Download Staff`s Role With Meds - THERAPY TIPS, TOOLS and HANDOUTS

STAFF’S
ROLE
WITH
MEDICATION
BIRTH
RITALIN
PROZAC
VIAGRA
DEATH
C. Koblin
6/3/2016
CONTENTS
 THE MEDICATIONS
 MULTIPLE USES OF MEDICATIONS
 ABUSED MEDICATIONS
 THE PATIENTS
 GENDER AND OTHER GROUP DIFFERENCES
 PRESCRIBING FOR CHILDREN
 THE PROBLEMS
 SIDE EFFECTS
 MEDICATION-BORNE ILLNESSES




TARDIVE DYSKINESIA
SEROTONIN SYNDROME
LONG QT SYNDROME
OTHER
 DISCONTINUATION
 INTERACTIONS
 POTENTIAL FOR OVERDOSE (not included)
 THE SOLUTIONS




LAB WORK
AIMS
TO EAT OR NOT TO EAT
WHEN TO ACCESS THE NURSE
 THE ROLE OF STAFF






NONCOMPLIANCE
SUPPLY (running out)
MEDICATION CHANGES
MISCELLANEOUS PROBLEMS
RESISTANCE
COMPETING CHEMICALS
 ARE YOU OVERSTEPPING?
 GLOSSARY
 MEDICATION LIST - attached
 BRAND NAME and GENERIC - attached
MULTIPLE USES OF MEDICATIONS
DRUG
USES
Cymbalta – antidepressant
chronic anxiety, low back pain, chronic pain, hot
flashes, peripheral neuropathy, fibromyalgia,
urinary retention (not in U.S.)
(FDA approved) (close to FDA approval)
Abilify – antipsychotic
dementia, Alzheimer’s, irritability with autism
Paxil - antidepressant
premature ejaculation
Lamictal - anti-seizure
depression, bipolar disorder, mood stabilization
Neurontin - anti-seizure
depression, nerve pain, migraines
Desyrel – antidepressant
sleep aid, alcohol cravings, panic disorder, ED
(adjunct)
Inderal - high blood pressure and
heart disease
performance anxiety
Risperdal – antipsychotic
Alzheimer’s disease, dementia, eating disorders,
irritability with autism
Topamax - anti-seizure
migraines, bipolar disorder, depression, nerve pain
Gabitril - anti-seizure
depression, mood stabilization
Tegretol - anti-seizure
Seizure disorder: adults and children
Trigeminal neuralgia
Glossopharyngeal neuralgia
Manic and mixed episodes of Bipolar I Disorder
(Equetro extended-release tablets only)
Pain associated with shingles
Alcohol and Cocaine withdrawal
Abnormally aggressive behavior
Migraine headaches
Benedryl - antihistamine
•
•
•
•
•
•
•
Allergic symptoms
Itchiness
Common cold
Insomnia
Motion sickness
Extrapyramidal symptoms
Local anesthetic
MULTIPLE USES OF MEDICATIONS
Tofranil - antidepressant
• Pain, bedwetting, urinary retention (Europe)
Tricyclics – antidepressants
• fibromyalgia, chronic tension headaches,
diabetic neuropathy, post-herpetic neuralgia,
cancer pain
Desyrel 50 mg. & Tryptophan 500 mg.
• aggressive behavior
Anafranil – OCD
• Autism, separation anxiety in dogs
Vyvanse – ADD
• Binge-Eating Disorder (January 2015)
Haldol
•
•
•
•
•
•
•
•
•
•
•
•
•
Bipolar with mania – injectable
Drug or alcohol-induced psychosis
Psychosis associated with high fever or metabolic disease
Hyperactivity, aggression
Agitation component of delirium
Uncontrollable, severe behavioral disorders in children and adolescents
Agitation and confusion from cerebral sclerosis
Alcohol and opioid withdrawal
Severe nausea and emesis in postoperative and palliative care, especially for palliating
adverse effects of radiation
Chemotherapy in oncology
Treatment of neurological disorders, such as tic disorders, Tourette’s, chorea
Intractable hiccups
Also used in aquaculture to block dopamine receptors to enable GNRHA function for
ovulation use in spawning fish
ABUSED MEDICATIONS
TYPE OF DRUG
Prescription
Opiates
NAMES
Morphine,
Hydrocodone,
Fentanyl, Methadone,
Oxycodone, Codeine
Anti-Anxiety
Xanax, Klonopin,
Valium, Ativan, Buspar
Stimulants
Dextroamphetamine
Methylphenidate
Amphetamines
NOTES
• act on the same receptors as heroin
• produce sedating or calming effects in
the same manner as the club drugs GHB
and Rohypnol
• higher doses like PCP or ketamine,
producing similar out-of-body
experiences
• When crushed it destroys the slowrelease mechanism allowing a rush
similar to amphetamines or crack
• Snorted or injected
• When injected other ingredients that are
meant to be processed by the digestive
system goes into your bloodstream
• Can cause embolisms (blood clots) or
abscesses in the veins or at the site of
injection
• Can cause extreme depression, insomnia,
confusion, hallucinations, seizures, and
anxiety attacks.
