Download Guidance for Staff on Medicines used to Treat Common Conditions

Appendix 22
Guidance for Staff on Medicines used to Treat Common Conditions
This guidance is designed to inform and support staff to understand the basic medicines used in
their work.
The following points apply to all medications that are administered to people
1
Medication can only be given to people by staff who have received and
successfully completed level 1 and 2 training, and have been assessed as
competent to administer medication.
2 Medication will only be given to the person for whom it has been prescribed.
3 All medication should be administered strictly in accordance with the prescriber’s
instructions.
4 All medication should be stored as directed on the label and used within the use by date.
5 Make sure you know as much as possible about the medication you are administering. If
you are unsure of any medication you can obtain information from the British National
Formulary reference book, which contains information regarding use, dosage, side effects
and alternative brand names.
6 Any medication administered to a person must be recorded on the appropriate Medication
Administration Record sheet. (MAR sheet) and signed by the staff member after the
medication has been administered.
7 Following the administration of medication, if the person displays any side effects, advice
should be sought from senior members of staff or medical advice sought (see Appendix
10a MHRA leaflet on side effects)
8 Any medication which has been purchased over the counter must be clarified with the
General Practitioner before administration.
9 People may not always report any symptoms of being unwell i.e. pain, nausea etc and this
could be due to a variety of reasons such as cognitive impairment, including learning
disabilities and dementia, communication needs or other physical or mental health needs.
Any concerns regarding the well being of a service used should be reported to a senior
member of staff promptly.
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Analgesia (Pain Killers)
These are some common medications used to control mild to moderate pain. These medications
can be either prescribed or bought over the counter.
Paracetamol
No more than 8 tablets in 24 hours. Take care that no other medication
containing paracetamol is given at the same time e.g. ‘Lemsip’ as too much
paracetamol can result in serious liver damage.
Co Codamol
Can cause constipation.
Ibuprofen
Anti-inflammatory
There are other painkillers which are similar e.g. Tramadol, Tylex, Dihdrocodeine, Codeine
Phosphate.
If the person is in moderate to severe pain then they will need their painkillers regularly, every 4-6
hours as prescribed. Painkillers work better if they are taken before the pain gets too bad. If the
pain is not relieved seek medical advice. Sometimes normal adult doses of painkillers can be too
strong for elderly people and cause confusion and disorientation.
Staff need to be aware that pain can have a significant impact on a person’s dignity and wellbeing. It can also exacerbate the behavioural and psychological symptoms of such illnesses as
dementia and could result in challenging behaviour. Staff should be aware of how to identify pain
and the methods used to treat pain.
When pain is severe and stronger analgesia is needed then the following medications may be
prescribed.
Controlled Medication
These medications are usually given to people who are in severe pain. The medications are very
strong and can be of an addictive nature; some of these medications are classified under the
Misuse of Drugs (Safe Custody) Regulations 1973 and must be stored in a controlled drugs
cupboard. After administration two staff must sign in a controlled drugs register and on the MAR
sheet wherever possible.
It is important that people who are in severe pain receive their painkillers regularly. If the pain is
not effectively controlled seek medical advice.
Most of these medications contain morphine, which can cause nausea (feeling sick) and usually
causes constipation.
Oramorph (M.S.T.)
This comes in both tablet and syrup form.
Diamorphine
This is usually given via syringe driver by a needle just below the skin
and administered by Community Nursing Services.
Durogesic
This comes in the form of a patch which is stuck on the skin like a
plaster.
Anti-emetics (medicines to prevent sickness and vomiting)
Sometimes these medications can be used to prevent sickness experienced when taking
medication for severe pain.
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Antibiotics
These are medications which fight infections. It is very important to finish the whole course of
tablets as this helps to kill the infection completely.
Some people are allergic to antibiotics, particularly Penicillin and can develop a serious reaction.
The reaction begins as a flat red rash spreading over the chest and arms and may develop into
severe breathlessness which will need emergency attention.
