Epilepsy client on Dilantin and Amlodipine

A calcium channel blocker and Dilantin for seizures can create more seizures and cramps. Why would a doctor prescribed these two meds at the same time for an epilepsy patient?

The epilepsy patient has no appetite and experiences more seizures and nausea. A statin medication was also prescribed without CoQ10 dietary supplement.

Only families who are aware of these medications can ask more questions from the doctor and communicate any side effects from the drug combination.

As caregiver, we can only note in our journal that the client has stomach cramps, loss of appetitie, increased nausea and loss of balance.

We care for our clients and so we educate them about the side effects of the medications.

Hopefully, their families can be proactive in their medication management.

Text 408-854-1883 if you need caring caregivers who also is aware and proactive about drug side effects.

card mother

 

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • seizures
  • suicidal thoughts or behaviour
  • symptoms of a serious allergic reaction (such as fever, swollen glands, yellowing of skin or eyes, or flu-like symptoms with skin rash or blistering)
  • symptoms of a serious skin reaction (such as skin rash; red skin; blistering of the lips, eyes, or mouth; skin peeling; fever; or joint pain)

Some people may experience side effects other than those listed.Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: Some people who are allergic to carbamazepine or barbiturates also experience allergic reactions to phenytoin. Before you take phenytoin, inform your doctor about any previous adverse reactions you have had to medications, especially other medications for seizures. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.

Dental hygiene: Because phenytoin can cause swollen and bleeding gums, it is important to practice good dental hygiene by flossing, brushing, and visiting your dentist regularly. Talk to your doctor to learn more about how to take care of your mouth, gums, and teeth while taking this medication.

Diabetes: Phenytoin can decrease the release of insulin from the pancreas, resulting in higher-than-normal levels of glucose (sugar) in the blood. It may also have an effect on the action of medications used to lower blood sugar for people with diabetes.

If you have diabetes, or are at risk of developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. It may be necessary to monitor your blood sugar more closely when starting or stopping phenytoin treatment.

If you experience symptoms of increased blood sugar, such as increased urinary frequency, increased thirst, excessive eating, unexplained weight loss, or a fruity breath odour, contact your doctor.

Drowsiness/reduced alertness: Some people who take phenytoin become drowsy. Avoid activities that require complete mental alertness, judgment, and physical coordination (such as driving a car or performing hazardous tasks) until you establish how you are affected by phenytoin.

Hypersensitivity syndrome: A severe allergic reaction called hypersensitivity syndrome has occurred for some people with the use of phenytoin. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering. These reactions may be more frequent in people of Asian origin.

Lactose intolerance: This capsule form of phenytoin contains lactose. If you have galactose intolerance (galactosemia, glucose-galactose malabsorption, or Lapp lactase deficiency), you should not take the capsule form of this medication.

Liver function: Some people have reported liver problems and, in rare instances, liver failure, with the use of phenytoin. These cases have been associated with an allergic reaction that includes fever, skin rashes or hives, or swollen lymph glands. The reaction usually occurs within the first 2 months of treatment.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately. If you have decreased liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Osteoporosis: Long term use of anti-seizure medications, including phenytoin, may affect the strength of your bones, because these medications reduce the amount of vitamin D available for your body to use. If you have or are at risk for developing osteoporosis, discuss with your doctor the need to take additional vitamin D.

Other medications and alcohol: Many medications and alcoholic beverages interact with phenytoin, causing decreased effectiveness or increased side effects. If you are taking phenytoin, consult with your doctor or pharmacist before taking any other medications or drinking alcoholic beverages.

Regular dosing: Remember that when you are taking phenytoin, it is very important to take the medication exactly as prescribed. Inform your doctor of any condition that prevents you from taking the medication as prescribed (e.g., surgery, illness, difficulty swallowing).

Stopping the medication: Do not stop taking phenytoin without consulting your doctor. Stopping the medication suddenly may cause an increase in the number or severity of seizures. If it is necessary to stop taking this medication, talk to your doctor about how to gradually reduce the dose of the medication before completely stopping.

Suicidal thoughts and behaviour: Some people taking anti-seizure medications may have suicidal thoughts or behaviour. If this happens to you or you notice this in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Pregnancy: When phenytoin is taken during pregnancy, it may cause harm to the developing baby. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking phenytoin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

What other drugs could interact with this medication?

