Be aware of the medications that your care recipient is taking

My dad had an appointment with his doctor in town the other day, and she gave him a prescription for a medication that she thought might help alleviate the pain he felt in his left arm and leg. It was a good effort, and one that I felt was well worth testing out - until I got the medication from the pharmacy and was able to look up what the side effects were for it.

I won't name the medication specifically, but I will note that one of the side effects on the pharmacy handout was suicidal thoughts. My mental brakes went on right there and I decided that was probably not something I want my dad to be taking, so I did some more research into the medication.

Common reactions, according to Epocrates Online, include:

Hostility
Tremor
Abnormal thinking
Accidental injury

Okay, there were a lot more, but I think that is enough to make me shy away from giving that medication to my dad as a test 'just to see if it helps the nerve pain he's feeling'. Add in that it has an interaction with the pain medication that he is taking that may lessen the effectiveness of that pain medication, and the "caution in elderly patients" warning I found at Epocrates Online, and I called back the doctor's office and told the nurse that I was not going to be giving him the medication until after I had consulted the doctor once again.

I'm glad that there are sites such as Epocrates Online where I can check for medication interactions and side effects, since the handouts that I get from the pharmacy are just the basics about medications. A few of them I had not even known what time of the day they should be taken, when later on I discovered that it does make a difference in the time the medicine is taken.

Intended for clinicians, the Epocrates Online website is also a very valuable resource for family caregivers wanting to make sure that the medications their care recipients get are not going to have adverse interactions with medications they are already prescribed.

Since my dad recently quit smoking, medications for stopping smoking are one of the things I have been looking at for helping make it easier for him and my mom, so being able to look up things such as Chantix and find out what the common and possible serious side effects of them are before considering them as a medication that my parents should be taking as a stop smoking aid. In the case of Chantix, I know that it would be a bad choice for my dad because of serious reactions such as anemia, GI bleed, and depression / suicidality.

I understand that you can not expect drugs not to have some kind of side effects and serious potential reactions, however, it is better in my experience to know what those potential side effects are and in particular what interactions the drug has with other drugs. Particularly when, like with my dad, there are multiple doctors that have written prescriptions for a variety of conditions.

This announcement was paid for by Epocrates. And while this is a paid posting, it is also a very important issue that I feel every family caregiver needs to be aware of and take the extra step it requires to get to know what their care recipient's medications are and what interactions they have with other medications. It takes only a few moments to check new prescriptions at Epocrates Online, but those few minutes could be the few that make all the difference.

Drug Safety Information: Acetaminophen

A very common drug that I am guessing every caregiver comes into contact with on at least a bi-weekly basis is the good old acetaminophen pill - aka Tylenol, Excedrin, etc... so, here's some things you may not have thought about concerning this medication.

IMPORTANT DRUG SAFETY INFORMATION

GENERIC NAME: acetaminophen
(a set a mee' noe fen)

BRAND NAMES: Acephen®, Allerest®, Anacin®, Axocet®, Bupap®, Capital® and Codeine, Duradrin®, Endocet®, Excedrin®, FeverAll®, Genapap®, Genebs®, Goody's®, Liquiprin® Drops, Midol®, Midrin®, Ornex®, Pamprin®, Percogesic®, Phrenilin®, Premsyn PMS®, Roxicet®, Sedapap®, Sinarest®, Sine-Off®, Sinutab®, Sominex®, Tylenol®, Tylox®, Ultracet®, Vanquish®, Wygesic®
SIDE EFFECTS:

While low in most side effects, there is at least one serious side effect that should be kept in mind, and that is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver.

HEALTH CONCERNS:

Acetaminophen is excreted in breast milk in small quantities. However, acetaminophen use by the nursing mother appears to be safe.

Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before it is felt by a person. I listed this note under health concerns because of the concerns I have in keeping careful track of any pains that my parents might experience.

INTERACTIONS:

The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.

Drugs that increase the action of liver enzymes that metabolize acetaminophen (e.g. carbamazepine, isoniazid, rifampin) may decrease the action of acetaminophen.

WHAT THE CAREGIVER NEEDS TO KNOW:

Before having any laboratory test done you should tell your doctor and the laboratory personnel that you, or your care recipient, are taking acetaminophen.

