As a general rule, caregivers usually are required to assist residents with medications because of a physical or mental condition which limits the resident’s ability to self-administer.
You will be assisting residents with medications as prescribed by a health care provider and perhaps, assisting with over-the-counter medications a resident chooses to take. All medications must be used carefully. Part of your role when assisting residents is to be aware that the resident may experience side-effects as a result of taking a medication. While we generally think a medication is supposed to make a person feel better, all medications have side-effects, some which may be tolerable and others which may be very dangerous and, in fact, life-threatening.
Residents take many different kinds of medications. Each medication taken has a specific effects on the body. As a result, medications are classified according to how they will act in the body. Knowing how the medication is classified will help you understand its effects on the body.
It is important to have some general knowledge of common medications classifications and their potential side-effects, adverse reactions, and drug interactions. Knowledge of common drug interactions can help prevent problems. [A “drug interaction” occurs when a drug interacts with other drugs and/or certain foods to produce side-effects.]
The following are examples of classes of drugs and the most common types used.
1. Cardiovascular System Medications:
- Vasodilators relax or dilate the walls of arteries so that less force is needed to push the blood through. They are used especially to control angina. Common vasodilators are sublingual nitroglycerine (Nitrostat) and isosorbide (Isordil, Imdur).
- Diurectics, or sometimes called “Water pills”, help the body eliminate excess fluids through urinary excretion. Certain diuretics are often given along with antihypertensive drugs to treat high blood pressure. Diuretics are often used to treat congestive heart failure (CHF). Commonly used diuretics include hydrochlorothiazide (HydroDiuril), spironolactone (Aldactone), furosemide (Lasix) and Demadex.
- Antihypertensives are drugs that lower blood pressure. Hydralazine (Apresoline), captopril (Capoten), nifedipine (Procardia), propranolol (Inderal), methyldopa (Aldomet), and metoprolol (Lopressor) are some of the major antihypertensive drugs.
- Antiarrhythmic medications are used to treat irregular heartbeats. They calm the heart so that it doesn’t beat too rapidly. Examples of antiarrhythmic medications are digitals (Lanoxin), quinidine (Quinora) and procainamide (Pronestyl).
- Anticoagulants, sometimes called “blood thinners” prevent blood from clotting. Warfarin (Coumadin) is an example of an oral anticoagulant.
NOTE: Most side effects from cardiovascular drugs come from over dosage. Report any of the following side effects to the health care provider immediately:
Headache, nervousness, “pounding pulse.”
Weakness, flushing of skin, fainting (especially when a person stands after lying down)
WARNING: Use of aspirin can be dangerous with anticoagulants.
2. Respiratory System Medications:
- Antitussive drugs are cough suppressants. Codeine is a narcotic antitussive. Dextromethorphan (Dimetapp-DM) is a non-narcotic antitussive.
- Expectorants break up thick mucous secretions of the lungs and bronchi so they can be coughed up.
Robitussin DM contains an expectorant. - Decongestants reduce swelling and some dry up the mucous membranes. Examples of decongestants include Neo-Synephrine, Benzedrex, and Afrin.
- Bronchodilators cause the bronchioles to relax and expand which helps ease breathing. Bronchodilator medications are most often prescribed as inhalers and include albuteral (Proventil and Ventolin), Primatine Mist, theophylline (Slo-Bid and Theo-Dur).
3. Medications for the Skin:
Each skin disorder has its own best treatment and drugs.
Most of the drugs fall into one or more of the following categories.
- Protectives and Astringents work by covering, cooling, drying, or something inflamed skin. Protectives form a long-lasting film. They protect the skin from water, air and clothing to allow healing. Astringents shrink blood vessels, dry up secretions from scrapes and cuts, and lessen the sensitivity of the skin.
- Antipruritics relieve itching caused by inflammation. Some of these drugs (emollients, oils, creams, and lotions) are soothing and relieve the itching.
Antihistamines such as Benadryl and Atarax also relieve itching. - Anti-Inflammatory drugs (also called topical corticosteroids) have three actions which work to relieve the symptoms of skin disorders: (1) relieve itching; (2) suppress the body’s natural reactions to irritation; and (3) tighten the blood vessels in the area of the inflammation. Examples of anti-infammatory drugs are triamcinolone (Aristocort, Kenalog) and hydrocortisone. These are usually be taken with food to decrease side effects.
- Anti-Infective drugs kill or inhibit organisms that cause skin infections. Antibiotic ointments, such as Neosporin and Bactroban, are anti-infective oitments.
- Antiseptics inhibit germs on skin surfaces. They are never given orally. Antiseptics are used to prevent infections in cuts, scratches, and surgical wounds.
Alcohol and Betadine are antiseptics. - Topical anesthetics relieve pain on the skin surface or mucous membranes by numbing the skin layers and mucous membranes. These are often used to treat wounds, hemorrhoids and sunburn. Solarcaine is a topical anesthetic.
- Parasiticides kill insect parasites that infest the skin such as scabies and lice. An example of a parasiticide is Kwell.
4. Urinary System Medications:
- Antibiotics may be used to treat urinary tract infections. Examples of antibiotics include Cipro, Bactrim and Septra.
- Diuretics are used to increase the output of water.
Diuretics are often given to maintain normal urine production for persons with kidney disorders.
5. Gastrointestinal (Digestive) System Medications:
Gastrointestinal disorders may require medications and physical care. Medication alone may not be sufficient to treat the problem. For example, a person with constipation needs to eat fresh fruits and bran, drink water regularly exercise, and get on a regular bowel program.
- Antacids relieve gastric and ulcer pain by neutralizing stomach acid. Too many antacids can interfere with digestion. Milk of Magnesia, Maalox, Gelusil and Mylanta are antacids.
- Acid blockers block acid from entering the stomach and causing pain. Common acid blockers include: Ranitidine (Zantac), Axid, Prevacid and Prilosec.
- Antiflatulents relieve gassiness and bloating taht accompanies indigestion. Phazyme, Di-Gel, and Mylanta are antiflatulents.
- Emetics produce vomiting in case of poisoning. Ipecac is an emetic syrup.
- Anticholinergics and antispasmodics are often used to treat ulcers and irritable bowel syndrome. Dicyclomine (Bentyl) and Levsin are examples.
- Anti-inflammatory drugs are used to treat colitis.
Examples of such medications are Medrol and Prednisone. - Laxatives and purgatives promote bowel movements.
In small dosages, they gently relieve constipation and are called laxatives. in larger dosages, they clean out the gastrointestinal tract and are called purgatives.
Purgatives are often given prior to surgery or exams.
There are several sub-categories of laxatives and purgatives. Some elderly get in acycle of use/abuse of laxatives. - Stimulant help push fecal matter through the intestines and include castor oil Senokot, Dulcolax, and Ex-Lax.
- Saline softens feces and stimulates bower movements. Examples include milk of magnesia and Epsom salts.
- Bulk formers stimulate bowel movements and include Metamucil.
- Emollients/lubricants are lubricants and detergents and detergents which work to allow fecal matter to pass more easily through the intestine. Also called stool softeners this group includes docusate (Colace), Peri-Colace and Senokot-S.
NOTE: Time of administration is important for these medications. Some medications must be given without food. Pay close attention to instructions about giving before, after or with food.
6. Endocrine System:
- Antidiabetic agents such as glipizide (Glucotrol), metformin (Glucophage) and glyburide (Micronase, Diabeta) are oral medications used to control blood sugar levels. Injectable antiabetic agents include insulins such as Humalog, Novolin and Humulin.
- Hormonal drugs are used for disorders related to problems with thyroid and pituitary glands, adrenal, pancreas, and ovaries and testes by regulating hormones. Common hormonal drugs include Thyroid, Synthroid, Vasopressin (Pitressin), and Cortioctropin (ACTH).NOTE: Ensure that residents take these medications at regularly scheduled times.
Do not miss dosages with these medications. The health care provider should be contacted immediately if a resident stops taking his/her medication.
7. Nervous System
Anticonvulsants are used to treat seizure disorders.
Phenytoin (Dilantin). Depakote, carbamazepine (tegretol), and clonazepam (Klonopin) are examples of anti-convulsant medication. If you have a resident on anticonvulsants, know what to do for a seizure.
8. Psychiatric Medications
Psychiatric medications are given to decrease the symptoms of mental disorders. Each medication helps a certain set of symptoms.
Anti-depressants are used to decrease symptoms of depression such as trouble concentrating, loss of enjoyment, changes in sleeping and eating patterns, or thoughts of wishing to die.
Brand name Generic name
Elavil Amitriptyline
Norpramin Desipramine
Tofranil Imipramine
Pamelor Nortriptyline
Sinequan Doxepin
Ludiomil Maprotiline
Paxil Paroxetine
Prozac Fluxetine
Wellbutrin Bupropion
Zoloft Sertraline
Desyrel Trazodone
9. Anti-anxiety medication
They are given to decraese symptoms of anxiety such as intense fears, panic, repetitous thoughts, stomaches, fast breathing and heartbeat, and tremors. These medications are often habit forming.
Brand name Generic name
Ativan Lorazepam
Klonopin Clonazepam
Librium Chloridiazepoxide
Serax Oxazepam
Traxene Clorazepate
Valium Diazepam
Xanax Alprazolam
Buspar Buspirone
10. Anti-psychotic Medications
They are given to decrease symptoms of psychosis such as hallucianations, delusions or disorganized thinking.
Brand name Generic name
Mellaril Thioridazine
Stelazine Trifluoperazine
Thorazine Chlorpromazine
Trilafon Perphenazine
Navane Thiothixene
Loxitane Loxapine
Moban Molindone
Clozaril Clozapine
Risperdal Risperidone
Haldol Haloperidol
Prolixin Fluphenazine
Zyprexa Olanzapine
Seroquel Quetiapine
Anti-psychotic medications can take as long as a month of consistent administration before they are effective. Close observation is important.
NOTE: Some side-effects associated with anti-psychotic medications are particularly dangerous. Tardive dyskinesia is often seen in persons taking anti-psychotic medications. Untreated, the symptoms characteristic of tardive dyskinesia can become permanent. These symptoms include involuntary movements such as facial tics, facial grimacing, eye blinking, lip smacking, tongue thrusting, foot tapping, shuffling gait, head-nodding, and moving one’s head to the back or to the side. If you notice any of these symptoms, notify the health care provider as soon as possible.
11. Mood Stabilizing Medications
They are used to treat the symptoms of bipolar disorder, such as not sleeping for several nights, frantic highs (mania), and drastic laws.
Brand name Generic name
Lithium Lithobid, Lithium
Eskalith Lithium
Tegretol Carbamazepine
Depakote Depakene, Valproic Acid
NOTE: Lithium Toxicity is a potentially life-threatening side-effect. It occurs when the body has too much lithium. It can happen becuase of high dosage or dehydration. Dehydration can result from diarrhea, too much alcohol, a really bad sunburn, vomiting; anything that causes the person to lose a lose a lot of body fluids.
A person who is lithium toxic would have some or all of the following symptoms: mental confusion, slurred speech, vomiting, diarrhea, severe muscle tremors, severe drowsiness, poor coordination, and coma. If a person seems to be showing signs of lithium toxicity, contact the health care provider or call 911 immediately.