There may be an interaction between phenytoin and any of the following:

  • abiraterone
  • acetaminophen
  • acetazolamide
  • alcohol
  • aliskiren
  • allopurinol
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
  • antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
  • antineoplastic agents (chemotherapy; e.g., carboplatin, cyclophosphamide, etoposide, irinotecan, vincristine)
  • antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • anti-psychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • apixaban
  • aprepitant
  • azelastine
  • azole antifungals (e.g., fluconazole, ketoconazole, voriconazole)
  • barbiturates (e.g., butalbital, phenobarbital)
  • benzodiazepines (e.g., clonazepam, diazepam, lorazepam)
  • birth control pills
  • bisoprolol
  • bosentan
  • brimonidine
  • buprenorphine
  • bupropion
  • buspirone
  • calcitriol
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)

Drug-Induced Urinary Incontinence

Pharmacologic agents including oral estrogens,alpha-blockerssedative-hypnotics,antidepressantsantipsychoticsACE inhibitors,loop diureticsnonsteroidal anti-inflammatory drugs, and calcium channel blockers have been implicated to some degree in the onset or exacerbation of urinary incontinence.

Drug-Induced Urinary Incontinence

Kiran Panesar, BPharmS (Hons), MRPharmS, RPh, CPh
Consultant Pharmacist and Freelance Medical Writer
Orlando, Florida

US Pharm. 2014;39(8):24-29.

ABSTRACT: Urinary incontinence affects both men and women, and especially the elderly. The Agency for Health Care Policy and Research identified four types of urinary incontinence: stress, urge, mixed, and overflow. Pharmacologic agents including oral estrogens, alpha-blockers, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, nonsteroidal anti-inflammatory drugs, and calcium channel blockers have been implicated to some degree in the onset or exacerbation of urinary incontinence. The pharmacist should consider urinary incontinence–inducing drugs when reviewing patient profiles.

In healthy humans, voiding occurs at intervals several times a day, even though the kidneys produce urine continuously. This means that the bladder must store urine for several hours, a feature that requires the musculature of the bladder-outflow tract to contract to generate resistance. Disturbances of this storage function of the bladder lead to urinary incontinence. A number of factors may be responsible, including disease and adverse effects of medical treatment.1

A number of medications have been proposed as possible causes of drug-induced urinary incontinence, including alpha1-adrenoceptor antagonists, antipsychotics, benzodiazepines, antidepressants, and drugs used for hormone replacement therapy.1 Since drugs are frequently metabolized and excreted in the urine, the lower urinary tract is particularly vulnerable to adverse effects. Furthermore, carcinogens or inflammatory agents in the urine are in close proximity to the epithelium for prolonged periods when they are stored in the bladder. The drugs may cause stress incontinence, urge incontinence, or overflow incontinence.2

This article discusses the different types of incontinence, their causes, and the possible mechanisms underlying incontinence resulting from medications.

Epidemiology

The prevalence of urinary incontinence increases with age, with an overall prevalence of 38% in women and 17% in men. In women, the prevalence is about 12.5% in those aged 60 to 64 years and rises to about 20.9% in those aged ≥85 years. Furthermore, a higher prevalence has been noted in non-Hispanic white women (41%) compared with non-Hispanic black (20%) and Mexican-American women (36%).3 In a similar study, the prevalence of weekly incontinence was highest among Hispanic women, followed by white, black, and Asian-American women.4

In men, the prevalence increases with age, from 11% in those aged 60 to 64 years to 31% in those aged ≥85 years. The rate of incontinence in black men is similar to that for black women, but in white and Mexican-American men, the rate is 2.5 times lower than in women of the same ethnicity.3

Urinary incontinence may be underreported, owing to the embarrassing nature of the condition.