If a person knows they are allergic to Penicillin or any other antibiotic this must be recorded in the
Personal plan and on the MAR sheet.
There is another less serious side effect of antibiotics which is diarrhoea.
Commonly used antibiotics (3 examples)
Fluoxicillin
Often used for skin infections
Augmentin
Often used for chest and urinary tract infections
Amoxycillin
Can be used for all types of infection (commonly referred to as a broad
spectrum antibiotic)
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Medication for Asthma
Asthma is a disease of the lungs which results in difficulty in breathing. The tubes which we
breathe through become swollen and blocked making it difficult to breathe. Two types of
medications are used. The first type is a steroid which helps stop the tubes from swelling up in the
first place and the second type helps clear the tubes and makes breathing easier.
Medications for asthma are either swallowed in tablet form or are breathed directly into the lungs
by using an inhaler or a nebuliser.
Commonly used inhalers
Ventolin (Salbutamol)
This is inhaled via inhaler or nebuliser.
Ventolin can cause a rapid heartbeat as a side effect.
Atrovent, Becotide
These are also inhalers
Seretide
Flixotide
Commonly used tablets
Phyllocontinos
Singulair
Prednisolone
Side effects may include headaches, palpitations, muscle cramp
USE OF OXYGEN
Some service users may require Oxygen to breathe; therefore they will use some type of
equipment, usually cylinders or an oxygen concentrator machine.
Anyone using this equipment must have the generic risk assessment and an individual risk
management plan in place while using the service, due to the dangers involved with storage and
use of compressed gases.
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Sedatives
Sedatives are prescribed to service users who may be experiencing difficulties in relaxing due to
anxiety, stress, and insomnia.
Careful monitoring of the effect of these medications is necessary
1 They can make clients very drowsy the next day and if elderly, prone to falls.
2 They can make clients dependent on them (particularly Temazepam).
3 People can get used to them so that they do not work any more.
Commonly used medication
Diazepam
Lorazepam
Night Sedation
Temazepam
The majority of Schedule 3 Controlled Drug are exempt from the safe
custody requirements, however Temazepam is an exception to this and
must be:
stored according to the Misuse of Drugs (Safe Custody)
Regulations 1973
recorded in the Controlled Drugs register
administered by 2 members of staff (wherever possible) and
recorded and signed for by two staff on the MAR sheet (wherever
possible).
Zopiclone
Used for insomnia
Sodium Amytal
This is another controlled drug and must be checked the same way as
Temazepam.
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Anti Depressants
Anti depressants are used to treat depression and may take some time to be effective when
initially prescribed. They are used to elevate mood, increase physical activity and restore interest
in every day activities.
Examples include:
Lustral (Sertraline)
Prothiadin (Dothiapin)
Prozac (Fluoxertine)
Citalopram
Gamanil
This can be effective with elderly people.
Lithium (Priadel, Camcolit )
Used since 1940’s for manic depression, decreases the intensity
and frequency of incidents of extreme excitement to deep
depression
Side effects can include nausea, vomiting, dyspepsia, diarrhoea
The following medication is commonly used to treat people who may have mental health
concerns e.g. Dementia, Schizophrenia, Psychiatric or Psychotic illnesses
Haloperidol (Seranace)
Most widely used. Is effective in reducing violent, aggressive
behaviour and hallucinations.
Quetapine (Seroquel)
Used to treat Schizophrenia
Risperidone (Risperdal)
Helps to alleviate distressing symptoms of acute psychiatric
disorders and long term psychotic illness
Clozapine (Clozaril)
Used to treat Schizophrenia. Prescribed to people who have not
responded to other treatments or who have experienced
intolerable side effects with other drugs
Side effects may include tremor, abnormal face and body movements, restlessness
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Diuretics (Water tablets)
The heart needs to pump in a strong and regular beat to keep the circulation flowing properly
around the body. If this doesn’t happen several problems develop.
