Medications and the I/DD Population
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- Paulina Hoover
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1 Medications and the I/DD Population A Supplemental Document to Session 4 in Webinar Series ADR Symptoms that Mimic Age Related/Associated Changes and Diseases Biological Changes Impaired senses Cardiovascular functioning Incontinence or retention Increased or decreased appetite Constipation or diarrhea Skin - rashes, itching Dryness of mouth Stomach nausea Male impotence Dehydration Behavior Changes Acute dementia (dementia symptoms mimic these) Agitation/excitable/restlessness/wandering Anxiety Behavioral changes (euphoria) Cognitive function decline Communication skills decline Confusion Disorientation to person, place or time Disturbed concentration Depression, sadness, irritability Delusion/hallucinations (auditory/visual) Increased or decreased sleep Loss of interest Memory loss (short and long term) Personality change Neurological Changes Black-out spells Coma Dizziness Headache High fever/elevated body temperature Numbness Tingling Muscle Coordination Convulsion Decreased or loss of muscle coordination Falls/uncoordinated movement Tremors/twitches Restlessness Seizures Unsteady gait Medications and the I/DD Population Page 1 of 6
2 Examples of Elements in Developing a Protocol on Identification and Reporting Observed Changes Medications and the I/DD Population Page 2 of 6
3 Case Study This case study is based on an older ID/DD adult. It illustrates how ADRs associated with medications may mimic, mask, exacerbate or cause ACSC that places them at risk for hospitalization. Remember that severe and profound ID/DD individuals also may express ADR-related behavior that may be subtle. Case History A male adult (71) with mild ID (Down s syndrome) has been diagnosed with senile dementia. He is confused and is apathetic to the environment around him - he refuses to participate in any activities. He is taking medications for hypothyroidism, ulcer and seizures. Recently he was placed on a medication to help increase his cognitive function and memory. Two weeks after he was started on this medication you noticed some changes from his normal behavior and from his prior symptoms of dementia. He appears to be more: confused, tired, lethargic/apathetic, and has problems sleeping, resulting in many short naps. His also appears to have loss his appetite along with black out spells and small muscle tremors. Medications Rivastigmine (Excelon) - (dementia memory) Levothyroxine (Synthroid)- (hypothyroidism) Ranitidine (Zantac) - (heart burn) Levetiracetam (Keppra)- (anticonvulsant) Known Medication Adverse Drug Reactions Exelon (rivastigmine) Use: Increase memory in AD individuals Common Side Effects Mental Confusion Hallucinations Insomnia CNS Tremors Biology - GI Nausea Anorexia Constipation Cramps Biology Urinary Infections At Risk GI Vomiting Zantac (ranitidine) Use: Acid reflux (reduces gastric acid) Medications and the I/DD Population Page 3 of 6
4 Common Side Effects Mental Sleeplessness Lethargic/apathetic Hallucinations CNS Headaches Biology - GI Constipation Biology CV Tachycardia Biology - EENT Blurred Vision At Risk None Keppra (levetiracetam) Use: Reduce Seizures Common Side Effects Mental Sleepy Dizziness CNS Headaches At Risk Mental Suicidal Ideation Process to Determine if Changes Experienced Are Due to ADRs Below are screenshots from a web-based software screening program called EMAS (Electronic Medication Alert System). The emedication Alert System s (emas) algorithm is a software web-based program that matches any changes observed in an older adult to their medications having similar adverse drug reactions. The emas generates a record of all medications that match the individual s observed changes. Patient Details and Medical Providers This is the screen with the patient and all those who will receive the record Medications and the I/DD Population Page 4 of 6
5 Observed Changes This is the screen showing all the observed changes added from the drop-down menu along with the dates the information was added Medications This is the screen with the medications added drug names are added from the drop-down menu When medications are added, the match link is used to quickly assess which medications may be causing the observed changes Match Screen This is the match screen showing which observed changes may be an ADR with the associated medication that may be causing it Medications and the I/DD Population Page 5 of 6
6 Confusion has 4 medications who associated ADRs may be causing this change, this is the same for the other two symptoms ACBS (anticholinergic cognitive burden scale) in an alert denoting that this medication has serious ADR implications in older adults (note that one medication falls into this category) This is the record that could be sent to the doctor, pharmacist, or nurse Additional Resources Medication Alert System: Anticholinergic Cognitive Burden Scale: Medications and the I/DD Population Page 6 of 6
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