1. Medication Side Effects

2. MEDICATION SIDE EFFECTS All medications can cause side effects All medications can cause side effects Contributing factors Contributing factors –Age –Weight –Sex –Overall health –Ethnicity –Severity of disease

3. Medication Side Effects Side Effect: an undesirable secondary effect of a drug or other form of medical treatment Side Effect: an undesirable secondary effect of a drug or other form of medical treatment –Minimal to serious and harmful –New medication –Change in dosage –Stops using medication Team Member Team Member –Seek medical help –Document the side effect and medical intervention and file Incident Report

4. COMMON MEDICATION SIDE EFFECTS Nausea Nausea Vomiting Vomiting Fatigue Fatigue Dizziness Dizziness Dry Mouth Dry Mouth Headache Headache Itching Itching Muscle Aches and Pains Muscle Aches and Pains

5. NEED FOR MEDICAL ATTENTION Abdominal Pain Abdominal Pain Blurred Vision Blurred Vision Constipation Constipation Diarrhea Diarrhea Dizziness Dizziness Headaches Headaches Loss of Appetite Loss of Appetite Memory Loss Memory Loss Heart Palpitations Heart Palpitations Coordination Problems Coordination Problems Ringing in the Ears Ringing in the Ears Skin Rashes or Hives Skin Rashes or Hives Swelling of Hands or Feet Swelling of Hands or Feet Loss of Consciousness or Fainting Loss of Consciousness or Fainting

6. APPROPRIATE RESPONSE TO OBSERVED SIDE EFFECTS Previously unobserved side effect the person’s physician should be contacted immediately. Previously unobserved side effect the person’s physician should be contacted immediately. Medication should NEVER be discontinued without approval from the person’s physician. Medication should NEVER be discontinued without approval from the person’s physician. If the side effect appears to be serious call the nurse and physician and then get the person to the emergency room as quickly as possible. If the side effect appears to be serious call the nurse and physician and then get the person to the emergency room as quickly as possible.

7. COMMON MEDICATIONS FOR PERSONS WITH INTELLECTUAL DISABILITIES Intellectually Disabled have greater incidences Intellectually Disabled have greater incidences –Epilepsy or other seizure disorders –Mental illness –Behavior disorders Anti-Seizure Medications Anti-Seizure Medications Psychotropic or Antipsychotic Medications Psychotropic or Antipsychotic Medications

8. ANTI-SEIZURE MEDICATIONS AND THEIR SIDE EFFECTS BRAND NAME (generic name) SIDE EFFECTS ATIVAN (lorazepam) Dizziness, drowsiness, blurred or double vision, nausea, skin rashes, abnormal blood counts (rare) DEPAKENE (valproate) Upset stomach, altered bleeding time, liver toxicity, hair loss, weight gain, tremor DEPAKOTE (divalproex sodium) Upset stomach, altered bleeding time, liver toxicity, hair loss, weight gain, tremor DIAMOX (acetazolamide) Appetite loss, frequent urination, drowsiness, confusion, extremity numbness, kidney stones

9. KEPPRA (levetiracetam) Sleepiness, fatigue, poor coordination, loss of strength, dizziness KLONOPIN (clonazepam) Drowsiness, sleepiness, fatigue, poor coordination, unsteadiness, behavior changes LAMICTAL (lamotrigine) Dizziness, headache, blurred vision, clumsiness, sleepiness, nausea, skin rash MYSOLINE (primidone) Clumsiness, dizziness, appetite loss, fatigue, drowsiness, hyperirritability, insomnia, depression, hyperactivity NEURONTIN (gabapentin) Sleepiness, dizziness, clumsiness, fatigue, twitching PHENOBARBITAL (phenobarbital) Drowsiness, irritability, hyperactivity (children), behavioral problems, difficulty concentrating, depression

10. PHENYTEK (extended phenytoin sodium) Clumsiness, insomnia, motor twitching, nausea, rash, gum overgrowth, hairiness TEGRETOL (carbamazepine) Dizziness, drowsiness, blurred or double vision, nausea, skin rashes, abnormal blood counts (rare) TEGRETOL XR (extended release carbamazepine) Dizziness, drowsiness, blurred or double vision, nausea, skin rashes, abnormal blood counts (rare) TOPAMAX (topiramate) Confusion, sleepiness, dizziness, clumsiness, difficulty thinking or talking, tingling sensation of the skin, nausea, decreased appetite TRANXENE (clorazepate) Drowsiness, sleepiness, fatigue, poor coordination, unsteadiness, behavior change TRILEPTAL (oxcarbazepine) Difficulty concentrating, sleepiness, fatigue, dizziness, double vision, nausea, unsteadiness, rash

11. ZARONTIN (ethosuximide) Appetite loss, nausea, drowsiness, headache, dizziness, fatigue, rash, abnormal blood counts (rare) ZONEGRAN (zonisamide) Sleepiness, dizziness, loss of appetite, headache, nausea, irritability, difficulty concentrating, unsteadiness, fever, kidney stones, rash NOTE: It is not necessary to memorize this or any chart in the training. It is, however, necessary to have this and other information on medication side effects readily available when working with persons with intellectual disabilities who may not be able to tell you that they are having these effects. The team member must recognize the side effects and respond appropriately.