Acetaminophen relieves pain in mild arthritis but if the pain is not due to inflammation, acetaminophen is as effective as aspirin.

IMPORTANT WARNING: From SafeMedication.com -

[Posted 01/12/2007] The Centers for Disease Control and Prevention (CDC) issued a Morbidity and Mortality Weekly Report (MMWR) article describing three deaths in U.S. infants aged less than 12 months associated with cough and cold medications. These medications were determined by medical examiners or coroners to be the underlying cause of death. The cases described in this report underscore the need for clinicians to use caution when prescribing and caregivers to use caution when administering cough and cold medications to children aged less than 2 years. For more information visit the FDA website at: http://www.fda.gov/medwatch/safety/2007/safety07.htm#coughcold and http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5601a1.htm.

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SOURCES: (one or more of the following web sites may have been consulted in the research for this drug)
U.S. Food and Drug Administration
MedlinePlus
MedicineNet.com
SafeMedication.com
Wikipedia.org

Drug Safety Information: ACE inhibitors

Okay, my first post is not specifically a drug, more like a classification of drugs. The ACE inhibitors. These are something that I keep hearing about and my dad has been on them a few times, so I decided to look into them. Here's what I found.

IMPORTANT DRUG SAFETY INFORMATION

Angiotensin Converting Enzyme (ACE) Inhibitors

GENERIC NAME: ACE inhibitor

BRAND NAMES:
captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril) fosinopril (Monopril), ramipril (Altace), perindopril (Aceon), quinapril (Accupril), moexipril (Univasc), and trandolapril (Mavik).

SIDE EFFECTS:
One of the side effects is coughing - it may take up to a month for coughing to subside.

The most serious, but rare, side effects of ACE inhibitors are kidney failure, allergic reactions, a decrease in white blood cells, and swelling of tissues (angioedema).

HEALTH CONCERNS:
Individuals who are pregnant and those that have severe kidney problems should usually not take ACE inhibitors.

INTERACTIONS:
They have few interactions with other drugs

excessive blood potassium levels may result if ACE inhibitors are taken in conjunction with potassium supplements, salt substitutes (which often contain potassium), or other drugs that increase the body's potassium.

ACE inhibitors may increase the blood concentration of lithium (Eskalith) and lead to an increase in side effects from lithium.

WHAT THE CAREGIVER NEEDS TO KNOW:
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, indomethacin, and naproxen may reduce the effects of ACE inhibitors; however, there is no conclusive evidence that this interaction, if it exists, is important.

ACE inhibitors case the muscles surrounding blood vessels to relax and the blood vessels enlarge, or dilate, which reduces the blood pressure.
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SOURCES: (one or more of the following web sites may have been consulted in the research for this drug)
U.S. Food and Drug Administration
MedlinePlus
MedicineNet.com
SafeMedication.com
Wikipedia.org

Drug Interactions Examined

Anyone hear anything about this? The premier episode of The Learning Channel’s new program, “Mystery Medicine,” which aired their first episode entitled “Brain on Fire/Killer in the Bottle” on May 30, had pharmacist Phil Johnston, Pharm.D. on there and showed how he helped find a previously unknown food-drug interaction.

The interaction caused tremors and nausea in a transplant patient at Vanderbilt University Medical Center, where Johnston was assistant director for education and research. According to the press release I read from the American Society of Health-System Pharmacists (ASHP), Johnston discovered that an ingredient in a citrus-flavored soft drink was causing tremors and nausea that the patient was suffering from.

It has been long known that certain foods can interact with certain drugs and cause potentially dangerous side effects. Coumadin is one medication that I know of that has a long list of foods that you can not take with it because of the high vitamin K content in the foods.

I am going to be running a series here on Family C.A.R.E. that will look at some drugs and provide some information on the different reactions that they can have to stuff and what you should not be taking when taking them. I've had to call too many doctors over the years on trying to give my dad medication that he could not take with one he was already on. It's scary. So maybe I can help some of my readers out.

Later on I'll move this all to the FamilyCaregiver.info website and into a more easily accessed database setting. For now I want to start collecting the information on these drugs and Capella University and Blogitive are being kind enough to give me enough sponsorship to let me dedicate my time to this project.