Medication Side Medication Side EffectsEffects

MEDICATION SIDE MEDICATION SIDE EFFECTSEFFECTS All medications can cause side effectsAll medications can cause side effects Contributing factorsContributing factors

– AgeAge– WeightWeight– SexSex– Overall healthOverall health– EthnicityEthnicity– Severity of diseaseSeverity of disease

Medication Side Medication Side EffectsEffects Side Effect: Side Effect: an undesirable secondary effect an undesirable secondary effect

of a drug or other form of medical treatmentof a drug or other form of medical treatment– Minimal to serious and harmfulMinimal to serious and harmful– New medicationNew medication– Change in dosageChange in dosage– Stops using medicationStops using medication

Team MemberTeam Member– Seek medical help Seek medical help – Document the side effect and medical Document the side effect and medical

intervention and file Incident Reportintervention and file Incident Report

COMMON MEDICATION COMMON MEDICATION SIDE EFFECTSSIDE EFFECTS NauseaNausea VomitingVomiting FatigueFatigue DizzinessDizziness Dry MouthDry Mouth HeadacheHeadache ItchingItching Muscle Aches and PainsMuscle Aches and Pains

NEED FOR MEDICAL NEED FOR MEDICAL ATTENTIONATTENTION Abdominal PainAbdominal Pain Blurred VisionBlurred Vision ConstipationConstipation DiarrheaDiarrhea DizzinessDizziness HeadachesHeadaches Loss of AppetiteLoss of Appetite Memory LossMemory Loss

Heart PalpitationsHeart Palpitations Coordination Coordination

ProblemsProblems Ringing in the EarsRinging in the Ears Skin Rashes or HivesSkin Rashes or Hives Swelling of Hands or Swelling of Hands or

FeetFeet Loss of Consciousness Loss of Consciousness

or Faintingor Fainting

APPROPRIATE RESPONSE TO APPROPRIATE RESPONSE TO OBSERVED SIDE EFFECTSOBSERVED SIDE EFFECTS

Previously unobserved side effect the person’s Previously unobserved side effect the person’s physician should be contacted immediately.physician should be contacted immediately.

Medication should NEVER be discontinued Medication should NEVER be discontinued without approval from the person’s physician. without approval from the person’s physician.

If the side effect appears to be serious call the If the side effect appears to be serious call the nurse and physician and then get the person to nurse and physician and then get the person to the emergency room as quickly as possible.the emergency room as quickly as possible.

COMMON MEDICATIONS FOR COMMON MEDICATIONS FOR PERSONS WITH INTELLECTUAL PERSONS WITH INTELLECTUAL DISABILITIESDISABILITIES

Intellectually Disabled have greater Intellectually Disabled have greater incidencesincidences– Epilepsy or other seizure disordersEpilepsy or other seizure disorders– Mental illnessMental illness– Behavior disordersBehavior disorders

Anti-Seizure MedicationsAnti-Seizure Medications Psychotropic or Antipsychotic Psychotropic or Antipsychotic

MedicationsMedications

ANTI-SEIZURE MEDICATIONS AND ANTI-SEIZURE MEDICATIONS AND THEIR SIDE EFFECTSTHEIR SIDE EFFECTS

BRAND NAME(generic name)

SIDE EFFECTS

ATIVAN(lorazepam)

Dizziness, drowsiness, blurred or double vision, nausea, skin rashes, abnormal blood counts (rare)

DEPAKENE(valproate)

Upset stomach, altered bleeding time, liver toxicity, hair loss, weight gain, tremor

DEPAKOTE(divalproex sodium)

Upset stomach, altered bleeding time, liver toxicity, hair loss, weight gain, tremor

DIAMOX(acetazolamide)

Appetite loss, frequent urination, drowsiness, confusion, extremity numbness, kidney stones

KEPPRA(levetiracetam)

Sleepiness, fatigue, poor coordination, loss of strength, dizziness

KLONOPIN(clonazepam)

Drowsiness, sleepiness, fatigue, poor coordination, unsteadiness, behavior changes

LAMICTAL(lamotrigine)

Dizziness, headache, blurred vision, clumsiness, sleepiness, nausea, skin rash

MYSOLINE(primidone)

Clumsiness, dizziness, appetite loss, fatigue, drowsiness, hyperirritability, insomnia, depression, hyperactivity

NEURONTIN(gabapentin)