Types of Incontinence

According to the clinical practice guidelines issued by the Agency for Health Care Policy and Research (now called Agency for Healthcare Research and Quality), there are four types of incontinence: stress, urge, mixed, and overflow. Other guidelines identify functional incontinence as a fifth type.5-8 TABLE 1 describes the various types of incontinence in more detail, along with the usual approaches used in the management of each.5-10

Mechanisms of Urinary Continence

In healthy individuals, the urinary bladder senses the volume of urine by means of distention. Distention of the bladder excites afferent A-delta fibers (and C fibers, in a pathologic condition) that relay information to the pontine storage center in the brain. The brain, in turn, triggers efferent impulses to enhance urine storage through activation of the sympathetic innervation of the lower urinary tract (hypogastric nerve). These impulses also activate the somatic, pudendal, and sacral nerves.1

The hypogastric nerves release norepinephrine to stimulate beta3-adrenoceptors in the detrusor and alpha1-adrenoceptors in the bladder neck and proximal urethra. The role of beta3-adrenoceptors is to mediate smooth-muscle relaxation and increase bladder compliance, whereas that of alpha1-adrenoceptors is to mediate smooth-muscle contraction and increase bladder outlet resistance.1 The somatic, pudendal, and sacral nerves release acetylcholine to act on nicotinic receptors in the striated muscle in the distal urethra and pelvic floor, which contract to increase bladder outlet resistance.1

Efferent sympathetic outflow and somatic outflow are stopped when afferent signaling to the brain exceeds a certain threshold. At this point, the parasympathetic outflow is activated via pelvic nerves. These nerves release acetylcholine, which then acts on muscarinic receptors in detrusor smooth-muscle cells to cause contraction. A number of transmitters, including dopamine and serotonin, and endorphins are involved in this process.1

Pharmacologic Agents That Cause Urinary Incontinence

A variety of drugs have been implicated in urinary incontinence, and attempts have been made to determine the mechanism responsible based upon current understanding of the processes involved in continence and the transmitters that play a role. Each of the processes described previously can be manipulated by pharmacologic agents to cause one or more types of incontinence.

The drugs commonly pinpointed in urinary incontinence include anticholinergics, alpha-adrenergic agonists, alpha-antagonists, diuretics, calcium channel blockers, sedative-hypnotics, ACE inhibitors, and antiparkinsonian medications. Depending upon the mode of action, the effect may be direct or indirect and can lead to any of the types of incontinence. Taking these factors into account, it is important to consider a patient’s drug therapy as a cause of incontinence, particularly in new-onset incontinence patients and in elderly patients, in whom polypharmacy is common.11,12

On the other hand, a pharmacologic agent or any other factor that results in chronic urinary retention can lead to a rise in intravesical pressure and a resultant trickling loss of urine. In this way, drugs that cause urinary retention can indirectly lead to overflow incontinence.2

Alpha-Adrenergic Antagonists: As described earlier, the stimulation of alpha1-adrenoceptors by norepinephrine leads to increased bladder outlet resistance. It has been shown that alpha1-adrenoceptors influence lower urinary tract function not only through a direct effect on smooth muscle, but also at the level of the spinal cord ganglia and nerve terminals. In this way, they mediate sympathetic, parasympathetic, and somatic outflows to the bladder, bladder neck, prostate, and external urethral sphincter.13 Blocking these receptors with such agents as prazosin, doxazosin, and terazosin would therefore lead to reduced bladder outlet resistance and, accordingly, to incontinence.2 One study found that the use of alpha-blockers increased the risk of urinary incontinence in older African American and white women nearly fivefold.14 Another study showed that almost half of female subjects taking an alpha-blocker reported urinary incontinence.15Phenoxybenzamine, a nonselective, irreversible alpha-adrenoceptor antagonist, has been associated with stress urinary incontinence.1

It is useful to note that many antidepressants and antipsychotics exhibit considerable alpha1-adrenoceptor antagonist activity.1

Alpha-Adrenergic Agonists: Alpha-adrenergic agonists such as clonidine and methyldopa mimic the action of norepinephrine at receptors. In this way they may contract the bladder neck, causing urinary retention and thus overflow urinary incontinence.2,16-18

Antipsychotics: A number of antipsychotics have been associated with urinary incontinence, including chlorpromazine, thioridazine, chlorprothixene, thiothixene, trifluoperazine, fluphenazine (including enanthate and decanoate), haloperidol, and pimozide.19-24 Incontinence occurs over a broad range of antipsychotic dosages. Additionally, whereas some patients experience urinary incontinence within hours of initiating antipsychotic therapy, others do not experience incontinence for weeks after initiation. In most cases, the incontinence remits spontaneously upon discontinuation of the antipsychotic. Typical antipsychotics are primarily dopamine antagonists and lead to stress urinary incontinence, whereas atypical antipsychotics are antagonists at serotonin receptors.24 Antipsychotics also cause incontinence by one or more of the following mechanisms: alpha-adrenergic blockade, dopamine blockade, and cholinergic actions on the bladder.25 Owing to these complex drug-receptor interactions, a generalized description of how antipsychotics cause urinary incontinence cannot be given.1