• Achieve their effects by acting on the
same neurotransmitter systems as
cocaine
Antidepressants
Wellbutrin
MAOI’s
Parnate
Nardil
Moban
• Increase dopamine like stimulants if dose
is 4-5 times higher, and won’t show on
drug screens
www.ctvnews.ca/healthheadlines
GENDER DIFFERENCES
•
•
•
•
•
•
•
•
•
•
•
WOMEN
Greater pain relief from opioids (estrogen
modulates pain relief?)
More likely to relapse—particularly in the
middle of the menstrual cycle, when
glucose in the brain is lower. Glucose is
necessary for self-control
50 and 75 percent more likely to
experience side effects
Antidepressants
• respond better to SSRI’S than men
(particularly Zoloft)
SSRI’s meds may be absorbed more quickly,
which can increase their toxicity
Body fat may trap antidepressants in the
body longer
Sleep aids
More of the drug in their system the next
morning—creating problems when they
have to be alert for work and driving
Stomachs are less acidic and feel the effects
of antianxiety medication faster and more
powerfully, and the drugs could be more
toxic
Women may need to wait longer before
taking a second dose, especially of
benzodiazepines
Ambien was discovered to be doubly
potent for women
•
www.scientificamerican.com
Men
• More likely to overdose on painkillers
• May have better luck with tricyclics
• Liver breaks down Ambien and other sleep
aids faster
• Kidneys filter out drug compounds faster
• Men's kidneys filter out drug compounds
faster
NON-GENDER
• For veterans wounded in the gut it is hard
to treat PTSD because of impact on
serotonin levels
• Can be true possibly for some gastric
procedures
OTHER GROUP DIFFERENCES
CHILDREN
•
NIMH funded the Preschoolers with ADHD Treatment Study (PATS), which involved
300 preschoolers (3 to 5 years old) diagnosed with ADHD. The study found that low
doses of the stimulant methylphenidate are safe and effective for preschoolers
•
Children of this age are more sensitive to the side effects, including slower growth
rates
SENIORS
•
Even healthy older people react to medications differently than younger people
because their bodies process it more slowly
•
Lower or less frequent doses may be needed
PREGNANT/NURSING
•
•
•
Antidepressant medications DO cross the placental barrier and may reach the fetus
Research is
Research shows SSRI’s associated with miscarriage or birth defects
interesting
Research shows no support for this
•
Research shows fetuses exposed to SSRI’s during the third trimester may be born with
"withdrawal" symptoms such as breathing problems, jitteriness, irritability, trouble
feeding, or hypoglycemia (low blood sugar)
•
Research shows most studies have found that symptoms in babies are
generally mild and short-lived, no deaths have been reported
•
Women who stop taking their antidepressant medication during pregnancy
may get depression again and may put both themselves and their infant at risk
•
Mood stabilizers are known to cause birth defects
•
Benzodiazepines may cause birth defects or other infant problems, especially if taken
during the first trimester
•
Benzodiazepines and Lithium have been shown to cause "floppy baby syndrome,"
•
Haloperidol has been studied more than others, and has been found not to cause
birth defects
•
A small amount of the psychiatric medications pass into breast milk
www.ncbi.nim.nih.gov
PRESCRIBING FOR CHILDREN
CONDITIONS
1.
Attention deficit hyperactivity disorder (ADHD)-marked by a short attention span, trouble
concentrating and restlessness. The child is easily upset and frustrated, often has problems
getting along with family and friends, and usually has trouble in school.
2.
