How to Manage Medications Caregiving Series Objectives Upon completion of this training, the participant will: Learn the warning signs of improper medication use Have an understanding of how aging changes the way the body responds to medications Be knowledgeable about safe practices for assisting or administering medications Understand proper medication storage Outline 1. Introduction 2. How aging changes the way our body responds to medication 3. Side effects and adverse reactions 4. Over the counter medications (OTC) 5. When you are in the doctor's office or emergency room 6. Questions to ask the pharmacist 7. Safe medication practices 8. How to give different medications 9. Warning signs of improper medication use 10. Medication containers and reminder system 11. Storage of medications
Key Points and Definitions 1. Drugs: Any substance that when taken into the body may change one or more of its functions. Prescribed and over-the-counter medications, herbal preparations, natural remedies, alcohol, caffeine and nicotine are all drugs. 2. Over-the-counter drugs: Medications you can buy without a doctor s prescription. 3. Aging changes the way that drugs are absorbed, distributed and eliminated from the body. 4. Many older adults take more than one medication. The more medications a person takes, the greater the chance of medication errors, falls and harmful drug interactions. 5. Older adults absorb medications more slowly because of changes in levels of stomach acid and functional changes in the kidneys and liver. 6. Muscle mass converts to fat as we age. Fat soluble drugs can be stored in the fat which may increase the risk of adverse effects or toxicity. 7. Response to medications is varied and may be unpredictable. Any unusual symptoms should be reported to the doctor. 8. Side effect: A common, known response to a medication. The side effect to most antihistamines, such as benadryl, is drowsiness. If a side effect is severe and long lasting or if it interferes with the ability to function, it should be reported to the doctor. 9. Adverse reaction: Any new, unusual, harmful or unexpected response to a medication. Adverse reactions may occur when food mixes with medicine or when medications interacts with each another. 10. Drug interaction: When one medicine reacts with another. The risk of drug interaction increases with the number of different drugs taken. 11. Some possible symptoms of adverse reactions: Change in mental alertness Difficulty concentrating, forgetfulness or confusion Fainting or extreme weakness Unusual swelling or rash Tremors or stiffness Gastrointestinal problems including digestion, constipation, diarrhea or vomiting
Loss of bladder control Blurred or double vision 12. Some adverse reactions develop slowly over weeks or months. Symptoms such as depression, fatigue or confusion may be due to an adverse reaction to medications. 13. Weakness, confusion and depression should not be ignored because they could be symptoms of an adverse reaction to medication. 14. Over the counter drugs when combined with a prescription drug may change the effect of the prescription drugs, making it stronger or less effective. Check with the doctor before giving or taking any over the counter medications. 15. Alcohol, nicotine and caffeine are also drugs. 16. Generic name: The standard accepted name for a drug not protected by a trademark registration. 17. Brand name: The manufacturer s name of a drug. For instance Bayer is a brand name of aspirin. Aspirin is the generic name. 18. When you pick up the prescription ask the pharmacist to write out complicated directions. The pharmacist can help with scheduling medications to fit you and your family's lifestyle and can answer questions you may have. 19. Using only one pharmacy allows easier tracking medication history and reduces the chances of adverse reactions. When you leave the pharmacy check the medication label to be sure it's correct. If you're refilling medication and the prescription looks different, such as having a different color, size or shape ask the pharmacist why before you give or take that medication. 20. Giving medications: Wash your hands before preparing to give medication. Have adequate lighting to reduce your chance of making errors. Do not give medications from unlabelled containers. Check the medication label for the correct name and correct dosage before removing medication from the container. Ask yourself the five Rs. 21. The five Rs (rights) for administering medications. Is it the: Right medication? Right person? Right dose? Right time? Right route? 22. Water is the safest liquid to use when giving oral medications. Milk and some juices can interfere with absorption.