Sleepiness, dizziness, clumsiness, fatigue, twitching

PHENOBARBITAL(phenobarbital)

Drowsiness, irritability, hyperactivity (children), behavioral problems, difficulty concentrating, depression

PHENYTEK(extended phenytoin sodium)

Clumsiness, insomnia, motor twitching, nausea, rash, gum overgrowth, hairiness

TEGRETOL(carbamazepine)

Dizziness, drowsiness, blurred or double vision, nausea, skin rashes, abnormal blood counts (rare)

TEGRETOL XR(extended release carbamazepine)

Dizziness, drowsiness, blurred or double vision, nausea, skin rashes, abnormal blood counts (rare)

TOPAMAX(topiramate)

Confusion, sleepiness, dizziness, clumsiness, difficulty thinking or talking, tingling sensation of the skin, nausea, decreased appetite

TRANXENE(clorazepate)

Drowsiness, sleepiness, fatigue, poor coordination, unsteadiness, behavior change

TRILEPTAL(oxcarbazepine)

Difficulty concentrating, sleepiness, fatigue, dizziness, double vision, nausea, unsteadiness, rash

ZARONTIN(ethosuximide)

Appetite loss, nausea, drowsiness, headache, dizziness, fatigue, rash, abnormal blood counts (rare)

ZONEGRAN(zonisamide)

Sleepiness, dizziness, loss of appetite, headache, nausea, irritability, difficulty concentrating, unsteadiness, fever, kidney stones, rash

NOTE: It is not necessary to memorize this or any chart in the training. It is, however, necessary to have this and other information on medication side effects readily available when working with persons with intellectual disabilities who may not be able to tell you that they are having these effects. The team member must recognize the side effects and respond appropriately.

EXTRAPYRAMIDAL SIDE EXTRAPYRAMIDAL SIDE EFFECTS OF ANTI-PSYCHOTIC EFFECTS OF ANTI-PSYCHOTIC MEDICATIONSMEDICATIONS Improper dosingImproper dosing Unusual reactions to neuroleptic medicationsUnusual reactions to neuroleptic medications Physical SymptomsPhysical Symptoms

– TremorTremor– Slurred speechSlurred speech– Akathisia Akathisia

restlessness in body and muscles, restlessness in body and muscles, move constantlymove constantly

EXTRAPYRAMIDAL SIDE EXTRAPYRAMIDAL SIDE EFFECTS OF ANTI-PSYCHOTIC EFFECTS OF ANTI-PSYCHOTIC MEDICATIONS (2)MEDICATIONS (2)

– Dystonia Dystonia handwriting deterioration, handwriting deterioration, foot cramps or foot pulls up or dragsfoot cramps or foot pulls up or drags Neck turns or pulls involuntarilyNeck turns or pulls involuntarily Rapid, uncontrolled blinking Rapid, uncontrolled blinking

– ParanoiaParanoia Anxiety or fearAnxiety or fear IrrationalityIrrationality DelusionDelusion

– Bradyphrenia - Slow thought processBradyphrenia - Slow thought process

More Typical Side Effects of More Typical Side Effects of Anti-Psychotic MedicationsAnti-Psychotic Medications AggressionAggression

AgitationAgitation

AngerAnger

DepressionDepression

HostilityHostility

HyperactivityHyperactivity

IrritabilityIrritability

Destruction of Destruction of PropertyProperty

Self-injurious behaviorSelf-injurious behavior

Socially inappropriate Socially inappropriate behaviorbehavior

Temper TantrumsTemper Tantrums

Difficulties Difficulties concentratingconcentrating

ConfusionConfusion

SedationSedation

Motor UncoordinationMotor Uncoordination

More Typical Side Effects of More Typical Side Effects of Anti-Psychotic MedicationsAnti-Psychotic Medications

Deterioration of teethDeterioration of teeth

Neuroleptic malignant syndrome – a sudden increase in Neuroleptic malignant syndrome – a sudden increase in temperature to dangerous levelstemperature to dangerous levels

Dysphoria – disquiet; restlessness; a vague sense of mental Dysphoria – disquiet; restlessness; a vague sense of mental or moral ill-beingor moral ill-being

ImpotenceImpotence

Tardive Dyskinesia – jerky, abnormal or delayed Tardive Dyskinesia – jerky, abnormal or delayed movements in the face; head; trunk or extremities, such as movements in the face; head; trunk or extremities, such as rapid eye blinking or repetitive lip sucking, rocking, or rapid eye blinking or repetitive lip sucking, rocking, or twistingtwisting