Bedwetting-if it persists regularly after age 5 and causes serious problems in low selfesteem and social interaction.
3.
Obsessive-compulsive disorder (OCD)-recurring obsessions (troublesome and intrusive
thoughts) and/or compulsions (repetitive behaviors or rituals such as handwashing,
counting, or checking to see if doors are locked) which are often seen as senseless but that
interfere with a youngster's daily functioning.
4.
Depression-lasting feelings of sadness, helplessness, hopelessness, unworthiness, guilt,
inability to feel pleasure, a decline in school work and changes in sleeping and eating
habits.
5.
Anxiety (school refusal, phobias, separation or social fears, generalized anxiety, or
posttraumatic stress disorders)-if it keeps the youngster from normal daily activities.
6.
Eating disorder-either self-starvation (anorexia nervosa) or binge eating and vomiting
(bulimia), or a combination of the two.
7.
Bipolar (manic-depressive) disorder-periods of depression alternating with manic periods,
which may include irritability, "high" or happy mood, excessive energy, behavior problems,
staying up late at night, and grand plans.
8.
Psychosis-symptoms include irrational beliefs, paranoia, hallucinations (seeing things or
hearing sounds that don't exist) social withdrawal, clinging, strange behavior, extreme
stubbornness, persistent rituals, and deterioration of personal habits. Psychosis may be
seen in developmental disorders, severe depression, schizoaffective disorder,
schizophrenia, and some forms of substance abuse.
9.
Autism-(or other pervasive developmental disorder such as Asperger's Syndrome)characterized by severe deficits in social interactions, language, and/or thinking or ability to
learn, and usually diagnosed in early childhood.
10.
Severe aggression-which may include assaultiveness, excessive property damage, or
prolonged self-abuse, such as head-banging or cutting.
11.
Sleep problems-symptoms can include insomnia, night terrors, sleep walking, fear of
separation, or anxiety.
acap.org
PRESCRIBING FOR CHILDREN
ALLOWABLE AGE TO START
DRUG
haloperidol (FGA)
paliperidone (SGA)
perphenazine (FGA)
Antipsychotic Medications
[ABILIFY]
10 and older for bipolar disorder, manic, or
mixed episodes; 13 to 17 for schizophrenia
and bipolar; 6 to 17 for irritability associated
with autistic disorder
[HALDOL]
3 and older
[INVEGA]
12
[TRILAFON]
12
pimozide (FGA)
[ORAP]
12(for Tourette’s disorder)
quetiapine (SGA)
[SEROQUEL]
risperidone (SGA)
[RISPERDAL]
13 and older for schizophrenia; 18 and older
for bipolar; 10 to 17 for treatment of manic
and mixed episodes of bipolar disorder
13 for schizophrenia; 10 for bipolar mania
and mixed episodes; 5 to 16 for irritability
associated with autism
aripiprazole (SGA)
thioridazine (FGA)
clomipramine (TCA)
[MELLARIL]
2
Antidepressant and Mood Stabilizer Medications
[ANAFRANIL] 10 (for OCD only)
doxepin (TCA)
escitalopram (SSRI)
[SINEQUAN]
[LEXAPRO]
12
12-17 (for major depressive disorder)
[LITHIUM]
12
imipramine
[TOFRANIL ]
6 (for bedwetting)
sertraline
[ZOLOFT ]
6 (for OCD only)
valproic acid
[DEPAKOTE]
2 (for seizures)
oxcarbazepine
[TRILEPTAL]
4
lisdexamfetamine dimesylate
[VYVANSE]
6
fluoxetine
[PROZAC]
8
fluvoxamine
[LUVOX]
FGA – 1st generation
SGA – 2nd generation
8 (for OCD only)
PRESCRIBING FOR CHILDREN
lorazepam
Anti-Anxiety Medications
[ATIVAN]
8
atomoxetine
[STRATTERA]
6
ADHD Medications
clonidine extended release (ER) IR- not approved for children
[CATAPRES, KAPVAY]
ER - 6-17 years old
methamphetamine
(“Desoxyn is given out in controlled tablet doses, while Crystal Meth is a
crystalline substance that is smoked, injected or swallowed in much larger
doses”)
6
Amphetamine/extended release [ADDERALL]
3/ 6 (XR)
dextroamphetamine
[DEXEDRINE]
3
guanfacine
[INTUNIV]
6
methylphenidate…
[RITALIN, CONCERTA]
6
Ages listed may have dose ceilings, which will increase with age.