23. If the medication needs to be crushed or split, there are pill crushers and pill splitters available at most drug stores. Don't chew, crush or break any capsules or tablets unless you have discussed this with your pharmacist. Some people have difficulty swallowing pills and it helps to mix the medicine with a small amount of food. Check first with the pharmacist and if the medicine can be crushed and mixed in food, a tablespoon of applesauce works well. 24. Sublingual medications: Medication taken below or under the tongue and absorbed through the lining of the mouth. Place the tablet under the tongue and let it slowly dissolve there. Do not chew or swallow the tablet. Do not swallow until the tablet has completely dissolved. 25. Ointment should be applied as directed and not too thickly. Apply cortisone cream and ointment in a thin film. Wear gloves to protect your hands. For smaller areas you can use a cotton swab. 26. Skin patches: Wash your hands before applying a patch. Patches should be applied at the same time each day. Unless your doctor tells you to use the same area, apply each patch to a new area. Choose an area that is not hairy, oily, irritated, broken, scarred or callused. Wash the new area thoroughly with soap and water. Then dry it. Remove the patch's protective backing. Try not to touch the exposed medication. Press the medicated side of the patch firmly against the skin, making sure that there is good skin contact. Press firmly with your palm for at least 10 seconds. Wash your hands thoroughly with soap and water to remove any medication that may have gotten on them. 27. Rectal suppositories: Have the person lie on his or her side, top leg bent at the knee toward the chest. Wear gloves to protect your hands. Squeeze some water soluble lubricant onto the rounded tip of the suppository. Be gentle when inserting the suppository into the rectum. Insert past the sphincter muscle, gently pushing the suppository against the wall of the rectum. Suppositories generally take 10-15 minutes to work. 28. Medication nebulizer: A device driven by compressed air or gas. Medication is converted to misty droplets that can be directly inhaled from the mouthpiece of the device. 29. Metered dose inhaler: A pressurized device used to deliver specific doses of medications to the lungs. 30. Eye drops: Should be administered with the person seated comfortably in a chair or reclining on a bed. The person should look up at the ceiling as you administer one drop, holding the lower lid out a bit to allow absorption. If a second drop must be given, wait a minute or two before administering it, or you will wash out the first drop.
31. Eye ointment: Have the person look up to the ceiling. Pull the lower lid down gently. Starting near the nose, squeeze the ointment in a ribbon about half an inch long and wrap it around the edge of the lid, pulling it back from the eye so that you do not poke the person in the eye with the applicator. Have the person close the eye. 32. Ear medication: Warm ear drops in warm water for 10-15 minutes. Cold medication going into the ear can cause nausea or dizziness. Never heat ear drops in the microwave or on the stove as this could burn the ear canal. Check the label to find out if the ear drops need to be shaken. With the head tilted to the side, place the prescribed drops into the ear and hold for one minute. Use a facial tissue to wipe any medication that may leak out. 33. Some questions to ask about whether a person can no longer manage his or her medications: Is he impaired mentally or physically? Does he have difficulty opening containers? Does he have hearing or vision problems? Is he confused or forgetful? Does he understand what the medication is for? Is he on several medications that must be taken at different times of the day? Is he too ill to take his medications? Is he being treated by more than one physician? Does he use more than one pharmacy? 34. The most common medication problem in the elderly is under-use of medication. People do not refill prescriptions, use outdated drugs or take less than is prescribed in order to save money. 35. Reminder systems: Helpful for people who forget to take their medications. The medicine is loaded into the device, which is programmed for the time of day the medicine needs to be taken. At that time, an alarm will go off, reminding the person to take the medication. The unit can be connected to a monitoring system. If the medication has not been taken after 30 minutes, the device dials the monitoring center and someone calls the person or you directly. 36. As a caregiver for someone with dementia, it is your responsibility to be with them or arrange for someone else to be with them when they need to take their medications. 37. If you receive help from a home health agency, the home care aide is not licensed to set up or give medications. Aides can only assist with medications which means that they can remind the patient to take the medication, open the container or steady the person's hand. 38. Medication storage: Light and heat can decompose some medications. Avoid storing medications on windowsills or in the car. Moisture can cause medications to spoil. Avoid storing medications in the bathroom or near sinks where there is a lot of moisture. Some medications need to be refrigerated. Do not automatically store medications in the refrigerator. Read storage instructions
on the medication container. Medications that do not need refrigeration should be stored in a cool, dry place. 39. Keep medications out of reach of children or people with dementia.
Commonly Used Medication Abbreviations Before using an abbreviation, be sure to check if the abbreviation has been approved by your agency. qd = once a day bid = twice a day tid = three times a day qid = four times a day qh = every hour q2h = every 2 hours q3h = every 3 hours q4h = every 4 hours qod = every other day AM = morning qam = every morning PM = evening or afternoon hs = bedtime (hour of sleep) qhs = every night at bedtime h or hr = hour prn = when necessary ac = before meals p = after pc = after meals stat = at once po = by mouth, orally NPO = nothing by mouth gtt = drops caps = capsule g (or gm or GM) = gram ml = milliliter mg = milligram H2O = water c = with s = without