LethargyLethargy

Intense dreams or nightmaresIntense dreams or nightmares

COMMON SIDE EFFECTS OF COMMON SIDE EFFECTS OF MORE TYPICAL TYPES OF MORE TYPICAL TYPES OF MEDICATIONMEDICATION

Types of Medications causing potential side effects

Potential Side Effects

Pain relievers; anti inflammatory agents (such as Ibuprofen); muscle relaxants; and sedatives

Agitation

Weight control; antidepressants; cholesterol reducers; cold/cough medicines; decongestants; and tranquilizers

Anxiety

Pain relievers, angina relief; arrhythmia control; anticonvulsants; antidepressants; antihistamines; anti-hypertension; anti-inflammatory agents; cold/cough medicines; steroids; decongestants; diuretics; muscle relaxants; sedatives; tranquilizers

Confusion

Anti-depressants Concentration Problems

Arrhythmia Control; Antidepressants Delirium

Angina relief; arrhythmia control; anticonvulsants; anti-inflammatory agents; migraine relief; cancer treatments; diuretics; hormones; muscle relaxants; birth control; sedatives; and tranquilizers

Depression

Pain relievers; antidepressants; migraine relief; nausea relief; cancer treatments; Sedatives; and tranquilizers

Disorientation

Anticonvulsants (anti-seizure) and most recreational drugs

Emotional Disturbances

Cold/cough medicines and tranquilizers Giddiness

Arrhythmia control; antihistamines; anti-itching drugs; cold/cough medicines; decongestants; muscle relaxants; and tranquilizers

Excitability

Pain relievers; weight control; antidepressants; antihistamines; migraine relief; anti-itching drugs; cold/cough medicines; steroids; decongestants; and tranquilizers

Euphoria (a sense of emotional well-being)

Pain relievers; antidepressants; anti-inflammatory agents; cold/cough medicines; decongestants; sedatives; and tranquilizers

Hallucinations

Tranquilizers Hyperactivity

Antihistamines and anti-itching drugs Hysteria

Anti-hypertension; diuretics; tranquilizers Impotence

Arrhythmia control; antidepressants; antihistamines; anti-hypertension; anti-inflammatory agents; migraine relief; nausea relief; anti-itching drugs; antispasmodics; bronchodilators; cholesterol reducers; cold/cough medicines; decongestants; muscle relaxants; sedatives and thyroid drugs

Insomnia

Anticonvulsants; antihistamines; bronchodilators; cold/cough medicines; decongestants

Irritability

Anti-inflammatory agents; cancer treatments; and tranquilizers

Lethargy

Weight control drugs Overstimulation

Anticonvulsants; antihistamines; anti-hypertension; nausea relief; anti-itching drugs; antispasmodics; bronchodilators; cholesterol reducers; cold/cough medicines; decongestants; diuretics; oral contraceptives/birth control; sedatives; thyroid medicines; tranquilizers; and vasodilators

Nervousness

Antidepressants; nausea relief; sedatives; and tranquilizers

Nightmares

Cancer treatments; estrogens (hormones); and oral contraceptives

Pre-menstrual symptoms

Anti-nausea medicines; and tranquilizers; as well as allergies to drugs

Psychotic symptoms

Pain relievers; weight control; angina relief; anti-hypertension; nausea relief; bronchodilators; cold/cough drugs; decongestants; diuretics; tranquilizers; and vasodilators

Restlessness

Anti-Itch medicines and cold/cough medicines

Weariness

SOURCES FOR RESEARCH SOURCES FOR RESEARCH ABOUT SIDE EFFECTSABOUT SIDE EFFECTS

Physician’s Desk Reference (PDRPhysician’s Desk Reference (PDR) – ) – Physician Drug and Health InformationPhysician Drug and Health Information

PDR.NETPDR.NET – website for professional medical – website for professional medical informationinformation

MedlinePlusMedlinePlus – offers patient-friendly – offers patient-friendly information on medications and herbs: information on medications and herbs: medlineplus.govmedlineplus.gov

RXListRXList – provides information on – provides information on medications and side effects: medications and side effects: www.rxlist.comwww.rxlist.com

PDR HealthPDR Health – Prescription Drug and Health – Prescription Drug and Health Information: Information: www.pdrhealth.netwww.pdrhealth.net