicine accordingly so that you can get through the entire winter.

[00:18:07]Medication stewardship also includes diet and exercise. Like We Said Medication Is Not Enough Alone. Diet and exercise also have to be followed.

[00:18:15]Whatever precautions have been told, please follow them all. But most of all I would like to reach out to the family members for medication. Step encourage the person living with obesity and with other diseases. Keep things optimistic. Help them when they take the medicine. Do not look down upon them. Do not laugh at them. Just say or do a small vaccine. You are looking good, smart and handsome.

[00:18:44]So that is the way to practice medications towards encouraging your patients to take the right therapy at the right time. A single message to everyone today is medication stewardship, which is the responsibility of all of us. We all have rights.

[00:18:59]But those who are associated with the medical profession should also give a good explanation. The patient who is coming should also understand the reality and at least bring the injection when they want to learn the technique.

[00:19:13]The people who take care of the person at home are the most important. Keep things happy, keep things optimistic, encourage your patient, your family member to take the medicine at the right time, help them maintain their diet and exercise. Do not criticize them and do not unnecessarily create situations which we call cruelty. Culinary cruelty means knowingly eating unhealthy food in front of someone. Don't do that to tease him.

[00:19:40]Tomorrow is Eid. Everything can be eaten. It is Bakrid. And it is a good idea to have high protein foods. This will not affect your diabetes at all.

[00:19:51]With this discussion on medications towards shim.

[00:19:53]We Will Meet You Again Next Week Every Wednesday, Professor Nitin Kapoor and I meet you in Barrowbodies. And this caution, this awareness that we are sharing amongst ourselves is of great benefit to everyone. It will only be beneficial if we share it further. So please share the points about good health with your friends and love boy. Gall bladder Sardar ji asks, yes sir, gas is formed.

[00:20:17]If you are feeling uneasy then get an operation done for gall bladder stones. Its indigenous medicine is mostly ineffective. Thank you everyone for your kindness. We would like to thank Faraz Bhai the most who is with us even on a holiday today. So before we conclude Faraz, I have a question for you and the question is Doctor Danish wants to ask you what will you eat tomorrow on Eid? That is our question to Farage who takes care of us on KK Met Talks and on Barrowbody every week.

[00:20:53]So now Faraz is a shy boy but here comes Faraz yes thank you so much sir I would like to thank you sir you have given me the opportunity again to share a stage with you so sir when it comes to food then sir we are from Indian family and in Indian family there is no control, I mean I eat whatever I get, it is not there even in Afghanistan yes sir so like sir first of all there is food but how to digest that food like that that is more what you are taking how to balance it if you are eating non veg then sir along with that you should eat slaked salad so that things remain balanced so like tomorrow I will eat everything but but in control sir because I am in your company so sir I will have to think and act very balanced message coming across from Faraz and please join us in wishing Faraz