High Alert Medications Medications that should be on high alert by thegza

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									                                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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