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HOME MEDICATIONS Bryan Bledsoe, DO, FACEP, EMT-P Corporate Sponsors Home Medications A patient’s medications can provide a tremendous amount of information regarding the patient’s underlying medical problems. Top-Ten Prescriptions in 2001 1. Hydrocodone/APAP 2. Lipitor 3. Premarin 4. Synthroid 5. Atenolol 6. Furosemide 7. Prilosec 8. Albuterol 9. Norvasc 10. Alprazolam Mrs. Helen McCurdy 76 year old female found unresponsive by rural postal carrier. No family or friends around. Vital Signs: Blood Pressure: 138/90 mmHg Heart Rate: 102 bpm Respirations: 10 per minute Mrs. Helen McCurdy Medications found in cupboard: Lanoxin Lasix Vasotec Ismo K-Dur Keflex MS-Contin Mrs. Helen McCurdy Medications found in cupboard: Lanoxin: CHF, atrial fibrillation Lasix: CHF, HTN Vasotec: CHF, HTN Ismo: Angina K-Dur: Potassium Depletion Keflex: Infection MS-Contin: Pain Mrs. Helen McCurdy Upon evaluation at Sundown ED: 1. Lacunar stroke due to HTN and AF 2. CHF (mild exacerbation) 3. Atrial Fibrillation 4. Stable angina pectoris 5. Moderate HTN (fair control) 6. Chronic sciatica due to degenerative disc disease 7. Recent sinus infection Home Medication Packaging Shoe Box Paper Grocery Bag (Sack) K-Mart Plastic Bag Wal-Mart Plastic Bag Pill holder bought by caring family member which sorts pills by time and date (with no labels whatsoever) What medicines do you take? Well, I take a little pink pill in the morning and two of the white pills in the evening. Oh honey…I don’t know. You better call Dr. Williams. He keeps up with all of my medications. Oxy-Contin….and I NEED MORE!!! Definitions Drugs are chemical agents used in the diagnosis, treatment, or prevention of disease. Medication Classes Analgesics Antianginals Anxiolytics Anticoagulants Anticonvulsants Antidepressants Antidiabetic Antihypertensives Antipsychotics Beta-Blockers Bronchodilators Calcium Channel Blockers Cardiotonics Diuretics Sedatives/Hypnotics Analgesics Used to alleviate pain and inflammation Narcotics Non-Steroidal Anti-Inflammatory Agents Non-Narcotic/Non-NSAIDs Anti-Migraine Agents Narcotic Analgesics Used to treat moderate to severe pain Morphine Codeine Vicodin Lorcet Darvocet Lortabs Percocet Percodan Oxy-Contin MS Contin Stadol NS Dilaudid Demerol Talwin Norco Fentanyl NSAIDs Alleviate pain and inflammation Motrin Toradol Naprosyn Anaprox Celebrex Lodine Relafen Tolectin Vioxx Voltaren Non-Narcotic/Non-NSAID Mild-moderate pain Acetaminophen Ultram Topicals Anti-Migraine Used to treat headache in documented migraineurs Inderal DHE Midrin Amerge Axert Imitrex Maxalt Zomig Anti-Anginals Used in the treatment of angina pectoris Nitroglycerin Ismo Isordil Cardizem Antihypertensives Used to decrease blood pressure Adrenergic blockers ACE Inhibitors Angiotensin II Receptor Antagonists Beta-Blockers Calcium-Channel Blockers Diuretics Vasodilators Combination Agents Adrenergic Blockers Cause peripheral vasodilation Cardura Hytrin Normodyne ACE Inhibitors Cause peripheral vasodilation Accupril Altace Captopril Lotensin Monopril Prinivil Univasc Vasotec Zestorectic Angiotensin II Receptor Antagonists Cause peripheral vosodilation Atacand Avapro Cozaar Diovan Beta Blockers Decrease heart rate and cause peripheral vasodilation Betapace Blocadren Corgard Inderal Sectral Tenormin Toprol Calcium-Channel Blockers Cause peripheral vasodilation and slow AV conduction Adalat Cardene Cardizem DynaCirc Isoptin Norvasc Procardia Diuretics Cause water excretion decreasing circulating volume Dyazide Maxzide Demedex Lasix Diuril Zaroxolyn Vasodilators Decrease peripheral vasodilation (many agents indirectly cause this affect) Nitrates Calcium Channel Blockers ACE Inhibitors Combination Agents Usually a combination of two antihypertensive agents Monopril HCT Prinizide Zestoretic Hyzaar Antiarrhythmics Corrects cardiac dysrhythmias I. II. III. IV. Mexitil, Quinidex, Rhythmol, Tambocor Betapace, Brevibloc, Inderal Cordarone, Corvert Cardizem, Isoptin Digoxin commonly used to control rate. Antilipidemics Lowers blood lipids (cholesterol) Lopid Baycol Lescol Lipitor Mevacor Pravachol Zocor Alzheimer’s Agents Helps manage s/s Alzheimer’s dosease Aricept Cognex Reminyl Anticonvulsants Used to prevent seizures Nembutal Neurontin Depakote Tegretol Dilantin Lamictal Zaorntin Antidiabetic Agents Used to lower blood sugar in diabetes Insulin Glucophage Glycet Precose Diabeta Glucotrol Antibiotics Used to treat infections (primarily bacterial) Cephalosporins Macrolides Penicillins Quinolones Sulfonamides Tetracyclines Cephalosporins Keflex Ceclor Cedax Ceftin Duricef