Medications

Medications: Promoting Safe and Appropriate Use Prepared and funded through collaboration between: The Developmental Disabilities Council of Washington, The University of Washington Center on Human Development and Disability, Northwest Center, and Washington State Division of Developmental Disabilities Project Staff  Sharan Brown, JD, EdD Principal Investigator Kathleen Watson, PhD, RN Project Director/Trainer and Parent Esther Moloney Project Assistant and Parent   Basic Assumptions  YOU, as the caregiver, have the opportunity to improve the quality of life for each of the participants with whom you work.  YOU can do this by assuming that it is all up to you and therefore being pro-active, assertive and behaving like a detective. responsibility in a home-like setting.  Professional What Is Causing the Behavior? or discomfort?  Emotional distress due to situation or environment?  Symptom of a mental health problem?  Side effect or adverse effect of a medication?  Just the person’s normal state?  Just a “behavior”.  Pain Being an Informed Consumer Have one staff member who is the health advocate for each client: develop relationship with providers.  Use websites by reputable organizations such as universities.  Keep reference books such as those designed for nurses.  Drug guides  Encyclopedia/dictionary  Safety Medication Rights+ right Drug  in the right Dose  by the right Route  at the right Time  to the right Person.  For the right Reason  The Medication ErrorsWhere Might They Happen?  Physician  Pharmacy transcribing to recording sheet  Person administering.  Person Physician Errors Incorrect dose or regimen  Incomplete dosage or unavailable dosage form or strength  Quantity or duration of treatment not specified  Dose or regimen not specified  Incorrect drug for the therapeutic indication  Drug interactions  Allergy or sensitivity  Duplicate therapy  Pharmacy Errors prescription incorrectly.  Dispenses drug with similar name.  Types label wrong.  Mixes up labels.  Wrong strength.  Wrong amount.  Forgets to put special instructions on bottle.  Reads At-Home Errors MAR incorrect.  Forget a dose or give a dose twice.  Give to wrong person.  Give wrong amount.  Give earlier or later than ordered.  Not following instructions.  Given in spite of indications there might be a problem.  Give for the wrong reason.  Reasons for Concern and Questioning pills are a different color, shape or size.  The directions for the drug are different.  The label directions don’t make sense.  The person is behaving differently or has new or unusual symptoms.  The drug is one you think the person is allergic to.  The Safety Tips If directions on the label are not clear, ask the pharmacist or call the prescriber to clarify them. Always use the same pharmacy so they will have a record of all current drugs and allergies for each individual. It helps to get to know the pharmacist. Keep the medicine in the original container. Always double check yourself. Reading a Prescription Bottle of pharmacy with phone number.  Prescription number for refills.  Name of doctor who prescribed it.  Who the drug is for.  Name of drug.  Form and dosage of drug.  When it should be discarded (thrown away).  Name Reading a Prescription Bottle (cont’d) Strength (how much of the drug in each pill or spoon full).  Amount to take (how many pills or spoonfuls).  How often to take it (once a day, every two hours, etc).  By what route to take it (swallow, under tongue, in eyes or nose, etc).  Under what conditions to take it (after every meal, only when in pain, etc).  Adverse Drug Effects Adverse Drug Reactions effects.  Allergic reactions.  Over-dosage.  Unusual and unpredictable reactions.  Side Monitoring for Drug Effects Very important to know the person’s normal baseline.  Observe for anything out of the ordinary for that person.  Not reasonable to remember all the side effects for every drug residents take.  Be familiar with the most likely side effects for long-term drugs.  Be proactive in contacting the pharmacist or health care provider if you are concerned!  Record-Keeping  Note on calendar or on record:  When new drug starts  When dosage changes  When old drug stops  When changes are made  Keep updated list of all current drugs to share with health care providers. Generic vs. Trade Names A new drug has patent - only one company can make it for several years.  A new drug has both a generic and trade name.  The generic name is the chemical name.  The trade name is the same as the brand name.  After the patent runs out, other companies can make it under the generic name and may add their own trade name.  Examples of Generic and Trade Names (Motrin, Advil)  diphenhydramine (Benadryl, Compoz, Sominex 2)  pseudoephedrine (Sudafed, Drixoral non-drowsy)  phenytoin (Dilantin)  acetominophen (Tylenol, Panadol, Datril, Tempra)  ibuprofen Combination Drugs  Contain more than one drug in the same pill or liquid.  The name doesn’t always tell you what’s in it.  Important to know what’s there so clients don’t receive a double dose.  Most common in over-the-counter drugs such as cold remedies. Over the Counter (OTC) as prescription drugs.  Still have risk for side effects, overdosing, crossreactions and allergic reactions.  Should be used carefully.  Often combination drugs-know what’s in the ones being used!  