Microsoft word - bag o medsbest.doc
Deborah J McCoy-Freeman, BS, RN, NREMT-P
Objectives
• Discuss a variety of commonly prescribed medications
• Discover the relationship between certain medications and their indication leading to more information of the past
• Describe interviewing techniques for achieving better assessment results
70 yo female, C/O dizziness and light headedness. Poor historian. S: dizziness, confusion A: none known M: Patient hands you her bag ‘o meds P: unknown L: unknown E: dizziness, called 911
Additional information will be difficult to obtain Without family or bystander input, this may be all you get The information you get in a patient’s past medical history (PMH) may be crucial to your treatment
What to do
• Many medical conditions/diseases are treated with a single med or a group of meds
• Certain meds can point to definite diagnoses
Solution?
• … to take a close look at the “bag ‘o meds”!
3 Simple Rules
• The medication list should never replace a good interview or assessment
• Is an augmentation of your history and physical
How to learn to be a Bag ‘o Meds
Private Eye
• Review the most common medications prescribed for that problem
• Take a look at the “multi-taskers”
• Drugs used for more than one medical malady
Pulmonary
• *Albuterol:
Ventolin,
Proventil, Combivent
• *Metaproterenol:
Alupent
• Salmetrol:
Serevent,
Advair
• Ipratoprium:
Atrovent, Combivent
•
TheoDur
*rescue inhalers
• Fluticasone
: Advair,
Flovent
• Triamcinolone
: Azmacort
• Flunisolide
: Aerobid
• Budesonide
: Pulmicort
• Methylprednisolone
: Medrol
• Cromolyn
: Intal
• Nedocromil
: Tilade
• Montelukast
: Singulair
• Zafirlukast
: Accolate
Allergies
• Loratidine:
Claritin, Alavert
• Fexofenadine:
Allegra
• Cetirizine:
Zyrtec
• Fluticasone:
Flonase
• Budesonide:
Rhinocort
• Triamcinolone:
Nasacort
• Beclomethasone:
Beconase, Vancenase
Allergies
•
Non-Steroidals
• Cromolyn
: Nasacrom
• Montelukast
: Singulair
Hypertension
• Propranolol:
Inderal
• Atenolol:
Tenormin
• Carvedilol:
Coreg
• Metoprolol:
Lopressor
• Acebutolol:
Sectral
• Labetalol:
Normodyne
Hypertension
• Clonidine:
Catapres
• Methyldopa:
Aldomet
• Terazosin:
Hytrin
• Prazosin:
Minipres
• Doxazosin:
Cardura
• Hydrochlorothiazide (HCTZ): Thiazide
• HCTZ/Triamterene:
Maxide, Dyazide
• Indapamide:
Lozol
Hypertension
• Diltiazem:
Cardizem, Dilacor, Tiazac
• Verapamil:
Isoptin, Calan, Verelan, Covera
• Amlodipine:
Norvasc
• Felodipine:
Plendil
• Isradipine:
DynaCirc
• Nicardipine:
Cardene
• Nifedipine:
Procardia, Adalat
Hypertension
• Benazepril:
Lotensin
• Captopril:
Capoten
• Enalapril:
Vasotec
• Fosinopril:
Monopril
• Lisinopril:
Prinivil, Zestril
• Moexipril:
Univasc
• Quinapril:
Accupril
• Ramipril:
Altace
• Trandolapril:
Mavik
• Losartan:
Cozaar
• Valsartan:
Diovan
• Irbesartan:
Avapro
Hypertension
• Atenolol/chlorthalidone:
Tenoretic
• Bisoprolol/HCTZ:
Ziac
• Metoprolol/HCTZ:
Lopressor HCT
• Propranolol/HCTZ:
Inderide
• Benazepril/HCTZ:
Lotensin HCT
• Captopril/HCTZ:
Capozide
• Enalapril/HCTZ:
Vaseretic
• Lisinopril/HCTZ:
Prinzide, Zestoretic
• Losartan/HCTZ:
Hyzaar
• Amlodipine/benazepril
: Lotrell
Congestive Heart Failure
• Carvedilol:
Coreg
• Nadolol:
Corgard
• Labetalol:
Normodyne
Congestive Heart Failure
• Nitroglycerin:
Minitran, Nitro-DUR, Nitrolingual,Transderm-Nitro, Nitrostat
• Isosorbide mononitrate:
Imdur, Ismo
• Isosorbide dinitrate:
Isordil
Congestive Heart Failure
• Furosemide:
Lasix
• Metolazone:
Zaroxolyn
• Bumetanide:
Bumex
• Torsemide:
Demadex
• Potassium Replacement:
KDur, KLyte
• Digoxin:
Lanoxin
Vascular Diseases
Vascular Disease
• Warfarin:
Coumadin
• Enoxaparin:
Lovenox
Vascular Disease
• Rosuvastatin:
Crestor
• Fluvastatin:
Lescol
• Atorvastatin:
Lipitor
• Lovastatin:
Mevacor
• Pravastatin:
Pravachol
• Simvastatin:
Zocor
• Cholestyramine:
Questran
• Colestipol:
Colestid
• Nicotinic Acid:
Niacin
• Fenofibrate:
TriCor
• Gemfibrozil:
Lopid
Cardiovascular Disease
•Diltiazem:
Cardizem, Dilacor, Tiazac
•Verapamil:
Isoptin, Calan, Verelan, Covera
•Amlodipine:
Norvasc
Cardiovascular Disease
• Amiodarone:
Cordarone
• Procainamide:
Procan
• Mexiletine:
Mexitil
• Quinidine:
Quinidex
• Flecainide:
Tambocor
• Clopidogrel:
Plavix
Peripheral Vascular Disease
• Pentoxifylline:
Trental
• Cilostazol:
Pletal
Cerebrovascular Disease
• Ticlopidine:
Ticlid
• Meds for causative problems
Remember Case #1?