Suprax Macrolides Erythromycin Biaxin Zithromax Penicillins Common Beta-Lactam Amoxicillin Penn VK Augmentin Gorrilacillins Unasyn Zosyn Quinolones Cipro Floxin Levaquin Noroxin Trovan Sulfonamides Bactrim Septra Tetracyclines Tetracycline Doryx Minocin Vibramycin HIV/AIDS Agents Reverse transcriptase inhibitors Rescriptor Viramune Combivir Epivir Retrovir Videx Zerit HIV/AIDS Agents Protease Inhibitors Agenerase Fortovase Norvir Viracept Anti-Viral Agents Inhibit viral growth/reproduction Famvir Flumadine Symmetrel Valtrex Zovirax Anti-Parkinsonian Helps minimize the symptoms of Parkinson’s disease Akineton Artane Benadryl Levsin Lodosyn Mirapex Requip Sinnemet Symmetrel Blood Modifiers Decrease blood clotting and viscosity Coumadin Persantine Aggrastat Plavix Ticlid Gastrointestinal Agents Antacids Anticholinergics Antidiarrheals Antiemetics Antispasmodics Laxatives Anti-Ulcer Agents Antacids Decrease gastric acid levels Calcium antacids Magnesium antacids Anticholinergics Decreases gastric acidity and motility Robinul Levsin Antidiarrheals Slow GI motility and increase stool bulk Immodium A-D Pepto-Bismol Antiemetics Decreases nausea and vomiting Compazine Phenergan Tigan Zofran Reglan Anti-spasmotics Decreases GI motility and spasm Donnatal Levsin Bentyl Laxatives Evacuates bowels Magnesium citrate Colace Senokot Anti-Ulcer Agents Decrease gastric acid, promote ulcer healing Prilosec Prevacid Aciphex Zantac Pepcid Hormones Substances secreted by ductless glands that control other glands and body functions Hormones How do you make a hormone? Don’t pay her! Hormones Estrogens Glucocorticoids Progesterone Thyroid Replacements Testosterone Estrogens Naturally-occurring female hormone used to replace natural hormone Estrace Ogen Premarin Glucocorticoids Used to reduce inflammation and the immune response Prednisone Pediapred Prelone Medrol Decadron Cortisone Progesterone Naturally-occurring female hormone used to replace natural hormone Provera Usually used in combination with estrogen OCPs Premphase Thyroid Hormones Used to replace defiicient natural hormone Syntrhoid Levothroid Testosterone Used for selected cases of impotence Testroderm Testred Anti-Depressants Used to treat depression and other affective disorders MAOIs SSRIs TCAs Miscellaneous Agents Monamine Oxidase Inhibitors Increases amount of dopamine by decreasing MAO Nardil Parnate There are many potential problems with patients on MAOIs and these should be a red flag. Selective Serotonin Reuptake Inhibitors (SSRI) Increases brain levels of dopamine Celexa Paxil Prozac Zoloft Tricyclic Antidepressants (TCAs) Increases levels of dopamine in the brain Etrafon Limbitrol Norpramin Sinaqual Elavil Miscellaneous Agents Various mechanisms Effexor Remeron Serzone Wellbutrin Antipsychotics Used to treat various psychotic states (i.e. schizophrenia) Serentil Thorazine Haldol Loxitane Moban Navane Risperdal Seroquil Psychotic Patients Patients with major psychiatric disorders, such as schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting antipsychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate) Anti-Manic Agents Used to control mania in bipolar disorder Lithium Lithobid Eskalith Obsessive-Compulsive Disorders Used to control obsessive/ritualistic behaviors Luvox Paxil Prozac Zoloft Antianxiety Agents Used to treat anxiety, panic disorders, and similar affective disorders Valium Ativan Xanax Librium Tranxene Buspar Sedatives/Hypnotics Used to sedate or induce sleep Commonly-used benzodiazepines Restoril Halcion Dalmane Related-Agents Ambien Sonata Respiratory Agents Used to decrease bronchospasm, inflammation, and to stimulate respirations. Beta-Agonists Xanthines Anti-Inflammatories Miscellaneous Agents Beta Agonists Cause bronchodiation by blocking beta 2 adrenergic receptors Albuterol Metaproterenol Isoetharine Maxair Serevent Xanthines Cause bronchodilation Theophylline Theo-Dur Aminophylline Uniphyl Anti-Inflammatories Decrease inflammation Prednisone Decadron Aerobid Azmacort Flovent Vanceril Combivent Miscellaneous Agents Used to augment other agents. Atrovent Intal Singulair Accolate Zyflo Case Studies 42 year old female with altered mental status and dyspnea. Medications: Prednisione Serevent Alupent Augmentin Case Studies 24 year old female with altered mental status and fever. Medications: Bactrim Retrovir Viracept Pentamidine Case Studies 72 year old male with chest pain. Medications: NTG ASA Prinivil Lipitor Persantine Lanoxin Coumadin Glucophage Case Studies 56 year old female with altered mental status Lanoxin Diabeta Vasotec Synthroid Betapace Maxzide Ventolin