Same Drug Classes on the main effects and actions of drugs  Some drugs fit in more than one class  Some drugs are used for other purposes than they were originally intended.  Drugs in the same class have some of the same side-effects.  Based Examples of Drug Classes  Antibiotic  Anti-epileptic  Anti-psychotic  Antihistamine  Decongestant  Antidepressant  Non-steroidal Anti-inflammatory (NSAID) Psychoactive Drugs Also called psychopharmacologic or psychotropic.  Drug classes:  Anti-anxiety (Xanax, BuSpar, etc)  Antidepressant (Elavil, Prozac, etc)  Anti-psychotic (Risperdal, Zyprexa, Haldol, etc)  Anti-mania (lithium)  Sedative/hypnotic (Restoril, Noctec, etc)  Stimulant (Ritalin)  Anti-seizure or Anti-epileptic (Tegretol, Neurontin)  Psychoactive Drugs to treat psychiatric conditions, but often given to control behavior.  Taken long term.  May have lots of side effects.  Must balance usefulness against side effects.  Doctor does the balancing based on the information we give her or him!!  Record-keeping helps a lot!  Intended Principles to Remember Monitor the condition or behavior the drug is being given for (eg., seizures, depression)  Be especially alert when a new drug is added, a drug is stopped or tapered off, or dosage is changed.  Set up a record-keeping system for behavior and side effects.  Make sure the participant gets to appointments for lab work.  Quality of Life Medications should improve the quality of life for participants, not make it worse.  Begin with the primary health care provider.  If quality of life seems to be declining rather than improving, seek help from local mental health center.  If this isn’t working, ask DDD Case Manager for assistance.  Be proactive and persistent!  Typical Antipsychotics  Chlorpromazine  Haloperidol  Fluphenazine  Thioridazine  Loxapine  Perphenazine Atypical Antipsychotics  Aripiprazole  Ziprasidone  Quetiapine  Olanzapine  Risperidone  Clozapine AbilifyR 2002 GeodonR 2001 SeroquelR 1998 ZyprexaR 1996 RisperdalR 1994 ClozarilR 1990 Anti-epileptic Drugs (AEDs) Some old standard ones and lots of new ones.  Some of the newer ones are also used for controlling behavior.  Important to monitor for side effects and keep seizure record.  Some require the provider to do periodic laboratory work to monitor for side effects.  Anti-Epileptics 1912 Phenobarbital 1993 Felbamate 1938 Phenytoin 1960 Ethosuximide 1974 Carbamazepine 1993 Gabapentin 1994 Lamotrigine 1997 Topiramate 1978 Valproate 1997 Tiagabine 1999 Levetiracetam 2000 Oxcarbazepine 2000 Zonisamide Anti-epileptics Important things to report affect level of alertness, balance, muscle tone, appetite, weight, mood.  Report any increased bruising or bleeding.  Any yellowing of skin or eyes.  A rash that gets worse or won’t go away.  Any fever or signs of infection.  May Anti-epileptics: Usual side effects • Usually short-term: • Skin rashes • Loss of co-ordination • Nausea or vomiting • Effects on thinking (could be long-term) • Most common: dizziness, headache, double vision, sleepiness Antibiotics taken with food to avoid stomach upset.  Some foods or medicines may interfere with absorption.  Watch for stomach upset or rashes.  Stop the drug immediately if rash, itching or difficulty breathing occurs.  Call 911 for problems with breathing or acute distress.  Some Important Side Effects To Observe and Report  Sudden or unusual skin color or temperature:  Bluish, red, pallor, yellow.  Rash or other unusual markings.  Feels hot or cold to the touch. Important Side Effects To Observe and Report  Sudden or unusual bowel or urinary change:  Diarrhea or constipation.  Frequent or infrequent urination.  Urination difficult, delayed or painful.  Bedwetting. Important Side Effects To Observe and Report  Sudden or unusual walking or gait changes: down.  Slow or shuffling walk.  Stumbling, poor balance, unsure of footing.  Falling Important Side Effects To Observe and Report  Sudden or unusual change in movement level or in muscles. slow, moves in slow motion, trouble getting started.  Jittery, antsy, pacing, can’t sit still, constantly jiggling or pumping legs, has to get out of chair after short period of time.  Muscle rigidity or stiffness.  Nausea, vomiting or gas.  Seems Important Side Effects To Observe and Report  Sudden or unusual change in sleep: longer or shorter.  Trouble getting to sleep.  Nightmares or bad dreams.  Sleeps Important Side Effects To Observe and Report  Sudden or unexpected change in eating or drinking: more or less.  Drinking more or less.  Eating Important Side Effects To Observe and Report  Sudden or unexpected change in speech. or dry mouth.  Seems to be slurring speech.  Doesn’t seem to be talking much any more.  Drooling Important Side Effects To Observe and Report  Sudden or unexpected fatigue. does not want to get up in morning.  Tired, day-time sleeping.  Sedation, lethargy, malaise.  Grogginess.  Suddenly Important Side Effects To Observe and Report  Sudden or unexpected mood changes:  Grouchy, irritable, hard to get along with.  Explosive behavior out of character.  Crying, tearful, sad, withdrawn.  Personality change. Important Side Effects To Observe and Report  Sudden and unexpected trouble concentrating: paying attention.  Trouble remembering things.  Trouble performing activity, work or play.  Trouble