High Risk Medications University of Illinois at Chicago College of Nursing 1
Learning Objectives Upon completion of this module, participants will be better able to: 1. Define Gain high risk medications and the impact on clients 2. Discuss why it is important to know if a client/member is on any of these medications In order to be able to 3. better assist clients/members with adherence 4. better identify if a member is having difficulty with adherence (taking too much, not taking it as prescribed, etc.)
Definition High risk medications are medications that carry elevated risk for negative outcomes due to toxicity and can lead to: Addiction, dependence, organ damage, coma, death Fundamentals: All medications carry risk Risk potential generally increases with increased dosing The nature of the an adverse outcome is medication-dependent
Incidence/Prevalence High risk medication use is very common, but it would be incredibly challenging to quantify Why?...because it includes several high risk medications, from different medication classes, used to treat different illnesses
Common High Risk Medications Insulin Cardiac medications Blood thinners (anti-coagulants) Pain relievers (narcotics) Anti-seizure medications (anti-epileptics) Benzodiazepines Mood stabilizers
Specific Medication & Associated Risks: Insulin Use: Diabetes Common names: Lantus Insulin (insulin glargine) Levemir (insulin detemir) Humalog (insulin lispro) Novolog (insulin aspart) Why is this medication high-risk? Too much insulin can cause blood sugar to drop Too little insulin can leave blood sugar too high *Risk of death is a serious concern with diabetic coma
Insulin: What to Watch For Chest pain or palpitations Persistent fatigue Confusion Numbness of mouth, lips, or tongue Muscle weakness or tremors Vision changes Swelling of feet Flu-like symptoms Swelling, itching, redness, warmth, or pain at the injection site.
Specific Medication & Associated Risks: Cardiac Medications Use: Heart Disease Common names: Lanoxin (digoxin) Why is this medication highrisk? Toxicity and death can occur
Lanoxin (Digoxin): What to Watch For Confusion Irregular pulse Loss of appetite Nausea/vomiting Diarrhea Fast heartbeat Vision changes - including blind spots, blurred vision, changes in how colors look, or seeing spots
Specific Medication & Associated Risks: Blood Thinners (Anticoagulants) Use: Blood Clot Prevention Common names: Coumadin (warfarin) Lovenox (enoxaparin) Why is this medication highrisk? Excess bleeding if dose is too high Blood clot if dose is too low
Blood Thinners: What to Watch For Swelling (may be sign of clot), unusual bruising Pink/brown urine, black/bloody stool Prolonged bleeding (gums, cuts), nose bleeds >7 minutes Unusually heavy/long menstrual flow Coughing blood, vomit that is bloody or looks like coffee grounds Severe dizziness, weakness, headache, fainting, unusual/persistent tiredness Pain in joints or back
Blood Thinners: Signs of a Clot In the lung: chest pain, fast heart rate, coughing, shortness of breath, fever In the heart: chest pain, shortness of breath, sweating, nausea and vomiting In the arm or leg: sudden leg, arm, or back pain, swelling, redness and warmth, tenderness In the brain: headache, vision changes, seizure, slurred speech, weakness on one side of body, dizziness In the abdomen: abdominal pain, vomiting, diarrhea
Specific Medication & Associated Risks: Narcotics Use: Pain Common names: Percocet (oxycodone / acetaminophen) Ultram (tramadol) MS Contin (morphine sulfate) Vicodin, Norco (hydrocodone / acetaminophen) Duragesic (fentanyl patch)- Why is this medication high-risk? Can cause over-sedation or diminish breathing if too much is taken (i.e. depression of the central nervous system)
Narcotics: What to Watch For Signs of overdose: Extreme fatigue, difficulty waking up, and/or shallow or very slow breathing Signs of withdrawal: Abruptly stopping the medicine after long-term use can lead to withdrawal symptoms (e.g., dilated pupils, runny nose, sweating, flushed face, flu-like symptoms, irritability, rapid breathing) *Watch for multiple medications containing acetaminophen* Increases risk of liver damage
Specific Medication & Associated Risks: Antiepileptics/Anti-convulsant Use: Prevent / Stop Seizures Common names: Dilantin (phenytoin) Keppra (levetiracetam) Topamax (topiramate) Trileptal (oxcarbazepine) Why is this medication highrisk? Can cause seizures to reoccur if not taken properly
Anti-epileptics/Anti-convulsant: What to Watch For If the member is not taking the medication as prescribed: May cause seizure May cause change in behavior (aggression, agitation, anxiety, hostility)
Specific Medication & Associated Risks: Benzodiazepines Use: Anxiety, Sleep Disorders (i.e. insomnia), Impulse Control Disorders (i.e., kleptomania, pyromania, pathological gambling) Common names: Ativan (lorazepam) Klonopin (clonazepam) Xanax (alprazolam) Why is this medication highrisk? Over-sedation or decreased breathing if taken inexcess Withdrawal symptoms if stopped abruptly
Benzodiazepines: What to Watch For Overdose: Slowed or difficulty breathing, over-sedation, or slurred speech may warrant medical attention. Can lead to coma or death if mixed with alcohol, opioids, barbiturates, or a specific class of antidepressants Tolerance can develop and the member may have withdrawal symptoms Sweating, agitation, confusion, or seizures
Specific Medication & Associated Risks: Mood Stabilizers Use: Treat Mood Instability Common names: Lithium carbonate, Eskalith, Lithobid (lithium) Depakote (valproic acid, valproate) Why is this medication high-risk? Toxicity, if Lithium is taken in excess Ineffective, if not taken properly (as directed) Both medications require regular blood level monitoring
Mood Stabilizers: What to Watch for Lithium toxicity: tremors, diarrhea, unsteady when walking, vomiting, sedation Symptoms of depression/mania
Mood Stabilizers: What to Watch for Slowed/difficulty breathing, confusion, change in mental status If used with benzodiazepines, alcohol, or other CNS depressants, patient can become profoundly sedated, resulting in coma, and possibly death. Abruptly stopping the medicine after long-term use can lead to withdrawal symptoms (e.g., runny nose, muscle pain, insomnia)
Specific Medication & Associated Risks: Opioids Use: Chronic Pain Management Detoxification of Opioid Dependence (i.e., narcotic medication, heroin) Common names: Methadone Norco Why is this medication highrisk? Risk of addiction, misuse, abuse which can lead to overdose/death Requires close monitoring by healthcare provider Hydromorphone
Management is Prevention : Mismanagement Promotes Risk Identification of effective medication management strategies Identification of potential barriers to medication adherence Positive member outcomes related to medication adherence
Resources CMS High Risk Medication List: https://www.centerforpatientsafety.org/resource/cmshigh-risk-medication-list/ Institute for Safe Medication Practices: High-Alert Medications in Community/Ambulatory Settings and in Long-Term Care Settings: https://www.ismp.org/recommendations/high-alertmedications-community-ambulatory-list
References National Institute of Health. (2018). U.S. National Library of Medicine: Daily Med. Retrieved from https://dailymed.nlm.nih.gov/dailymed/
. Thank you all for being here and for your commitment to improving the health and well-being of your client members