nimh.nih.gov/health/publications/mental-health-medications
SIDE EFFECTS
Antidepressants
Sexual
Sedation
modest weight • all phases of
loss with
sexual function,
bupropion and
including libido,
modest weight
arousal, and
gain with
orgasm
mirtazapine and • both FGAs and
paroxetine
SGAs can impair
(Ludiomil, Paxil)
arousal and
orgasm in men
and women
• FGAs especially
have been found
to cause erectile
and ejaculatory
dysfunction in
men, including
spontaneous,
painful, or
retrograde
ejaculation, as well
as priapism
Remeron
Fanapt Saphris
Brintellix
Clozaril Zyprexa
Cymbalta
Most tricyclics
Weight gain
Antipsychotics
Wellbutrin
Celexa
Lexapro
Prozac
Zoloft
Effexor XR
Anticholinergic Some tricyclics
(blocks activity of
nerves responsible for control
of heart rate, gut
motion, and rate
of saliva
production )
http://www.aafp.org
http://www.ncbi.nlm.nih.gov
http://portal.mah.harvard.edu
Mood Stabilizers
←
1st,2nd generation
antipsychotics
←
All
Haldol
Latuda
Risperdal/Invega
Zyprexa!!!!!!!!
Seroquel
Fanapt
Risperdal
especially prominent
with weaker-binding
first-generation
antipsychotics, as well
as with the secondgeneration
antipsychotic clozapine
high with
lithium and
valproate and
low with
carbamazepine,
lamotrigine, and
oxcarbazepine
Trileptal
does not
seem to be
dose
dependent
SIDE EFFECTS
AIMS (vs. PARKINSONIAN vs. EXTRAPYRAMIDAL) :
This is a collection of abnormal movements effecting voluntary muscles and coordination
of the neck, spine, gait/walking, oral/facial, fingers, limbs. Also problems with eyes
(oculogyric crisis), thick tongue, cogwheeling, vocalizations, breathing and swallowing.
ANTICHOLINERGIC:
Dry mouth, decreased sweating, headache, dilated pupils, blurred vision, urinary hesitancy
& retention
TOXIC ANTICHOLINERGIC:
May resemble psychosis (disorientation, confusion, hallucination, delusions, anxiety,
agitation, and restlessness); dilated, non-reactive pupils; blurred vision; hot, dry, flushed
skin; dry mucous membranes; difficulty swallowing; decreased/absent bowel sounds; urine
retention; hyperthermia; tachycardia; hypertension; increased respiratory rate.
OBESITY
SEIZURES
MEMORY LOSS
DIABETES
SUNBURN
ACNE
HYPERTENSION
ALLERGIC REACTIONS
COGNITIVE IMPAIRMENT
Partial list of psychiatric medications known to cause heat or sun sensitivity
**Lithium causes excessive loss of fluids, such as through excessive sweating,
and can cause the lithium level in your blood to become too high.
Range is 0.5 – 1.5
**Drink plenty of liquids and use salt unless instructed not to do so.
MEDICATION ILLNESSES
(TARDIVE DYSKINESIA and GYNOMASTIA)
DEFINITION
TARDIVE – “describing a disease in which a period of time passes between exposure and the
first symptoms.”
DYSKINESIA – “Impaired ability to make voluntary movements”
“Tardive dyskinesia is a serious side effect that occurs when you take medications called
neuroleptics. Most often, it occurs when you take the medication for many months or
years. In some cases, it occurs after you take them for as little as 6 weeks.”
“If diagnosed early, the condition may be reversed by stopping the drug that caused the
symptoms. Even if the drug is stopped, the involuntary movements may become
permanent, and in some cases, may become worse.”
EXTRAPYRAMIDAL SYMPTOMS
•tremor
•akathisia (motor restlessness)
•slurred speech
•dystonia (continuous spasms
and muscle contractions, ex.
oculogyric crisis)
•bradyphrenia (slowed thought
processes)
•bradykinesia (slowed movement)
•muscular rigidity
•
•
•
•
•
facial grimacing
finger movement
jaw swinging
repetitive chewing
tongue thrusting
www.nlm.nih.gov
GYNOMASTIA
DEFINITION
Hormonal imbalance resulting in a decrease
in testosterone as compared to estrogen,
resulting in enlarged male breast tissue.