Blood starts to pool and this makes it lose some of its fluid into neighbouring tissues causing
swelling and discomfort. This can happen in the legs where the calves become swollen, tight and
eventually ooze clear fluid and in the lungs where clients keep coughing, become breathless and
sometimes feel that they are drowning as the amount of fluid builds up to unbearable levels. This
is called Heart Failure.
This is treated by giving the patient diuretics (water tablets). These tablets help get rid of all the
excess fluid which is turned into urine and passed away. This process also helps control high
blood pressure.
The person will go to the toilet more frequently when they are on diuretics.
There are many different types of diuretic. Here are a few examples.
Frusomide
Clients need to go to the toilet to pass urine, sometimes as soon as ½
hour after taking Frusomide.
Burinex
Frumil
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Medication used to treat heart conditions
Sometimes the heart must be made to beat slower and more regularly. The following medications
may be used.
Capoten (Captopril)
Innovace (Enalapril Maleate)
Tenormin (Tenolol)
Lanoxin (Digoxin)
Many of these tablets also help control high blood pressure.
Side effects may include sleep disturbances, fatigue and stomach upset.
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Diabetic Medication
Diabetes is a condition where the body cannot digest glucose. Glucose is the substance that is
formed after digesting sugary foods and carbohydrates (bread, rice, pasta, biscuits, potatoes etc.)
Insulin is the hormone required to digest glucose and some people are unable to produce this.
When people cannot produce their own insulin it must be given artificially. If insulin is not given
then the person will gradually lapse into a coma (hyperglycaemic or diabetic coma) and eventually
die. This is called Type 1 Diabetes or insulin dependent Diabetes.
Some people can produce their own insulin but not enough. Tablets can help by reducing the
glucose levels or by stimulating the production of slightly more insulin, enough to make digestion
possible. This is type 2 Diabetes.
When people are taking insulin it is vital that care staff observe the amount they eat at every
mealtime. If the person is not hungry and rejects the meal he/she must be given an alternative.
This is because the dose of insulin is calculated to last for most of the day and to digest all the
carbohydrate (glucose) that the person would be expected to eat. If less carbohydrate than
expected is eaten there is too much insulin and this results in the client becoming confused,
sweaty, aggressive and comatose (hypoglycaemic coma).
The person’s blood sugar should be checked regularly as directed by the G.P. and their urine
tested regularly for ketones.
Medical advice should be sought if the person is ill and/or reluctant to eat or drink.
Examples of tablets used for controlling diabetes are:
Daonil (Glibenclamide)
Diamicron (Gliclazide)
Glucophage (Metformin)
Rastinon (Tolbutamide)
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Medications to prevent the blood clotting
(Anti coagulants)
These are given to people who have had problems with their blood clotting. This causes problems
when parts of the clot enter the circulation and block off important blood vessels resulting in a
stroke if this happens in the brain and deep vein thrombosis if it happens in the legs.
People who are on anti coagulant therapy are looked after by their G.P. and also by the hospital
who calculate the dose of the tablets depending on the results of regular blood tests.
Important points to remember for clients on anti coagulants
1 Take the tablets regularly as prescribed.
2 Contact the G.P. immediately if too many tablets have been taken by mistake.
3 Inform the G.P. of any more frequently or unusual bleeding e.g. nose bleeds.
4 Test urine weekly or more frequently if client is ill and report any result showing blood.
5 Attend the anti coagulant clinic as directed.
Examples
Marevan (Warfarin)
Heparin
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Medication to Treat Dementia
Medicines used in the treatment of dementia are generally used in one of two ways. The first way
is to try and effectively treat the actual dementia itself whilst the second way is to treat the
symptoms that people who have dementia may experience i.e. depression, anxiety, agitation,
sleep disorders and hallucinations, to name a few.
The most commonly known medicines for treating dementia are donepezil (Aricept), rivastigmine
(Exelon), galantamine (Reminyl), and the newest of these type of drugs memantine (Ebixa).
These medicines generally work by increasing the levels of acetylcholine, a chemical messenger
in the brain which is known to be involved in memory, judgement and other thought processes.