If it is not possible to discontinue the antipsychotic, urinary incontinence caused by antipsychotics can be managed with a variety of pharmacologic agents. Desmopressin is perhaps the most effective, but also the most expensive, therapeutic agent available for this use. Other agents include pseudoephedrine, oxybutynin, benztropine, trihexyphenidyl, and dopamine agonists.25

Antidepressants: There are a number of classes of antidepressants, all with varying pharmacologic properties. This makes it difficult to generalize the underlying mechanisms that lead to urinary incontinence as a result of antidepressant use. However, all antidepressants result in urinary retention and, eventually, in overflow incontinence. Most antidepressants are inhibitors of norepinephrine and/or serotonin uptake. Some also act as antagonists at adrenergic, cholinergic, or histaminergic receptors at therapeutic doses.1

Diuretics: The purpose of a diuretic is to increase the formation of urine by the kidneys. As a result, diuretics increase urinary frequency and may cause urinary urgency and incontinence by overwhelming the patient’s bladder capacity. One study reported a link between diuretics and/or conditions associated with their use and urinary incontinence in community-dwelling women.26 In another study, the use of a loop diuretic with an alpha-blocker almost doubled the risk of urinary incontinence versus alpha-blockers alone, but no increased risk was noted when thiazide diuretics or potassium-sparing diuretics were added to the alpha-blockers.27

Calcium Channel Blockers: Calcium channel blockers decrease smooth-muscle contractility in the bladder. This causes urinary retention and, accordingly, leads to overflow incontinence.10

Sedative-Hypnotics: Sedative-hypnotics result in immobility secondary to sedation that leads to functional incontinence.10 Furthermore, benzodiazepines can cause relaxation of striated muscle because of their effects on gamma-aminobutyric acid type A receptors in the central nervous system.1,28

ACE Inhibitors and Angiotensin Receptor Blockers: The renin-angiotensin system exists specifically in the bladder and the urethra. Blocking angiotensin receptors with ACE inhibitors or angiotensin receptor blockers decreases both detrusor overactivity and urethral sphincter tone, leading to reduced urge incontinence and increased stress urinary incontinence.29 Furthermore, ACE inhibitors can result in a chronic dry cough that can cause stress incontinence. This was demonstrated in a female patient with cystocele who was receiving enalapril. The patient developed a dry cough and stress incontinence, which ceased within 3 weeks of discontinuing the ACE inhibitor.

Estrogens: One study showed that oral and transdermal estrogen, with or without progestin, increased the risk of urinary incontinence by 45% to 60% in community-dwelling elderly women.14 A summary of randomized, controlled trials also showed that the use of oral estrogen increased the risk of urinary incontinence by 50% to 80%.30

Hydroxychloroquine: Hydroxychloroquine has recently been identified as an agent that can induce urinary incontinence. There is currently only one report supporting this finding. In this report, a 71-year-old female patient developed urinary incontinence as an adverse reaction to hydroxychloroquine administered at therapeutic doses to treat rheumatoid arthritis. Urinary incontinence remitted with drug withdrawal and reappeared when the drug was readministered.31

Conclusion

A variety of drugs have been associated with urinary incontinence. This may be due to direct incontinence or overflow incontinence secondary to urinary retention. When reviewing patient profiles, pharmacists should take into consideration the use of oral estrogens, alpha-blockers, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, nonsteroidal anti-inflammatory drugs, and calcium channel blockers that may lead to urinary incontinence. It is important to keep in mind that some incontinence patients taking these medications may be too embarrassed to discuss their condition voluntarily.

Common side effects of Gabapentin

Common side effects of Gabapentin

Sleepiness
Dizziness
Fatigue
Clumsiness while walking
Visual changes, including double vision
Tremor
Runny nose
Weight gain
Indigestion or nausea
Nervousness
Muscle ache
Dry mouth or sore throat
Memory loss
Headache
Unusual thoughts
Diarrhea or constipation
Swelling of hands or feet
Fever
Itchy eyes
Serious side effects can also occur. If you have any of these side effects, call your doctor right away:

Thoughts of suicide or harming yourself
Fever or swelling of lymph nodes
Severe rash
Swelling of the face, lips, or tongue
Difficulty breathing or swallowing
Seizure

What Is Gabapentin (Neurontin)?

