Medications: Promoting Safe and Appropriate Use. Prepared and funded through collaboration between: The Developmental Disabilities Council of Washington,

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.

Professional responsibility in a home-like setting.

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 person’s normal state? Just a “behavior”.

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+

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

Medication Errors- Where Might They Happen?

Physician Pharmacy Person transcribing to recording sheet Person administering.

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

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.

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

The 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.

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

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).

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

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

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 startsWhen dosage changesWhen old drug stopsWhen 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

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

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)

Same as prescription drugs. Still have risk for side effects, overdosing, cross-

reactions and allergic reactions. Should be used carefully. Often combination drugs-know what’s in the ones

being used!

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.

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

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!

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 AbilifyR 2002 Ziprasidone GeodonR 2001 Quetiapine SeroquelR 1998 Olanzapine ZyprexaR 1996 Risperidone RisperdalR 1994 Clozapine 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-Epileptics1912 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

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 won’t go away. Any fever or signs of infection.

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 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.

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.


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


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


Sudden or unusual change in movement level or in muscles.Seems 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.


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


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


Sudden or unexpected change in speech.Drooling or dry mouth.Seems to be slurring speech.Doesn’t seem to be talking much any more.


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


Sudden or unexpected mood changes:Grouchy, irritable, hard to get along with.Explosive behavior out of character.Crying, tearful, sad, withdrawn.Personality change.


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

Documents

Medications: Promoting Safe and Appropriate Use. Prepared and funded through collaboration between: The Developmental Disabilities Council of Washington,