Transcript Drug Induced Dementia

Drug Induced Dementia:
Proceed with Caution
David M. Angaran, MS, FASHP, FCCP
Clinical Professor University Florida College of
Pharmacy
Angaran Associates, LTD
Presentation Objectives
• Explain how and when this may happen.
• Present examples of drug caused
conditions and symptoms that worsen
dementia.
• Provide drug examples that can worsen
dementia
• Describe how to reduce the chance of this
happening.
Dementia
• Mental condition which represents a
deterioration from previous function in at
least three of the following functions:
• Language, understand what you are
seeing, memory/reasoning and emotion
• Includes:
– Alzheimer’s, Mild Cognitive Impairment,
Lewy Body, and Vascular
But First a Reminder
“The SUNNY side”
Medications can be vital to a better life for
the caregiver and patient
– Slow progression and relieve symptoms of
dementia
– Treat diseases that worsen dementia
• Depression
• Pain
• Anxiety
Drugs make Dementia Worse:
How?
• Direct acting on the brain
– Delirium
– Agitation
– Memory Loss
Dizziness
Hallucinations
Depression
• Indirect acting on the body
– Constipation
– Urinary retention
Blood sugar
Dehydration
How often does this happen?
• No ONE really knows
• Patients with mental changes
– 10-30% thought to be drug induced.
• Adverse drug effects emergency room visits
for >65 yr. (Gurwitz JH et al. JAMA 2003;289:1107-1116)
– Dementia related
• Neuropsychiatry 5%
• Falls, dizzy, 8.5%
• If it happens to you or a loved one it is 100%.
Who is at greatest risk?
•
•
•
•
•
Already demented or brain injury
Frail elderly, the older the more susceptible.
Has other disease states
Taking more drugs
Taking drugs unknown to physician or
pharmacist
– Prescription (another Dr, another Pharmacy)
– Over the counter (OTC) eg. Sleep meds.
– Herbal
When can it happen?
• When a new drug is started.
– >65 yr. Go low and slow
• When the dose is changed.
• When another drug is added, stopped, or
changed
• When a drug is stopped
– Treated condition can get worse
– Withdrawal side affects eg. Valium,
antidepressants
What Can YOU Do To Help?
“Talk with your Dr. and RPh”
• Must know every drug the person is taking.
–
–
–
–
–
OTC: Benadryl
Herbal: St. Johns Wart
Home remedy
Nutritional supplements eg. Ephedrine
Alcohol
• Must know HOW the drugs are being taken.
–
–
–
–
How much
How often
How regular
How long
What Can you Do to Help?
“Be Informed”
• Keep a Drug log. Name, Use, Directions.
• Do NOT stop, start or change drug regimen
without consulting your Dr. or RPh.
• Know what trouble looks like and what to do.
– Side effects
– What action to take
• Ensure the drugs are taken as prescribed.
– What to do if you miss a dose.
• Ask for a “Medication Review” at regular
intervals.
Drugs that MAY worsen
Dementia
• Anti Cholinergic
–
–
–
–
Elavil- antidepressant
Benadry-allergy
Demerol-pain
Mellaril-antipsychotic
Alternative
Paxil
Claritin
Percocet
Risperdal
• Anti anxiety
– Valium
Xanax
• The list goes on and on……….
Nursing Home Do NOT use list
Pentazocine (Talwin): Confusion, hallucinations, dizziness,
lightheadedness, euphoria, and sedation
Long-acting benzodiazepines(Librium): Sedation,
drowsiness, ataxia, fatigue, confusion, weakness, dizziness,
vertigo, syncope, psychological changes
Amitriptyline(Elavil) Anticholinergic and sedating properties,
which can result in confusion, delirium, or hallucinations
Doxepin(Sinequan):Anticholinergic and sedating properties,
which can result in confusion, delirium, or hallucinations
Meprobamate(Equanil): Highly addictive and sedating,
which can result in drowsiness and ataxia
Lisi DM. Medscape Pharmacotherapy 2000;2 www.medscape.com adapted
Nursing Home Do NOT use
list(cont)
Digoxin(Lanoxin): Toxic signs include headache,
fatigue, malaise, drowsiness, and depression
Methyldopa(Aldomet) May exacerbate depression
Chlorpropamide(Diabenese) Hypoglycemia, which
can result in altered mental state (confusion,
amnesia, coma)
GI antispasmodics(Bentyl) Highly anticholinergic
properties, which can result in confusion, delirium, or
hallucinations
Barbiturates(Seconal) Highly addictive and sedative,
resulting in drowsiness, lethargy, depression, severe
CNS depression
Nursing Home DO NOT use list(cont)
Muscle relaxants(Robaxin): Anticholinergic properties, which can
result in sedation, weakness, confusion, delirium, or
hallucinations
Antihistamines(Chlortrimeton): Anticholinergic properties, which
can result in confusion, delirium, or hallucinations
Reserpine: Depression, sedation
Diphenhydramine(Bendaryl) Highly anticholinergic, which can
result in confusion, delirium, or hallucinations
Indomethacin(Indocin) Headache, dizziness, vertigo,
somnolence, depression, fatigue
Disopyramide(Norpace): Strongly anticholinergic properties,
which can result in confusion, delirium, and hallucinations
Drugs that May worsen Dementia (cont)
• What is IN that over the counter (OTC)?
– DON’T trust the name: Excedrin/Excedrin
PM
– Unfamiliar contents: Ask and let them know
why you are asking.
– Cautions on the labels are NOT enough.
• Heavy machinery and driving cautions
• Sedation and excitement
Mental status has suddenly gotten
worse;what will your Dr. Do?
• Drug related questions:
–
–
–
–
Could it be caused by a drug?
What are ALL the drugs the patient is taking?
Has any drug been started, stopped, or changed?
How are they TAKING these drugs?
• Actions that may take place.
– Medication review
– Stop, substitute, increase/decrease dose
Getting Help
• Your Pharmacist
– Consultants for nursing homes and assisted living
homes.
– Drug needs at ONE pharmacy
• Complete drug profile
• Get to know you and your situation
• Rx medication information sheet NOT written for people
suffering from dementia
• Web sites
– www.medscape.com
– www.intelihealth.com
Medscape
Harvard Medical School
REMEMBER
• Medications can be VERY beneficial
for you and your loved one.
• Keep all your healthcare providers
informed about what and how drugs
are used.
• Keep a record of all the drugs.
• Know what “trouble” looks like and
what to do about it.