RISKS
Possible pain, embarrassment
CONTRIBUTING DRUGS
Risperdal
MEDICATION ILLNESSES
(SEROTONIN SYNDROME and LONG QT SYNDROME )
SEROTONIN SYNDROME
DEFINITION
• Illness that occurs when medications cause high
levels of serotonin to accumulate in your body.
Symptoms usually occur within several hours of
taking a new drug or increasing the dose of a
drug. This includes prescribed drugs, street
drugs and dietary supplements.
• Milder - go away within a day of stopping the
medications, taking drugs that block serotonin.
• Severe - can be fatal
CONTRIBUTORS – not all-inclusive
• All antidepressants
• Anti-migraine medications: Imitrex, Tegretol,
Depakote
• Pain medications: Flexeril, Fentanyl, Demerol,
Tramadol (Ultram), Lithium
• Illicit drugs: LSD, Ecstasy, cocaine,
amphetamines
• Herbal supplements: St. John's Wort, ginseng,
nutmeg
• Over-the-counter cough and cold medications
containing dextromethorphan
LONG QT SYNDROME
DEFINITION
•
•
Long QT syndrome (LQTS) is a heart rhythm
disorder that can potentially cause fast,
chaotic heartbeats. These rapid heartbeats
may trigger a sudden fainting spell or
seizure. In some cases, your heart may beat
erratically for so long that it can cause
sudden death.
You can be born with a genetic mutation
that puts you at risk of long QT syndrome.
In addition, certain medications and
medical conditions may cause long QT
syndrome.
www.currentpsychiatry.com
www.mayoclinic.org
SYMPTOMS INCLUDE:
• HIGH FEVER
•
•
•
•
SEIZURES
IRREGULAR HEARTBEAT
UNCONSCIOUSNESS
agitation or restlessness
•
•
•
•
•
•
•
•
•
•
confusion
rapid heart rate
high blood pressure
dilated pupils
loss of muscle coordination or muscle rigidity
twitching muscles
heavy sweating
diarrhea
Headache
shivering/goose bumps
GREATER IMPACT DUE TO
•
•
•
•
•
age >65
female
electrolyte imbalances (specifically low
serum potassium and magnesium
levels)
high or toxic serum levels of the
suspected drug
preexisting cardiovascular impairment,
such as bradycardia
ALSO DEPENDENT UPON
•
•
•
•
overdose
combined with other
toxic levels
predisposition
DISCONTINUATION and INTERACTIONS
DISCONTINUATION (Not always recognized for what it is)
Antidepressants
• sudden withdrawal include feeling sick, vomiting, loss of appetite, headaches, dizziness,
chills, insomnia, anxiety and panic, brain zap
Antipsychotics
• earlier, and often more severe, illness episodes than are seen with gradual
discontinuation
• withdrawal dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant
syndrome
Antipsychotics and Lithium, or certain anticonvulsant drugs
• rapid versus gradual discontinuation is more likely to lead to greater mood instability and
manic relapse
INTERACTIONS
• May affect: absorption, distribution, metabolism, elimination
• Can result in serum concentration changes are generally most relevant for drugs with a
narrow therapeutic index such as lithium and clozapine, where increases or decreases
play a role in worsening clinical condition or increasing the risk of serious adverse effects.
