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HOME MEDICATIONS Bryan Bledsoe, DO, FACEP, EMT-P. Home Medications. A patient’s medications can provide a tremendous amount of information regarding the patient’s underlying medical problems. Top-Ten Prescriptions in 2001. 1. Hydrocodone/APAP 2. Lipitor 3. Premarin 4. Synthroid

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HOME MEDICATIONS

Bryan Bledsoe, DO, FACEP, EMT-P


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Home Medications

  • A patient’s medications can provide a tremendous amount of information regarding the patient’s underlying medical problems.


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Top-Ten Prescriptions in 2001

  • 1. Hydrocodone/APAP

  • 2. Lipitor

  • 3. Premarin

  • 4. Synthroid

  • 5. Atenolol

  • 6. Furosemide

  • 7. Prilosec

  • 8. Albuterol

  • 9. Norvasc

  • 10. Alprazolam


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Mrs. Helen McCurdy

  • 76 year old female found unresponsive by rural postal carrier. No family or friends around.

  • Vital Signs:

    • Blood Pressure: 138/90 mmHg

    • Heart Rate: 102 bpm

    • Respirations: 10 per minute


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Mrs. Helen McCurdy

  • Medications found in cupboard:

    • Lanoxin

    • Lasix

    • Vasotec

    • Ismo

    • K-Dur

    • Keflex

    • MS-Contin


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Mrs. Helen McCurdy

  • Medications found in cupboard:

    • Lanoxin: CHF, atrial fibrillation

    • Lasix: CHF, HTN

    • Vasotec: CHF, HTN

    • Ismo: Angina

    • K-Dur: Potassium Depletion

    • Keflex: Infection

    • MS-Contin: Pain


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Mrs. Helen McCurdy

  • Upon evaluation at Sundown ED:

    • 1. Lacunar stroke due to HTN and AF

    • 2. CHF (mild exacerbation)

    • 3. Atrial Fibrillation

    • 4. Stable angina pectoris

    • 5. Moderate HTN (fair control)

    • 6. Chronic sciatica due to degenerative disc disease

    • 7. Recent sinus infection


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Home Medication Packaging

  • Shoe Box

  • Paper Grocery Bag (Sack)

  • K-Mart Plastic Bag

  • Wal-Mart Plastic Bag

  • Pill holder bought by caring family member which sorts pills by time and date (with no labels whatsoever)


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What medicines do you take?

  • Well, I take a little pink pill in the morning and two of the white pills in the evening.

  • Oh honey…I don’t know. You better call Dr. Williams. He keeps up with all of my medications.

  • Oxy-Contin….and I NEED MORE!!!


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Definitions

  • Drugs are chemical agents used in the diagnosis, treatment, or prevention of disease.


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Analgesics

Antianginals

Anxiolytics

Anticoagulants

Anticonvulsants

Antidepressants

Antidiabetic

Antihypertensives

Antipsychotics

Beta-Blockers

Bronchodilators

Calcium Channel Blockers

Cardiotonics

Diuretics

Sedatives/Hypnotics

Medication Classes


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Analgesics

  • Used to alleviate pain and inflammation

    • Narcotics

    • Non-Steroidal Anti-Inflammatory Agents

    • Non-Narcotic/Non-NSAIDs

    • Anti-Migraine Agents


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Used to treat moderate to severe pain

Morphine

Codeine

Vicodin

Lorcet

Darvocet

Lortabs

Percocet

Percodan

Oxy-Contin

MS Contin

Stadol NS

Dilaudid

Demerol

Talwin

Norco

Fentanyl

Narcotic Analgesics


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Alleviate pain and inflammation

Motrin

Toradol

Naprosyn

Anaprox

Celebrex

Lodine

Relafen

Tolectin

Vioxx

Voltaren

NSAIDs


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Mild-moderate pain

Acetaminophen

Ultram

Topicals

Non-Narcotic/Non-NSAID


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Used to treat headache in documented migraineurs

Inderal

DHE

Midrin

Amerge

Axert

Imitrex

Maxalt

Zomig

Anti-Migraine


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Anti-Anginals

  • Used in the treatment of angina pectoris

    • Nitroglycerin

    • Ismo

    • Isordil

    • Cardizem


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Antihypertensives

  • Used to decrease blood pressure

    • Adrenergic blockers

    • ACE Inhibitors

    • Angiotensin II Receptor Antagonists

    • Beta-Blockers

    • Calcium-Channel Blockers

    • Diuretics

    • Vasodilators

    • Combination Agents


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Adrenergic Blockers

  • Cause peripheral vasodilation

    • Cardura

    • Hytrin

    • Normodyne


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ACE Inhibitors

  • Cause peripheral vasodilation

    • Accupril

    • Altace

    • Captopril

    • Lotensin

    • Monopril

    • Prinivil

    • Univasc

    • Vasotec

    • Zestorectic


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Angiotensin II Receptor Antagonists