Gabapentin is a prescription drug, marketed as Neurontin and Horizant, that’s used to treat epilepsy.

Doctors can prescribe gabapentin to treat epilepsy in people older than 12, and partial seizures in children ages 3 to 12.

Gabapentin may also be prescribed to treat restless legs syndrome (RLS), to relieve numbness and tingling related to diabetes, to prevent hot flashes, and to relieve pain that can accompany shingles (known as postherpetic neuralgia).

The Food and Drug Administration (FDA) approved gabapentin in 1993 under the brand name Neurontin for the drug manufacturer Pfizer.

In 2003, the FDA approved generic gabapentin, and it’s now made by several drug companies.

An extended-release form of gabapentin is available under the brand name Horizant.

In 2004, the drug maker Pfizer settled charges for marketing Neurontin for unapproved uses, and agreed to pay $430 million.

While it’s legal for a doctor to prescribe drugs for off-label purposes, it’s illegal for a drug manufacturer to actively promote off-label uses.

A study in the Canadian Journal of Anesthesia in 2013 revealed that gabapentin may help ease moderate to high levels of anxiety among people about to have surgery.

The researchers noted that doctors are increasingly using the drug to treat pain after surgery as well as a variety of psychiatric diseases, such as chronic anxiety disorders.

Gabapentin Warnings

You should know that gabapentin may increase the risk for suicide.

Suicidal thoughts or behavior occurs in about one in 500 people taking medications like gabapentin. This risk may begin within a week of starting treatment.

Let your doctor know if you experience:

Thoughts of suicide
Symptoms of depression
Aggression
Irritability
Panic attacks
Extreme worry
Restlessness
Acting without thinking
Abnormal excitement
You should also let friends and family members know about these symptoms.

If you have any thoughts of suicide, or if a friend or family member thinks you are acting strange, call your doctor right away.

Children ages 3 to 12 may experience behavior changes while taking gabapentin.

These changes could include restlessness, inability to pay attention, poor performance at school, and angry or aggressive behavior.

Children younger than age 3 should not take gabapentin to treat seizures.

Also, children should not take gabapentin to treat postherpetic neuralgia.

If you are older than 75 or have kidney disease, use caution when taking gabapentin.

Drinking alcohol may make some side effects of gabapentin more severe.

Once you start taking gabapentin, don’t stop suddenly or you could experience withdrawal symptoms including anxiety, sleep disturbance, nausea, pain, and sweating.

You need to reduce your dose of gabapentin gradually over a period of at least one week.

Tell your doctor if you are taking any prescription pain medications called opiates. These medications may increase drowsiness or dizziness when you also take gabapentin.

Your doctor will also want to know if you have kidney disease, if you have any surgery planned (including dental), or if you have ever had a problem with drug or alcohol abuse.

Gabapentin ‘High’ and Abuse

  • Numerous reports suggest that gabapentin has become a widely abused drug that gives users a euphoric “high.”
  • A 2014 study found that almost one-fourth of people in substance-abuse clinics reported abuse of gabapentin.
  • Not only is abuse of gabapentin likely to result in serious side effects, it may also lead to severe withdrawal symptoms in users.

Gabapentin and Pregnancy

Researchers don’t know if gabapentin is safe to take during pregnancy.

If you are pregnant or may become pregnant, talk with your doctor before taking gabapentin.

Gabapentin can pass into breast milk, and the effects on breastfeeding babies are unknown.

Ask your doctor if the benefits of breastfeeding outweigh the potential risks of gabapentin to your infant.

 Gabapentin Interactions

It’s very important to let your doctor know about all drugs you are taking, including illegal or recreational drugs, over-the-counter medications, herbs, or supplements.

Types of drugs that are known to interact with gabapentin and may cause problems include:

Opiate pain medications, including Vicodin and morphine, among others
Naproxen (also known as the brands Aleve, Naprosyn, and others)
Medications used for heartburn, including Mylanta, Maalox, and cimetidine
If you do dipstick tests to check your urine for protein, tell your doctor. Gabapentin may affect the results of some of these types of tests.

