medication-manager

name	medication-manager
description	Comprehensive medication management skill for tracking prescriptions, monitoring adherence, checking drug interactions, managing refills, and providing medication education. Supports chronic medications, PRN/as-needed drugs, and complex multi-drug regimens. Triggers on: medication, prescription, drug, medicine, pill reminder, refill, interaction, side effect, my meds, when to take, dosage.
allowed-tools	["bash","glob","read"]
version	1.0.0

Medication Manager — Your Personal Pharmacy Assistant

Comprehensive medication management skill to help you take the right medications at the right time, avoid dangerous interactions, and stay on top of refills.

Core Capabilities

💊 Medication Tracking

• Current prescriptions and dosages
• PRN (as-needed) medication logs
• Over-the-counter supplements
• Allergy medications and emergency meds

⏰ Adherence Monitoring

• Daily medication schedule
• Adherence rate calculation
• Missed dose tracking
• Pattern analysis (e.g., weekend effect)

⚠️ Safety Checks

• Drug-drug interaction screening
• Drug-allergy cross-check
• Contraindication alerts
• Side effect monitoring

📦 Supply Management

• Refill reminders
• Days supply tracking
• Prescription expiration alerts
• Pharmacy coordination

Medication Categories I Track

By Schedule

Type	Description	Examples
Scheduled	Taken at specific times	Daily BP meds, twice-daily diabetes meds
PRN (As-Needed)	Taken when symptoms occur	Pain relievers, rescue inhaler
Cyclic	Based on cycles or phases	Hormonal contraceptives, fertility meds
Tapering	Gradually changing dose	Steroid tapers, antidepressant discontinuation
Single Course	Short-term treatment	Antibiotics (usually 7-14 days)

By Purpose

• Chronic disease management (ongoing)
• Symptom relief (PRN)
• Preventive (vaccines, prophylaxis)
• Supplements (vitamins, minerals, herbs)

Data Structure

medication-registry.json

{
  "active_medications": [
    {
      "id": "med_001",
      "name": "Lisinopril",
      "generic_name": "lisinopril",
      "brand_names": ["Prinivil", "Zestril"],
      "drug_class": "ACE Inhibitor",
      "purpose": "hypertension",
      "prescribed_by": "Dr. Smith",
      "prescribed_date": "2025-08-10",
      "dosage": {
        "strength": "10",
        "unit": "mg",
        "form": "tablet"
      },
      "schedule": {
        "type": "fixed_time",
        "frequency": "daily",
        "times": ["08:00"],
        "with_food": false,
        "instructions": "Take in the morning"
      },
      "supply": {
        "quantity_dispensed": 90,
        "quantity_remaining": 45,
        "days_supply": 90,
        "days_remaining": 45,
        "refills_left": 2,
        "refill_due": "2026-04-15",
        "pharmacy": "CVS Pharmacy #1234"
      },
      "adherence_log": [
        {"date": "2026-03-20", "taken": true, "time": "08:05", "notes": ""}
      ],
      "side_effects": ["dry_cough"],
      "allergies_related": false,
      "status": "active"
    }
  ],
  "discontinued_medications": [...],
  "adherence_summary": {
    "overall_30day": 0.94,
    "overall_7day": 1.0,
    "by_medication": {
      "med_001": 0.95,
      "med_002": 0.93
    }
  }
}

prn-medication-log.json

{
  "medications": [
    {
      "name": "Acetaminophen",
      "max_daily_dose": "4000mg",
      "usage": [
        {
          "date": "2026-03-19",
          "time": "14:30",
          "dose": "500mg",
          "reason": "headache",
          "effective": true
        }
      ],
      "monthly_usage": {
        "march_2026": 6
      }
    }
  ]
}

Universal Drug Interaction Check

Severity Levels

Level	Description	Action Required
Contraindicated	Never combine	Absolute avoidance
Major	May be life-threatening	Usually avoid combination
Moderate	Significant concern	Monitor closely, may need dose adjustment
Minor	Minimally significant	Monitor, usually manageable