  • Cause peripheral vosodilation

    • Atacand

    • Avapro

    • Cozaar

    • Diovan


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Beta Blockers

  • Decrease heart rate and cause peripheral vasodilation

    • Betapace

    • Blocadren

    • Corgard

    • Inderal

    • Sectral

    • Tenormin

    • Toprol


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Calcium-Channel Blockers

  • Cause peripheral vasodilation and slow AV conduction

    • Adalat

    • Cardene

    • Cardizem

    • DynaCirc

    • Isoptin

    • Norvasc

    • Procardia


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Diuretics

  • Cause water excretion decreasing circulating volume

    • Dyazide

    • Maxzide

    • Demedex

    • Lasix

    • Diuril

    • Zaroxolyn


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Vasodilators

  • Decrease peripheral vasodilation (many agents indirectly cause this affect)

    • Nitrates

    • Calcium Channel Blockers

    • ACE Inhibitors


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Combination Agents

  • Usually a combination of two antihypertensive agents

    • Monopril HCT

    • Prinizide

    • Zestoretic

    • Hyzaar


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Antiarrhythmics

  • Corrects cardiac dysrhythmias

    • Mexitil, Quinidex, Rhythmol, Tambocor

    • Betapace, Brevibloc, Inderal

    • Cordarone, Corvert

    • Cardizem, Isoptin

      Digoxin commonly used to control rate.


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Antilipidemics

  • Lowers blood lipids (cholesterol)

    • Lopid

    • Baycol

    • Lescol

    • Lipitor

    • Mevacor

    • Pravachol

    • Zocor


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Alzheimer’s Agents

  • Helps manage s/s Alzheimer’s dosease

    • Aricept

    • Cognex

    • Reminyl


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Anticonvulsants

  • Used to prevent seizures

    • Nembutal

    • Neurontin

    • Depakote

    • Tegretol

    • Dilantin

    • Lamictal

    • Zaorntin


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Antidiabetic Agents

  • Used to lower blood sugar in diabetes

    • Insulin

    • Glucophage

    • Glycet

    • Precose

    • Diabeta

    • Glucotrol


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Antibiotics

  • Used to treat infections (primarily bacterial)

    • Cephalosporins

    • Macrolides

    • Penicillins

    • Quinolones

    • Sulfonamides

    • Tetracyclines


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Cephalosporins

  • Keflex

  • Ceclor

  • Cedax

  • Ceftin

  • Duricef

  • Suprax


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Macrolides

  • Erythromycin

  • Biaxin

  • Zithromax


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Penicillins

  • Common

    • Amoxicillin

    • Penn VK

  • Beta-Lactam

    • Augmentin

  • Gorrilacillins

    • Unasyn

    • Zosyn


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Quinolones

  • Cipro

  • Floxin

  • Levaquin

  • Noroxin

  • Trovan


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Sulfonamides

  • Bactrim

  • Septra


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Tetracyclines

  • Tetracycline

  • Doryx

  • Minocin

  • Vibramycin


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HIV/AIDS Agents

  • Reverse transcriptase inhibitors

    • Rescriptor

    • Viramune

    • Combivir

    • Epivir

    • Retrovir

    • Videx

    • Zerit


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HIV/AIDS Agents

  • Protease Inhibitors

    • Agenerase

    • Fortovase

    • Norvir

    • Viracept


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Anti-Viral Agents

  • Inhibit viral growth/reproduction

    • Famvir

    • Flumadine

    • Symmetrel

    • Valtrex

    • Zovirax


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Anti-Parkinsonian

  • Helps minimize the symptoms of Parkinson’s disease

    • Akineton

    • Artane

    • Benadryl

    • Levsin

    • Lodosyn

    • Mirapex

    • Requip

    • Sinnemet

    • Symmetrel


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Blood Modifiers

  • Decrease blood clotting and viscosity

    • Coumadin

    • Persantine

    • Aggrastat

    • Plavix

    • Ticlid


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Gastrointestinal Agents

  • Antacids

  • Anticholinergics

  • Antidiarrheals

  • Antiemetics

  • Antispasmodics

  • Laxatives

  • Anti-Ulcer Agents


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Antacids

  • Decrease gastric acid levels

    • Calcium antacids

    • Magnesium antacids


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Anticholinergics

  • Decreases gastric acidity and motility

    • Robinul

    • Levsin


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Antidiarrheals

  • Slow GI motility and increase stool bulk

    • Immodium A-D

    • Pepto-Bismol


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Antiemetics

  • Decreases nausea and vomiting

    • Compazine

    • Phenergan

    • Tigan

    • Zofran

    • Reglan


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Anti-spasmotics

  • Decreases GI motility and spasm

    • Donnatal

    • Levsin

    • Bentyl


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Laxatives

  • Evacuates bowels

    • Magnesium citrate

    • Colace

    • Senokot


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Anti-Ulcer Agents

  • Decrease gastric acid, promote ulcer healing

    • Prilosec

    • Prevacid

    • Aciphex

    • Zantac

    • Pepcid


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Hormones

Substances secreted by ductless glands that control other glands and body functions


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Hormones

  • How do you make a hormone?