12. EXTRAPYRAMIDAL SIDE EFFECTS OF ANTI-PSYCHOTIC MEDICATIONS Improper dosing Improper dosing Unusual reactions to neuroleptic medications Unusual reactions to neuroleptic medications Physical Symptoms Physical Symptoms –Tremor –Slurred speech –Akathisia restlessness in body and muscles, restlessness in body and muscles, move constantly move constantly

13. EXTRAPYRAMIDAL SIDE EFFECTS OF ANTI-PSYCHOTIC MEDICATIONS (2) –Dystonia handwriting deterioration, handwriting deterioration, foot cramps or foot pulls up or drags foot cramps or foot pulls up or drags Neck turns or pulls involuntarily Neck turns or pulls involuntarily Rapid, uncontrolled blinking Rapid, uncontrolled blinking –Paranoia Anxiety or fear Anxiety or fear Irrationality Irrationality Delusion Delusion –Bradyphrenia - Slow thought process

14. More Typical Side Effects of Anti-Psychotic Medications Aggression Aggression Agitation Agitation Anger Anger Depression Depression Hostility Hostility Hyperactivity Hyperactivity Irritability Irritability Destruction of Property Destruction of Property Self-injurious behavior Self-injurious behavior Socially inappropriate behavior Socially inappropriate behavior Temper Tantrums Temper Tantrums Difficulties concentrating Difficulties concentrating Confusion Confusion Sedation Sedation Motor Uncoordination Motor Uncoordination

15. More Typical Side Effects of Anti-Psychotic Medications Deterioration of teeth Deterioration of teeth Neuroleptic malignant syndrome – a sudden increase in temperature to dangerous levels Neuroleptic malignant syndrome – a sudden increase in temperature to dangerous levels Dysphoria – disquiet; restlessness; a vague sense of mental or moral ill-being Dysphoria – disquiet; restlessness; a vague sense of mental or moral ill-being Impotence Impotence Tardive Dyskinesia – jerky, abnormal or delayed movements in the face; head; trunk or extremities, such as rapid eye blinking or repetitive lip sucking, rocking, or twisting Tardive Dyskinesia – jerky, abnormal or delayed movements in the face; head; trunk or extremities, such as rapid eye blinking or repetitive lip sucking, rocking, or twisting Lethargy Lethargy Intense dreams or nightmares Intense dreams or nightmares

16. COMMON SIDE EFFECTS OF MORE TYPICAL TYPES OF MEDICATION Types of Medications causing potential side effects Potential Side Effects Pain relievers; anti inflammatory agents (such as Ibuprofen); muscle relaxants; and sedatives Agitation Weight control; antidepressants; cholesterol reducers; cold/cough medicines; decongestants; and tranquilizers Anxiety Pain relievers, angina relief; arrhythmia control; anticonvulsants; antidepressants; antihistamines; anti-hypertension; anti- inflammatory agents; cold/cough medicines; steroids; decongestants; diuretics; muscle relaxants; sedatives; tranquilizers Confusion

17. Anti-depressantsConcentration Problems Arrhythmia Control; AntidepressantsDelirium Angina relief; arrhythmia control; anticonvulsants; anti-inflammatory agents; migraine relief; cancer treatments; diuretics; hormones; muscle relaxants; birth control; sedatives; and tranquilizers Depression Pain relievers; antidepressants; migraine relief; nausea relief; cancer treatments; Sedatives; and tranquilizers Disorientation Anticonvulsants (anti-seizure) and most recreational drugs Emotional Disturbances Cold/cough medicines and tranquilizersGiddiness

18. Arrhythmia control; antihistamines; anti- itching drugs; cold/cough medicines; decongestants; muscle relaxants; and tranquilizers Excitability Pain relievers; weight control; antidepressants; antihistamines; migraine relief; anti-itching drugs; cold/cough medicines; steroids; decongestants; and tranquilizers Euphoria (a sense of emotional well-being) Pain relievers; antidepressants; anti- inflammatory agents; cold/cough medicines; decongestants; sedatives; and tranquilizers Hallucinations TranquilizersHyperactivity Antihistamines and anti-itching drugsHysteria Anti-hypertension; diuretics; tranquilizersImpotence

19. Arrhythmia control; antidepressants; antihistamines; anti-hypertension; anti-inflammatory agents; migraine relief; nausea relief; anti-itching drugs; antispasmodics; bronchodilators; cholesterol reducers; cold/cough medicines; decongestants; muscle relaxants; sedatives and thyroid drugs Insomnia Anticonvulsants; antihistamines; bronchodilators; cold/cough medicines; decongestants Irritability Anti-inflammatory agents; cancer treatments; and tranquilizers Lethargy Weight control drugs Overstimulation Anticonvulsants; antihistamines; anti-hypertension; nausea relief; anti-itching drugs; antispasmodics; bronchodilators; cholesterol reducers; cold/cough medicines; decongestants; diuretics; oral contraceptives/birth control; sedatives; thyroid medicines; tranquilizers; and vasodilators Nervousness

20. Antidepressants; nausea relief; sedatives; and tranquilizers Nightmares Cancer treatments; estrogens (hormones); and oral contraceptives Pre-menstrual symptoms Anti-nausea medicines; and tranquilizers; as well as allergies to drugs Psychotic symptoms Pain relievers; weight control; angina relief; anti-hypertension; nausea relief; bronchodilators; cold/cough drugs; decongestants; diuretics; tranquilizers; and vasodilators Restlessness Anti-Itch medicines and cold/cough medicines Weariness

21. SOURCES FOR RESEARCH ABOUT SIDE EFFECTS Physician’s Desk Reference (PDR) – Physician Drug and Health Information Physician’s Desk Reference (PDR) – Physician Drug and Health Information PDR.NET – website for professional medical information PDR.NET – website for professional medical information MedlinePlus – offers patient-friendly information on medications and herbs: medlineplus.gov MedlinePlus – offers patient-friendly information on medications and herbs: medlineplus.gov RXList – provides information on medications and side effects: www.rxlist.com RXList – provides information on medications and side effects: www.rxlist.com PDR Health – Prescription Drug and Health Information: www.pdrhealth.net PDR Health – Prescription Drug and Health Information: www.pdrhealth.net