• pharmacodynamic - result of the combined impact of medications on the body when
there is no direct effect on absorption, distribution, metabolism, or excretion
• pharmacokinetic - does affect the above
• drugs act at the same or interrelated receptor sites, resulting in additive, synergistic, or
antagonistic effects of each drug at the target receptor
www.currentpsychiatry.com
www.medscape.com
www.ncbi.nim.nih.gov
OVERDOSE
KEEP IN MIND:
•
•
•
•
•
All physiologies are different (especially with tolerance)
Interactions can make a big difference
Therapeutic levels are likely true for most people
There’s overdose and there’s overdose
Potentiation can make an amount that seems small actually much stronger
TOXIC LEVELS (not all inclusive)
SSRI’s
• rarely fatal in overdose when taken alone
• far safer than the TCA’s in overdose
minor or no symptoms to drowsiness, tremor, nausea, and vomiting to seizures,
arrhythmia, renal and respiratory failure…
ATYPICAL ANTIPSYCHOTICS
• overdose of antipsychotics common “in Western society”
• CNS depression, tachycardia and orthostasis
STIMULANTS
• result in blurred vision, spasms, heart irregularities, and respiratory failure
BENZODIAZEPINES
• extremely low risk of acute toxicity when they are used alone
• with alcohol: can impair ability to breathe, dangerously lower blood pressure, result in
coma and death
www.toxipedia.org
www.ncbi.nim.nih.gov
OVERDOSE and LAB WORK
MEDICATION
TOXICITY
LEVELS
FREQUENCY
Lithium
(Eskalith, Lithobid)
Flu-like symptoms,
tinnitus, blurred vision,
lack of coordination
1.0 - 2.0
6 months
Depakote
(Valproic Acid,
Depokene)
Hyperthermia/hypotherm
ia, Tachycardia, Hypotension, cardiac arrest,
respiratory depression
85 - 125
6 months
Clozaril
(Clozapine)
Agranulocytosis,
fever, weakness, lethargy,
or sore throat, sore
mouth and gums
250-350 ng.ml
Weekly  biweekly
 monthly
Tegretol
(Carbamazepine)
Dizziness, uncoordinated
movement, sleepiness,
blurred or double vision,
involuntary back and
forth movement of the
eyeball…
5 to 12
mcg/mL
NOTES:
•
Depakote: recommended range for the treatment of epilepsy is 50-100 µg/ml. as
compared to acute mania
•
Agranulocytosis is a rare condition that occurs when the bone marrow does not make
enough neutrophils, the white blood cells needed to fight infections. Agranulocytosis
can turn minor infections into serious ones.
AIMS
ABNORMAL INVOLUNTARY MOVEMENT SCALE
*AIMS test has a total of twelve items rating involuntary movements.
Facial and Oral Movements
• Muscles of facial expression
e.g., movements of forehead, eyebrows, periorbital area, cheeks. Include frowning,
blinking, grimacing of upper face.
• Lips and perioral area
e.g., puckering, pouting, smacking.
• Jaw
e.g., biting, clenching, chewing, mouth opening, lateral movement.
• Tongue
Rate only increase in movement both in and out of mouth, not inability to sustain
movement.
Extremity Movements
• Upper (arms, wrists, hands, fingers)
Include movements that are choreic (rapid, objectively purposeless, irregular,
spontaneous) or athetoid (slow, irregular, complex, serpentine). Do notinclude tremor
(repetitive, regular, rhythmic movements).
• Lower (legs, knees, ankles, toes)
e.g., lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and
eversion of foot.
Trunk Movements
• Neck, shoulders, hips
e.g., rocking, twisting, squirming, pelvic gyrations. Include diaphragmatic movements
Incapacitation due to abnormal movements
0 = none, normal
1 = minimal 2 = mild
3 = moderate
4 = severe
Patient's awareness of abnormal movements
0 = no awareness
1 = aware, no distress
3 = aware, moderate distress 4 = aware, severe distress
2 = aware, mild distress
TO EAT OR NOT TO EAT
TAKE MEDS WITH FOOD
Trazedone/Desyrel – 20% more absorption, amount not specified
Geodon – 500 calories
Latuda – amount not specified
Viibryd - amount not specified
Lithium – food or milk
 Grapefruit juice potentiates effects of certain drugs:
 Degree of the grapefruit effect can vary - just one serving like taking multiple
doses
 Can occur when eaten many hours before the medication
 Example - Simvastatin, when taken with about a 7 oz. glass of grapefruit juice
once a day for three days, produced a 330% greater concentration of the drug
compared to taking it with water
 Some examples:
 MAJOR: BuSpar, Tegretol, Anafranil, benzodiazepines,
 MODERATE: Luvox, Elavil, Haldol
 MAOI’s:
 Avoid foods containing tyramine (matured cheese, some bananas, yogurt,
shrimp paste, salami)
 May/will cause hypertensive crisis
 Don’t trust the transdermal patch
 Lithium
 Too much salt - level rises / too little salt – level falls
 Be careful with: processed cheeses , meats, ham, canned meats and fish;
packaged mixes; most frozen meals; soups and broths, snack foods, soy sauce,
smoked foods, olives, pickles, tomato juice, fast foods, salt, seasonings and
condiments like ketchup and meat sauces.