Common Major Interactions to Watch

Drug 1	Drug 2	Effect	Management
Warfarin	Aspirin/NSAIDs	Increased bleeding	Avoid or monitor INR closely
ACE-I/ARB	Potassium supplements	Hyperkalemia	Avoid combination
Statins	Clarithromycin	Myopathy/rhabdomyolysis	Use azithromycin instead
Metformin	Contrast dye	Lactic acidosis	Hold metformin 48h before/after
MAOIs	Tyramine foods	Hypertensive crisis	Strict dietary restrictions

Adherence Tracking

Adherence Calculation

Adherence Rate = (Doses Taken / Doses Prescribed) × 100

Example:
- Prescribed: 1 tablet daily × 30 days = 30 doses
- Taken: 28 doses
- Adherence: (28/30) × 100 = 93.3%

Adherence Interpretation

Rate	Category	Action
≥95%	Excellent	Maintain current regimen
85-94%	Good	Monitor for barriers
75-84%	Fair	Identify and address barriers
<75%	Poor	Immediate intervention needed

Common Barriers to Adherence

1. Forgetfulness → Reminder systems, pill organizers
2. Complex regimen → Simplify if possible, combination pills
3. Side effects → Discuss alternatives with doctor
4. Cost → Generic alternatives, patient assistance programs
5. Lack of understanding → Education about condition/medication
6. Cultural beliefs → Address concerns respectfully

Refill Management

Refill Timeline

Days Remaining	Action
7-10 days	Request refill
3-5 days	Urgent refill needed
<3 days	Contact pharmacy immediately
0 days	Emergency supply may be needed

Automatic Refill Criteria

• Chronic maintenance medications
• Stable dosing for >3 months
• No recent changes
• Good adherence history

Special Medication Protocols

Warfarin Management

• INR monitoring: Weekly when starting, then per protocol
• Target INR: Usually 2.0-3.0 (individualized)
• Diet: Consistent vitamin K intake
• Interactions: Many drugs affect INR

Insulin Management

• Types: Rapid, short, intermediate, long-acting
• Timing: Critical for meal-time insulin
• Storage: Refrigerate unopened; room temp for in-use
• Monitoring: Blood glucose before each dose

Opioid Management

• Risk assessment: Opioid risk tool at initiation
• Monitoring: Pain scores, functional improvement
• Naloxone: Recommended for high doses or risk factors
• Disposal: Safe disposal of unused medication

Biologics

• Storage: Refrigeration critical
• Timing: Precise intervals
• Missed dose: Specific protocols per drug
• Infection risk: Screen for TB, hepatitis

Output Report Format

# Medication Management Report — March 20, 2026

## 💊 Current Medications (4 Active)

### Morning Medications (8:00 AM)
| Medication | Dose | Purpose | Days Left | Refills | Adherence |
|------------|------|---------|-----------|---------|-----------|
| ✅ Lisinopril | 10mg | BP | 45 | 2 | 95% |
| ✅ Metformin | 1000mg | Diabetes | 30 | 1 | 93% |
| ✅ Atorvastatin | 20mg | Cholesterol | 60 | 3 | 100% |

### Evening Medications (8:00 PM)
| Medication | Dose | Purpose | Days Left | Refills | Adherence |
|------------|------|---------|-----------|---------|-----------|
| ✅ Metformin | 1000mg | Diabetes | 30 | 1 | 93% |
| ✅ Aspirin | 81mg | Heart | 90 | 5 | 98% |

---

## 📊 Adherence Summary

### Overall Adherence (Last 30 Days)
| Period | Rate | Status |
|--------|------|--------|
| Overall | 94.2% | ✅ Good |
| Last 7 days | 100% | ✅ Excellent |
| Last 30 days | 94.2% | ✅ Good |

### By Medication
| Medication | 7-Day | 30-Day | Pattern |
|------------|-------|--------|---------|
| Lisinopril | 100% | 95% | Consistent |
| Metformin AM | 100% | 93% | Missed weekends |
| Metformin PM | 100% | 93% | Missed weekends |
| Atorvastatin | 100% | 100% | Perfect |
| Aspirin | 100% | 98% | Very good |

**Insight**: Weekend adherence drops for Metformin. Consider linking to consistent daily activity.

---

## ⚠️ Safety Checks

### Drug Interactions
**Status**: ✅ No major interactions detected

**Minor Interactions to Monitor**:
- Metformin + Lisinopril: Potential for kidney function changes
  - Action: Ensure regular kidney function tests

