High Alert Medications Medications that should be on high alert in include: Notes: • Warfarin and other anticoagulants: Blood thinners. Getting too much of these can lead to bleeding problems including ulcers or cranial bleeding both which can lead to death. Not getting enough of the blood thinner medications can lead to clots including a stroke. [ Coumadin®, Heparin, Aspirin, Plavix®, Lovenox®, Ticlid®, Fragmin®, Danaparoid®) • Insulin and other antidiabetic agents: Getting too much can lead to hypoglycemia (low blood sugar) and death. Not getting enough can lead to hyperglycemia (high blood sugar) and death. [Insulin, glyburide, glipizide, metformin, pioglitazone] • Opioids (controlled substances, narcotics): Getting too much can lead to respiratory depression (shallow or decreased breathing) and death. Not getting enough can allow residents to suffer needlessly in severe pain. • Methotrexate Tablets: (other oral chemotherapy agents): Methotrexate is commonly used for arthritis. It may not be given each day so errors in dosage commonly occur. Getting too much leads to significant side effects and death. There are a lot of new oral chemotherapy medications that have similar concerns. • Chloral hydrate (other long acting sleep medications i.e. Valium®): These medications can put elderly at risk for falls. • Antipsychotics: In long term care typically responsible for the most adverse drug events typically falls, tardive dyskinesia and other movement symptoms. • Antibiotics: Many of these reactions may be minimal and go away on there own ie rash. However if therapy is stopped because resident refuses or developed a rash etc. that needs to be communicated for possible changes. The TOP TEN DANGEROUS drug interactions in the elderly: 1. Warfarin and Nonsteroidal Antiinflammatory Drugs NSAIDS: Aleve, Anaprox, Ansaid, Arthrotec, Cataflam, Clinoril, Daypro, diclofenac, diflunisal, Dolobid, etodolac, Feldene, fenoprofen, flurbiprofen, ibuprofen, Indocin, indomethacin, ketoprofen, ketorolac, Lodine, meclofenamate, meclomen, meloxicam, Mobic, Morin, nabumetone, Nalfon, Naprelan, Naprosyn, naproxen, Orudis, Oruvail, oxaprozin, piroxicam, Ponstel, Relafen, sulindac, Tolectin, tolmetin, Toradol, Voltaren 2. Warfarin and Sulfa medications SULFA: Bactrim, Cotrim, Eryzole, Gantanol, Gantrisin, Microsulfon, Pediazole, Septra, sulfadiazine, Sulfatrim, sulfamethizole, sulfamethoxazole 3. Warfarin and Macrolides MACROLIDES: Azithromycin, Biaxin, Clarithromycin, Dynabac, Dirithromycin, E-Mycin, erythromycin, EES, Ery-Tab, Eryped, Zithromax 4. Warfarin and Quinolones QUINOLONES: Alatrofloxacin, Avelox, Cipro, ciprofloxacin, enoxacin, Floxin, gatifloxacin, Levaquin, levofloxacin, lomefloxacin, Maxaquin, moxifloxacin, Noroxin, norfloxacin, ofloxacin, sparfloxacin, Tequin, trovofloxacin. 5. Warfarin and Phenytoin (Dilantin) 6. Ace Inhibitors and Potassium Supplements POTASSIUM: K-Dur, Klor-con, Micro-K 7. Ace Inhibitors and Spironolactone ACE INHIBITORS: Accupril, Aceon, Altace, benazepril, Capoten, captopril, enalapril, fosinopril, lisinopril, Lotensin, Mavik, noxipril, Monopril, perindopril, Prinivil, quinapril, ramipril, trandolapril, Univasc, Vasotec, Zestril. 8. Digoxin and Amiodarone (Cordarone, Pacerone) 9. Digoxin and Verapamil 10. Theophylline and Quinolones Adapted from the American Medical Directors Association and American Society of Consultant Pharmacists.
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