Gabapentin and Alcohol

Drinking alcohol may make some side effects of gabapentin more severe.

Some doctors recommend drinking little or no alcohol while taking gabapentin.

In 2014, a study published in JAMA Internal Medicine found that gabapentin holds promise as a treatment for alcohol dependence.

The drug improved people’s ability to remain abstinent from alcohol. It also reduced symptoms related to relapse, like insomnia and cravings for alcohol.

The study’s findings are particularly important because there are relatively few medications available to help treat alcohol dependence.

Gabapentin and Other Interactions

Gabapentin may make you feel drowsy and could affect your judgment.

Until you know how gabapentin will affect you, do not drive or operate machinery.

Gabapentin may affect the results of tests to check your urine for protein.

Drugs that can cause constipation

Agents that cause constipation especially among the elderly include:-

  • Opoid pain relievers like Morphine, Codeine etc.
  • Anti-cholinergic agents like Atropine, Trihexiphenidyl
  • Antispasmodics like dicyclomine
  • Tricyclic antidepressants like amytriptyline
  • Calcium channel blockers used in arrhythmias and high blood pressure such as verapamil
  • Anti-Parkinsonian drugs – Parkinson’s disease itself may cause constipation and the drugs used for this condition including Levodopa cause constipation as well
  • Sympathomimetics like ephedrine and terbutaline. Terbutaline is commonly used on bronchial asthma
  • Antipsychotics like clozapine, thioridazine, chlorpromazine used for psychiatric disorders
  • Diuretics for heart failure like furosemide
  • High blood pressure lowering agents like methyldopa, clonidine, propranolol etc.
  • Antihistamines like diphenhydramine
  • Antacids especially calcium and aluminium containing
  • Calcium supplements
  • Iron supplements
  • Antidiarrheal agents (loperamide, attapulgite)
  • Anticonvulsants e.g. phenytoin, clonazepam
  • Pain relievers or NSAIDs (Non steroidal anti-inflammatory drugs) like ibuprofen, aspirin etc.
  • Miscellaneous compounds including Octreotide, polystyrene resins, cholestyramine (for lowering high blood cholesterol) and oral contraceptives
  • ————

Foods to eat when constipated

  • baked beans
  • black-eyed peas
  • garbanzo beans
  • lima beans
  • pinto beans, or
  • kidney beans
  • kiwi
  • plums
  • pears
  • sweet potatoes with skin

 

Reducing Antipsychotic Medication Use in Nursing Homes: A Qualitative Study of Nursing Staff Perceptions

Background and Objectives:

The purpose of this study was to use qualitative methods to explore nursing home staff perceptions of antipsychotic medication use and identify both benefits and barriers to reducing inappropriate use from their perspective.

Research Design and Methods:

Focus groups were conducted with a total of 29 staff in three community nursing homes that served both short and long-stay resident populations.

Results:

 

The majority (69%) of the staff participants were licensed nurses. Participants expressed many potential benefits of antipsychotic medication reduction with four primary themes:

(a) Improvement in quality of life,

(b) Improvement in family satisfaction,

(c) Reduction in falls, and

(d) Improvement in the facility Quality Indicator score (regulatory compliance).

Participants also highlighted important barriers they face when attempting to reduce or withdraw antipsychotic medications including:

(a) Family resistance,

(b) Potential for worsening or return of symptoms or behaviors,

c) Lack of effectiveness and/or lack of staff resources to consistently implement nonpharmacological management strategies, and

(d) Risk aversion of staff and environmental safety concerns.

Discussion and Implications:

Nursing home staff recognize the value of reducing antipsychotic medications; however, they also experience multiple barriers to reduction in routine clinical practice.

Achievement of further reductions in antipsychotic medication use will require significant additional efforts and adequate clinical personnel to address these barriers.

https://academic.oup.com/gerontologist/article-abstract/doi/10.1093/geront/gnx083/3858251/Reducing-Antipsychotic-Medication-Use-in-Nursing?redirectedFrom=fulltext


Connie’s comments : Family members must evaluate effectiveness and side effects of meds. It is easy for nursing homes to give Antipsychotic meds to calm the patient.

%d bloggers like this: