just got the bill today from pharmacy for last month an it looks to me like LO is being over dosed,maybe to make her easyer to handle?Anyway heres a list Quanity for 1 month cephalexin monohydrate 250 MG Cap-----------21 Alprazolam 0.5MG PO TAB-------120 Azithromycin 500 MG PO TAB 6
Sertralin HCL 50 MG PO TAB---------31 Carvedilol 3.125MG PO TAB----62 Divalproex Sodium 125MG PO CAP------124 Hydrocloroththiszide 25MGPO TAB-------31 Famotidine 20MG PO TAB------31 Levothyroxine 150MCG PO TAB--31 Namenda 10MG PO TAB-----62 Lisinopril 10MG PO TAB----31 Abilify 5MG PO TAB-----31 Vitamin D3 1000 UNIT PO TAB-62 Havn't been able to contact the doctor yet but from the number prescribed the best I can figure out she's taking roughly 20+ pills a day,never had heart problems but I see two of the meds are for heart failure,three for anxiety an depression an one for autism,an two for infection. Doesn't seem right to me that they are dumping that many meds into her,anyone else feel like their LO is being doped up to make care easyr?
ol don, I would agree that it seems like she is taking too many meds. Based on the number of pills, the 2 antibiotics were given for only short term (one week), which is correct. I would definitely discuss this with her doctor. Have all the meds been prescribed by the same doctor? Sometimes, if she is seeing more than one doctor, they don't all know all the meds.
As a comparison, my wife takes 3 pills in the morning (2 for diabetes, 1 for blood pressure) and 2 in the evening (1 for diabetes, 1 for gastric reflux).
Marsh is your best advisor for this kind of thing.
Was she agitated and prone to rages when she was home? It looks like they are giving her an anti anxiety (Alprazolam); an anti depressant (Sertralin), and Abilify, which is usally the combination when the patient is out of control. Also, if she's in a facility, she must be in a later stage, so if it were me, I would question the Namenda. Especially since they are giving it without Aricept or Exelon. No neurologist I know would prescribe Namenda alone.
Besides the heart medication, one is for ulcers, and one is for thyroid. (I looked them up)
I would definitely discuss it with her doctor.
BTW - Between the high blood pressure, high triglycerides, high cholesterol, diabetes, and Alzheimer's Disease (which includes anxiety, depression, and rages), Sid takes 15 different medications.
yes all meds from same doctor,thanks Marsh an Joan an I will be talking to doctor as soon as possible,she did get out of control at home but that was almost a year ago,since she's having a hard time walking and using a walker I can't see how she can be a threat to anyone there,every time I visit she's asleep in a chair an then can't keep her eyes open while I'm visiting,but then she tells me her classroom is over loaded with students an she's been correcting papers all night lol
I question four differant drugs for depression an one, Alprazolam givn four times a day,it seeems to me they just load them up with meds an turn them into zombies,plus two separate meds givn for heart failure when she has never had a heart problem in the 20+ years I've known her
marilyninMD, my husband also has a very slow heart rate. In the low 50's, when at rest at times under 50. He has been on Aricept for 2.5 years. I heard that Aricept can cause bradycardia. How is your husband doing now without the Aricept. I was thinking of having it first reduced, perhaps to 5 mg, to see how he is handling it. Also heard that Aricept can cause more agitation/aggressive behavior in some.
My husband's heart rate is in the low 40's range (avid runner). Several years ago he experienced bradycardia and was very close to having a pace maker installed. This was a few months after starting Aricept. Our doctor felt that the Alzheimer's drug caused this. DH is still on both drugs and hasn't had another episode since he got out of the hospital. His cardiologist told him to drink lot's of coffee and consume more salt.
My husband only walks about 30 min. a day (very slowly, now). He does have high blood pressure and gets easily agitated, so he can only have decaff drinks.
Monika--pre dx, my husband's heart rate was in the 50's. In March, he was in an inpatient facility for 13 days for medication adjustment (the Seroquel--anti-psychotic--stopped working). You asked how he's doing without the Aricept--I really cannot judge the effect of that alone, because concurently, Zyprexa was substituted for the Seroquel; Citalopram (anti-depressant) dosage was doubled; he was put on Prazosin, as BP med that helps empty his bladder; as well as discontinuing the Aricept. The positive results I'm seeing are that he's much more compliant with care, calmer,happier. Before the stay, I had to cover all reflective surfaces in our home because his image was upsetting him and he was alaso refusing to bathe. He would no longer attend daycare, upset all the time, etc. I have now been able to send him back to daycare and think I can put him in an ALF for a respite stay later this summer. The negative changes are a definite increase in agnosia and apraxia (both of which may simply be due to disease progression). So I really can't say what the result of stopping the Aricept has been.
Alprazolam 0.5MG PO TAB-------120 Sertralin HCL 50 MG PO TAB---------31 Divalproex Sodium 125MG PO CAP------124 Abilify 5MG PO TAB-----31 Namenda 10MG PO TAB-----62
Carvedilol 3.125MG PO TAB----62 Lisinopril 10MG PO TAB----31 Hydrocloroththiszide 25MGPO TAB-------31
Famotidine 20MG PO TAB------31 Levothyroxine 150MCG PO TAB--31
Vitamin D3 1000 UNIT PO TAB-62
First question: is there anything you observe that makes you think he is on too many meds (uncomfortable, sedated, nauseated, weight loss) or does he appear comfortable? If he appears great, in some ways I would be tempted to leave it alone.
The first two are antibiotics. Cephalexin (Keflex) is used most commonly for skin infections (wounds/cellulitis) or urinary tract infections. Zithromax is often used for respiratory infections. If he had those, fine I guess. Keflex is fairly benign. Zithromax can interfere with coumadin (which he is not on).
The next group of meds are for psych reasons. Alprazolam (Xanax) is a geriatric no no generally speaking. It is associated with increased risk of falls and delirium. Half life ranges in the 6-8 hour range (meaning each dose lasts 24-32 hours). It’s a sedative. If he needs it, or if a geripsychiatrist recommended it, I would just ask what criteria are being used before it is given. It is not uncommon for nurses to have an as needed med for “agitation” but never have agitation really defined. Abilify is an atypical antipsychotic. FDA black box warning that it increases risk of death in those with dementia. However I do use it (along with every geriatrician/geripsych person I know) sparingly. If he has been on it 3 months or more, I would consider a dose reduction. Divalproex (Depakote) is an antiseizure med also used for mood/behavior issues in patients with dementia. Aside from liver issues, it is being used more and more. Sertraline (Zoloft) is fairly benign but it can cause nausea, diarrhea, weight loss. Behavior issues need to be managed (both without med and with meds). Namenda is its own issue. Most people don’t benefit from it but the saving grace it that it has much fewer side effects than Aricept etc..
The next group is for Blood pressure but also for congestive heart failure. Does he have edema (swelling in the legs)? Has an echocardiogram been done to see what type of heart failure it is? If it is diastolic heart failure (much more common in the elderly who have never had a heart attack) then the Lisinipril/coreg is not going to be effective. The only thing that matters is blood pressure control and he could probably be managed on two meds instead of three.
Famotidine (pepcid) can always be stopped for a couple of weeks and mylanta used as needed.
Vitamin D never hurt anyone
Thyroid meds are easy to check to see if they are needed. A simple blood test (TSH) will give you the answer.
Summary: 1. If he seems like he’s doing great, consider leaving the meds alone. 2. Consider trial off of Famotidine (simplest thing to do) 3. Adjust psych meds: Change alprazolam to "as needed," consider dose reduction of abilify. As if a psych consult has been done, ask what behaviors have been the problem 4. Consider stopping Namenda (I’ll post a picture later to show why) 5. Consider consolidating heart meds to two instead of three. 6. Find out what type of infection he’s had and whether the antibiotics are still needed.
Take everything I’m saying with a grain of salt because I’ve obviously never met your LO. But I do around 100-200 med reviews a month, this is how I typically approach a med list to make sure folks aren’t on too many meds a month.
The main concern is that the greater the number of meds, the greater the risk for side effects, medication interaction, mistakes (missed doses, doubled doses, wrong med given) all of which is associated with hospitalizations and ER visits and things like sedation. Fewer meds the better.
joshuy thanks for the med briefing,my concern is the last few times there she has a hard time keeping her eyes open,when I get there she's usually sitting in a chair asleep,seems like she's in a daze most of the time,she did have a urinary tract infection about a month ago an since that time has had to use walker(she was able to walk without before infection)as for the alprazolam,if each dose lasts 24-32 hours an they have prescribed 120 pills meaning to me 4 a day wouldn't that be considered an overdose?
If she is receiving xanax every 6 hours (4x/day) as a routine, I would really be concerned that it is too much. Behaviors in dementias come and go. Good moments, bad moments, good days, bad days, good months, bad months. The need for xanax should reflect that. Is it an overdose? There could always be some specific issue regarding your LO that would make her unique so it's hard for me to say for sure, but I would be worried. Xanax is associated with increased risk for infections too.
I almost forgot, every nursing home has a consulting pharmacist. You could always ask to see his/her most recent recommendations and what the physician response was to those recommendations. My pharmacist is super nice and would be willing to meet with families. Not every one is however (they are often overworked). But they can be a help in med reduction, drug interaction. If the physician is minimally involved in caring for patients and just signs off on things, the pharmacist rec can make a big difference too.