    • Don’t pay her!


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Hormones

  • Estrogens

  • Glucocorticoids

  • Progesterone

  • Thyroid Replacements

  • Testosterone


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Estrogens

  • Naturally-occurring female hormone used to replace natural hormone

    • Estrace

    • Ogen

    • Premarin


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Glucocorticoids

  • Used to reduce inflammation and the immune response

    • Prednisone

    • Pediapred

    • Prelone

    • Medrol

    • Decadron

    • Cortisone


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Progesterone

  • Naturally-occurring female hormone used to replace natural hormone

    • Provera

  • Usually used in combination with estrogen

    • OCPs

    • Premphase


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Thyroid Hormones

  • Used to replace defiicient natural hormone

    • Syntrhoid

    • Levothroid


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Testosterone

  • Used for selected cases of impotence

    • Testroderm

    • Testred


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Anti-Depressants

  • Used to treat depression and other affective disorders

    • MAOIs

    • SSRIs

    • TCAs

    • Miscellaneous Agents


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Monamine Oxidase Inhibitors

  • Increases amount of dopamine by decreasing MAO

    • Nardil

    • Parnate

      There are many potential problems with patients on MAOIs and these should be a red flag.


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Selective Serotonin Reuptake Inhibitors (SSRI)

  • Increases brain levels of dopamine

    • Celexa

    • Paxil

    • Prozac

    • Zoloft


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Tricyclic Antidepressants (TCAs)

  • Increases levels of dopamine in the brain

    • Etrafon

    • Limbitrol

    • Norpramin

    • Sinaqual

    • Elavil


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Miscellaneous Agents

  • Various mechanisms

    • Effexor

    • Remeron

    • Serzone

    • Wellbutrin


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Antipsychotics

  • Used to treat various psychotic states (i.e. schizophrenia)

    • Serentil

    • Thorazine

    • Haldol

    • Loxitane

    • Moban

    • Navane

    • Risperdal

    • Seroquil


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Patients with major psychiatric disorders, such as schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

Psychotic Patients


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Anti-Manic Agents schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Used to control mania in bipolar disorder

    • Lithium

    • Lithobid

    • Eskalith


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Obsessive-Compulsive Disorders schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Used to control obsessive/ritualistic behaviors

    • Luvox

    • Paxil

    • Prozac

    • Zoloft


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Antianxiety Agents schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Used to treat anxiety, panic disorders, and similar affective disorders

    • Valium

    • Ativan

    • Xanax

    • Librium

    • Tranxene

    • Buspar


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Sedatives/Hypnotics schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Used to sedate or induce sleep

    • Commonly-used benzodiazepines

      • Restoril

      • Halcion

      • Dalmane

    • Related-Agents

      • Ambien

      • Sonata


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Respiratory Agents schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Used to decrease bronchospasm, inflammation, and to stimulate respirations.

    • Beta-Agonists

    • Xanthines

    • Anti-Inflammatories

    • Miscellaneous Agents


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Beta Agonists schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Cause bronchodiation by blocking beta 2 adrenergic receptors

    • Albuterol

    • Metaproterenol

    • Isoetharine

    • Maxair

    • Serevent


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Xanthines schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Cause bronchodilation

    • Theophylline

    • Theo-Dur

    • Aminophylline

    • Uniphyl


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Anti-Inflammatories schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Decrease inflammation

    • Prednisone

    • Decadron

    • Aerobid

    • Azmacort

    • Flovent

    • Vanceril

    • Combivent


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Miscellaneous Agents schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • Used to augment other agents.

    • Atrovent

    • Intal

    • Singulair

    • Accolate

    • Zyflo


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Case Studies schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • 42 year old female with altered mental status and dyspnea.

  • Medications:

    • Prednisione

    • Serevent

    • Alupent

    • Augmentin


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Case Studies schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • 24 year old female with altered mental status and fever.

  • Medications:

    • Bactrim

    • Retrovir

    • Viracept

    • Pentamidine


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Case Studies schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • 72 year old male with chest pain.

  • Medications:

    • NTG

    • ASA

    • Prinivil

    • Lipitor

    • Persantine

    • Lanoxin

    • Coumadin

    • Glucophage


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Case Studies schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)

  • 56 year old female with altered mental status

    • Lanoxin

    • Diabeta

    • Vasotec

    • Synthroid

    • Betapace

    • Maxzide

    • Ventolin


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STAY WARM schizophrenia, are often non-compliant with needed medications. Doctors often prescribe long-acting anti-psychotics that can be given fortnightly or at even longer intervals (Haldol Decanoate)