(I think Jello is okay)
MISCELLANEOUS MEDICATION INFORMATION
 Difference between benzodiazepines and sleepers is how fast they work and how long
they last
 Wellbutrin SR/XL is always prescribed early in the day, but takes 4-7 hours to get into
the system and then may cause insomnia or waking during sleep. If taken HS will be
ready to go to start the day.
 Sometimes if a client is showing signs of mania, skipping 1 or 2 doses of their
antidepressant might be all that is needed (of course sleep is the most important
concern)
NURSE’S ROLE
DO REFER CLIENT TO NURSE FOR:






How to take medication as prescribed
Severe side effects that need to be immediately discussed
Possible allergic reaction
Discontinuation problems
To schedule an injection appointment
Assistance finding the data necessary to fill out the
YELLOW FORM
DON’T REFER TO NURSE FOR:
INSTEAD:
Medication changes
Schedule with psychiatrist, fill out a
YELLOW FORM and place in psychiatrists
box for review
Counseling on non-CMH medications
Advise them to take all medications as
prescribed and refer to their prescribing
physician
Running out of medications
Should first be evaluated for the necessity
of an EMR, MAPS, complete YELLOW FORM
ARE YOU OVERSTEPPING? / DID YOU KNOW
ARE YOU OVERSTEPPING?
1.
2.
3.
4.
5.
6.
7.
8.
Does it change the doctor’s prescription?
Is it a decision left up to the client?
If you talk about a side effect they will get it?
Could there be an allergy?
Have there been any changes?
Side effects – what’s on print out
Clients don’t hear everything the doctor tells them, is it medical advice to remind?
Can you explain the purpose of medication?
DID YOU KNOW?
 Nutmeg: contains the psychoactive substance myristicin in its aromatic oil. Chronic
effects of nutmeg abuse resemble those of marijuana abuse and can present as a
mood disorder resembling bipolar disorder
 Lithium, which is a naturally occurring metallic salt,
was first used to treat gout
 Thorazine was first used for general anesthesia and as an antihistimine
 1st antidepressant before 1980 – Valium, Librium, Phenobarbatal (another source said
Dexedrine)
 Depression - official name in DSM-III (1980) – Melancholia
 Tryptophan is a monoamine
 The heart secretes serotonin during a heart attack
 A stingray attacks by injecting serotonin
 95% of all serotonin is found in the intestines (humans, not stingrays)
 St. John’s Wort is the most often prescribed antidepressant in Germany
 (30) Tenex (guanfacine) for hypertension is $3.60 - $10 for generic – Intuniv for ADHD
is $125 - $243
 (30) Catapres (clonidine) for generic $3.60 – $1
http://www.currentpsychiatry.com
GLOSSARY
NEUROLEPTIC - term that refers to the effects of antipsychotic drugs on a patient,
bringing about emotional quietening without impairing consciousness.
PSYCHOTROPIC - mood-altering drug that affects mental activity, behavior, or perception
PYRAMIDAL Abnormal Involuntary Movement Scale (AIMS)
ANTICHOLINERGIC – blocks activity of nerves responsible for control of heart rate, gut
motion, and rate of saliva production
POTENTIATION - enhancement of one agent by another so that the combined effect is
greater than the sum of the effects of each one alone
TRICYCLIC – 3 chemical rings (tetracyclics – 4 rings)
INTRACTABLE – no treatment works
QD - every day
QOD - every other day
BID - twice a day
TID - three times a day
QID - four times a day
PRN - as needed
HS - at bedtime
PO - by mouth
SL- sublingual
DAW – dispense as written
(no generic)
If no treatment helps to alleviate symptoms, is it
because:
1. There are compliance issues
2. They have unusual biology/physiology
3. The psychosocial factors don’t allow for
improvement
4. What they or the doctor defines as
improvement isn’t realistic
5. Medication can’t remove trauma, ex.
dissociation, hallucinations indicate psychosis
but is the medication going to the same
receptor sites as it would for schizophrenia
6. They are android and the medication
ingested is clogging up their motors.
PARKINSON’S DISEASE - a gradual loss of neurons that produce dopamine, resulting in
insufficient dopamine to parts of the brain involved with movement
PARKINSONIAN – similar symptoms, different origin
WISH I HAD TIME FOR:
More about drug interactions
Overdose thresholds
Street value
Starting a new medication: overlap, not overlap, etc.
When to take a missed dose
“BETTER
LIVING
THROUGH
CHEMISTRY”
WHAT IS YOUR ROLE