What this may mean for the individual, although everyone will react differently, is that their memory
loss may slow and they are able to reason and/or understand things better or for longer.
Unfortunately these acetylcholinesterase inhibitors do not stop the underlying destruction of nerve
cells within the brain and their ability to improve symptoms eventually declines as brain cell
damage progresses.
The National Institute for Health and Clinical Excellence (NICE)1 have issued updated guidance in
March 20112 which advises when people can have these medicines. These medicines are used
to treat the symptoms of Alzheimer’s disease, but do not slow the progression of the disease.
They are not usually recommended for other forms of dementia as the evidence for their
effectiveness is limited and, in some cases, may make the symptoms worse.
Anti-psychotics are the treatment primarily used to treat the behavioural and psychological
symptoms of dementia, such as aggression or agitation. These medicines were originally
developed to treat mental health conditions such as schizophrenia and other psychoses (delusions
and/or hallucinations), agitation, severe anxiety, mania and violent or dangerously impulsive
behaviour. However the use of these drugs is not usually recommended for the treatment of
dementia because of the risks associated with taking them.
Antipsychotics are usually only used in cases where there are severe symptoms of challenging
and disruptive behaviour that is judged to place the person with dementia or others at risk of harm.
Antipsychotics will be prescribed at the lowest dose possible and or as short a time as possible.
The person’s health will also need to be carefully monitored whilst they are taking antipsychotics
The following commonly used antipsychotics licensed for use in the UK: are risperidone
(Risperdal, Risperdal Consta), olanzapine (Zyprexa), amisulpride (Solian), and clozapine
(Clozaril, Denzapine), chlorpromazine (Largactil), flupentixol (Depixol), sulpiride (Dolmatil,
Sulpor) and haloperidol (Dozic, Haldol, Serenace). This is not an exhaustive list of the range of
antipsychotics available or used.
Information from The Alzheimer’s Society3 indicates that there is no evidence of any beneficial
effects of antipsychotic symptoms in people with dementia with Lewy bodies, and
there are currently no clinical trials looking at these drugs in people with vascular dementia.
Other commonly prescribed drugs may be used to treat symptoms that people with dementia may
experience i.e. anti-depressants for depression, benzodiazepines for anxiety states (generally
best avoided due to risk of excessive sedation, unsteadiness and a tendency to fall. These drugs
may also accentuate any confusion and memory deficits that are already present), and hypnotics
for sleep disturbances.
1
National Institute for Health and Clinical Excellence http://www.nice.org.uk/
National Institute of Health and Clinical Excellence – TA217 Alzheimer’s disease - Donepezil, galantamine,
rd
understanding NICE guidance 23 March 2011.
3
Alzheimer’s Society Factsheet 408 Dementia: drugs used to relieve depression and behavioural symptoms
2
rivastigmine and memantine:
http://www.alzheimers.org.uk
Sunderland City Council – Medication Procedures for Adults and Older People
Appendix 22
Other common conditions of people
using Adult Services
Parkinson’s Disease
This is a progressive degenerative disease that effects the nervous system, suffers can develop a
tremor, shuffling gait and rigidity.
Common medications are Co-beneldopa
Multiple Sclerosis (MS)
This is the degenerative wasting of muscles and can cause stiffness and rigidity of limbs.
Common medication is Baclofen
Epilepsy
This is a condition that causes electrical abnormality in the brain, causing the person to have a
seizure. Seizures can be very mild or very severe.
Common medications are Sodium Valporate, Clobazam, Carbamazepine
Stroke
A stroke occurs when the blood supply to the brain is interrupted and suffers a lack of Oxygen. A
stroke may leave a person mildly or severely disabled and can affect not only limbs but speech
also.
Medications used to prevent strokes are Aspirin and Warfarin.
Huntingdons Disease
This is a heredity condition that affects the nervous system and results in loss muscle tone and
involuntary movements.
Medications commonly used are Tetrabenazine
Sunderland City Council – Medication Procedures for Adults and Older People