Medications:

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Medications

• Promoting Safe
• and Appropriate Use

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Prepared and funded through collaboration
betweenThe Developmental Disabilities Council
of Washington,The University of Washington
Center on Human Development and Disability,
Northwest Center, and Washington State
Division of Developmental Disabilities
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Project Staff

• Sharan Brown, JD, EdD
• Principal Investigator
• Kathleen Watson, PhD, RN
• Project Director/Trainer and Parent
• Esther Moloney
• Project Assistant and Parent

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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.
• Professional responsibility in a home-like
  setting.

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What Is Causing the Behavior?

• Pain 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 persons normal state?
• Just a behavior.

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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

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Safety
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Medication Rights

• The right Drug
• in the right Dose
• by the right Route
• at the right Time
• to the right Person.
• For the right Reason

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Medication Errors- Where Might They Happen?

• Physician
• Pharmacy
• Person transcribing to recording sheet
• Person administering.

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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

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Pharmacy Errors

• Reads prescription incorrectly.
• Dispenses drug with similar name.
• Types label wrong.
• Mixes up labels.
• Wrong strength.
• Wrong amount.
• Forgets to put special instructions on bottle.

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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.

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Reasons for Concern and Questioning

• The pills are a different color, shape or size.
• The directions for the drug are different.
• The label directions dont make sense.
• The person is behaving differently or has new or
  unusual symptoms.
• The drug is one you think the person is allergic
  to.

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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.

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Reading a Prescription Bottle

• Name 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).

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Reading a Prescription Bottle(contd)

• 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).

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Adverse Drug Effects
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Adverse Drug Reactions

• Side effects.
• Allergic reactions.
• Over-dosage.
• Unusual and unpredictable reactions.

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Monitoring for Drug Effects

• Very important to know the persons 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!

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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.

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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.

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Examples of Generic and Trade Names

• ibuprofen (Motrin, Advil)
• diphenhydramine (Benadryl, Compoz, Sominex 2)
• pseudoephedrine (Sudafed, Drixoral non-drowsy)
• phenytoin (Dilantin)
• acetominophen (Tylenol, Panadol, Datril, Tempra)

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Combination Drugs

• Contain more than one drug in the same pill or
  liquid.
• The name doesnt always tell you whats in it.
• Important to know whats there so clients dont
  receive a double dose.
• Most common in over-the-counter drugs such as
  cold remedies.

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Over the Counter (OTC)

• Same as prescription drugs.
• Still have risk for side effects, overdosing,
  cross-reactions and allergic reactions.
• Should be used carefully.
• Often combination drugs-know whats in the ones
  being used!

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Drug Classes

• Based 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.

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Examples of Drug Classes

• Antibiotic
• Anti-epileptic
• Anti-psychotic
• Antihistamine
• Decongestant
• Antidepressant
• Non-steroidal Anti-inflammatory (NSAID)

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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)

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Psychoactive Drugs

• Intended 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!

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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.

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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 isnt working, ask DDD Case Manager for
  assistance.
• Be proactive and persistent!

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Typical Antipsychotics

• Chlorpromazine
• Haloperidol
• Fluphenazine
• Thioridazine
• Loxapine
• Perphenazine

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Atypical Antipsychotics

• Aripiprazole AbilifyR 2002
• Ziprasidone GeodonR 2001
• Quetiapine SeroquelR 1998
• Olanzapine ZyprexaR 1996
• Risperidone RisperdalR 1994
• Clozapine ClozarilR 1990

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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.

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Anti-Epileptics

• 1912 Phenobarbital 1993 Felbamate
• 1938 Phenytoin 1993 Gabapentin
• 1960 Ethosuximide 1994
  Lamotrigine
• 1974 Carbamazepine 1997 Topiramate
• 1978 Valproate 1997
  Tiagabine
• 1999
  Levetiracetam
• 2000
  Oxcarbazepine
• 2000
  Zonisamide

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Anti-epilepticsImportant things to report

• May 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 wont go away.
• Any fever or signs of infection.

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Anti-epilepticsUsual 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

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Antibiotics

• Some 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.

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Important Side EffectsTo 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.

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Important Side EffectsTo Observe and Report

• Sudden or unusual bowel or urinary change
• Diarrhea or constipation.
• Frequent or infrequent urination.
• Urination difficult, delayed or painful.
• Bedwetting.

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Important Side EffectsTo Observe and Report

• Sudden or unusual walking or gait changes
• Falling down.
• Slow or shuffling walk.
• Stumbling, poor balance, unsure of footing.

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Important Side EffectsTo Observe and Report

• Sudden or unusual change in movement level or in
  muscles.
• Seems slow, moves in slow motion, trouble getting
  started.
• Jittery, antsy, pacing, cant 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.

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Important Side EffectsTo Observe and Report

• Sudden or unusual change in sleep
• Sleeps longer or shorter.
• Trouble getting to sleep.
• Nightmares or bad dreams.

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Important Side EffectsTo Observe and Report

• Sudden or unexpected change in eating or
  drinking
• Eating more or less.
• Drinking more or less.

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Important Side EffectsTo Observe and Report

• Sudden or unexpected change in speech.
• Drooling or dry mouth.
• Seems to be slurring speech.
• Doesnt seem to be talking much any more.

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Important Side EffectsTo Observe and Report

• Sudden or unexpected fatigue.
• Suddenly does not want to get up in morning.
• Tired, day-time sleeping.
• Sedation, lethargy, malaise.
• Grogginess.

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Important Side EffectsTo 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.

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Important Side EffectsTo Observe and Report

• Sudden and unexpected trouble concentrating
• Trouble paying attention.
• Trouble remembering things.
• Trouble performing activity, work or play.