### Allergy Cross-Check
**Status**: ✅ No conflicts with known allergies

Known Allergies: Penicillin (anaphylaxis), Sulfa (rash)

### Contraindications
**Status**: ✅ No contraindications for your conditions

### Side Effect Tracking
| Medication | Reported Side Effects | Severity | Action |
|------------|----------------------|----------|--------|
| Lisinopril | Dry cough | Mild | Monitor, may need alternative |
| Metformin | GI upset (initial) | Resolved | — |
| Atorvastatin | None | — | — |

---

## 📦 Refill Status

### Upcoming Refills
| Medication | Current Supply | Refill Due | Refills Left | Action |
|------------|---------------|------------|--------------|--------|
| Lisinopril | 45 days | Apr 15 | 2 | Schedule in 2 weeks |
| Metformin | 30 days | Apr 5 | 1 | Schedule now |
| Atorvastatin | 60 days | May 10 | 3 | No action needed |
| Aspirin | 90 days | Jun 15 | 5 | No action needed |

### Prescription Expiration Alert
⚠️ **Metformin prescription expires**: May 10, 2026
- Action: Schedule doctor appointment before May for renewal

---

## 🔄 PRN (As-Needed) Medications

### Usage This Month
| Medication | Max Daily | Used This Month | Last Used | Notes |
|------------|-----------|-----------------|-----------|-------|
| Acetaminophen | 4000mg | 6 doses | Mar 19 | Headache relief |
| Ibuprofen | 1200mg | 2 doses | Mar 15 | Back pain |
| Lorazepam | 2mg | 0 doses | — | Not used (good) |

### Pattern Analysis
- Acetaminophen: Used 6 times for headaches
  - Recommendation: Track headache triggers, discuss with doctor if >10/month

---

## 📅 Daily Schedule

### Optimized Medication Schedule

8:00 AM (with breakfast): ✓ Lisinopril 10mg ✓ Metformin 1000mg ✓ Atorvastatin 20mg (can take any time, but morning is consistent)

8:00 PM (with dinner): ✓ Metformin 1000mg ✓ Aspirin 81mg

**Tips**:
- Atorvastatin can be taken morning or evening; choose consistent time
- Taking Metformin with meals reduces GI upset

---

## 💡 Recommendations

### Adherence Improvement
1. **Weekend Routine**: Set phone reminders for Saturday/Sunday doses
2. **Pill Organizer**: Consider weekly pill box for visual confirmation
3. **Pharmacy App**: Enable automatic refill reminders

### Safety Optimization
1. **Lisinopril Cough**: If dry cough persists, ask doctor about ARB alternative
2. **Kidney Function**: Ensure next lab work includes creatinine/eGFR
3. **Medication List**: Carry updated list to all appointments

### Cost Optimization
1. **Metformin**: Already generic, cost optimized
2. **Lisinopril**: Ask about 90-day supply for cost savings

---

## 🚨 Emergency Information

### In Case of Emergency
Your medications include:
- Blood pressure medication (do not stop abruptly)
- Blood thinner (aspirin — inform medical team)
- Diabetes medication (may need glucose monitoring)

### Overdose Protocol
**If you took too much**:
1. Call Poison Control: 1-800-222-1222 (US) or local emergency number
2. Do not induce vomiting unless instructed
3. Have medication bottles ready

---

## 📋 Action Items

### This Week
- [ ] Request Metformin refill (30 days remaining)
- [ ] Report dry cough to doctor (discuss ARB alternative)

### This Month
- [ ] Schedule doctor appointment for prescription renewals
- [ ] Review medication list with pharmacist

### Ongoing
- [ ] Continue daily adherence tracking
- [ ] Log any new side effects

---

## 🔗 Cross-References

| Skill | Relationship |
|-------|--------------|
| musculoskeletal-care | NSAIDs tracking for orthopedic pain management |
| chronic-care | Disease-specific medication management |
| symptom-assistant | Side effect assessment |
| nutrition-advisor | Drug-food interactions |

---

**Disclaimer**: This medication report is based on your records and general drug information. Always consult your pharmacist or physician before making medication changes. In case of adverse reactions or emergencies, contact healthcare providers immediately.

**Last Updated**: March 20, 2026