Gastrointestinal Disease
Peptic Ulcer Disease
• Sucralfate:
Carafate
• Ranitidine:
Zantac
• Cimetidine:
Tagamet
• Nizatidine:
Axid
• Famotidine:
Pepcid
• Omeprazole:
Prilosec
• Lansoprazole:
Prevacid
• Pantoprazole:
Protonix
• Rabeprazole:
Aciphex
• Esomeprazole:
Nexium
Gastroesophageal Reflux Disease
• Metoclopramide:
Reglan
• Omeprazole:
Prilosec
• Lansoprazole:
Prevacid
• Pantoprazole:
Protonix
• Rabeprazole:
Aciphex
• Esomeprazole:
Nexium
Renal Failure
• Phosphate Binders:
Phoslo, Phosex
• Furosemide:
Lasix (usually very high doses)
Diabetes Mellitus
• Ultrashort acting:
Humalog, Novolog
• Short acting:
Humulin R, Novolin R
• Long acting:
Humulin N, Novolin N
• Mixed:
Humulin 70/30, Novolin 70/30
• Longer acting:
Lente, Ultralente, Lantus
• Pramlintide:
Symlin
• Glipizide:
Glucotrol
• Glyburide:
Micronase, Diabeta, Glynase
• Glimepiride:
Amaryl
• Metformin:
Glucophage
• Metformin/Glyburide:
Glucovance
• Acarbose:
Precose
• Miglitol:
Glyset
• Pioglitazone:
Actos
• Rosiglitazone:
Avandia
• Repaglinide:
Prandin
• Nateglinide:
Starlix
Parkinson’s Disease
• Amantadine:
Symmetrel
• Levodopa/Carbidopa:
Sinemet
• Bromocriptine:
Parlodel
• Ropinirole:
Requip
• Selegiline:
Eldypryl
• Benzatropine:
Cogentin
Alzheimer’s Disease
• Donepezil:
Aricept
• Galantamine:
Reminyl
• Rivastigmine:
Exelon
Seizure Disorders
• Carbamazepine:
Tegretol
• Gabapentin:
Neurontin
• Levetiracetam
: Keppra
• Lamotrigine:
Lamictal
• Phenytoin:
Dilantin
• Topiramate
: Topamax
• Valproic Acid:
Depakote
Migraines
• Non-specific:
Inderal, Tenormin
• Valproic acid:
Depakote
• Topiramate:
Topamax
• Gabapentin:
Neurontin
• Verapamil:
Calan
• Amlodipine:
Norvasc
• Amitriptyline:
Elavil
• Fluoxetine:
Prozac
• Ibuprofen:
Motrin
• Ergotamine/Caffeine:
Cafergot
• Sumatriptan:
Imitrex
• Naratriptan:
Amerge
• Almotriptan:
Axert
• Zolmitriptan:
Zomig
Psychiatric Diagnoses
Mood Disorders
• Nortriptyline:
Pamelor
• Imipramine:
Tofranil
• Fluoxetine:
Prozac
• Sertraline:
Zoloft
• Paroxetine:
Paxil
• Bupropion:
Wellbutrin
• Citalopram:
Celexa
• Escitalopram:
Lexapro
• Fluvoxamine:
Luvox
• Trazodone:
Desyrel
• Venlafaxine:
Effexor
• Mirtazapine:
Remeron
• Nefazodone:
Serzone
• Diazepam:
Valium
• Alprazolam:
Xanax
• Lorazepam:
Ativan
• Clonazepam:
Klonopin
• Buproprion:
BuSpar
• Lithium:
Lithobid, Eskalith
Psychosis
• Chlorpromazine:
Thorazine
• Fluphenazine:
Prolixin
• Haloperidol:
Haldol
• Thiothixene:
Navane
• Trifluoperazine:
Stelazine
• Perphenazine:
Trilafon
• Thioridazine:
Mellaril
• Risperidone:
Risperdal
• Clozapine:
Clozaril
• Quetiapine:
Seroquel
• Ziprasidone:
Geodon
• Olanzapine:
Zyprexa
• Benztropine:
Cogentin
Musculoskeletal Problems
• Ibuprofen:
Motrin, Advil
• Naproxen:
Naprosyn
• Diclofenac:
Voltaren
• Flurbiprofen:
Ansaid
• Ketorolac:
Toradol
• Ketoprofen:
Orudis
• Etodolac:
Lodine
• Nabumetone:
Relafen
• Oxaprozin:
Daypro
• Piroxicam:
Feldene
• Sulindac:
Clinoril
• Celecoxib:
Celebrex
• NSAIDs
- Indomethacin
: Indocin
• Allopurinol:
Zyloprim
Multi-Tasker Medications/Common Multi-Tasks
Other Multi-Taskers
• Prevention of movement complications
• Testosterone Blocker in Transgender patients
The MEGA Multi-Taskers
The MEGA Multi-Taskers
3rd PLACE
The MEGA Multi-Taskers
2nd PLACE
The MEGA Multi-Taskers
THE #1 MULTI-TASKER
85 yo male, wife C/O “I can’t take care of him anymore”. Poor historian. S: Confusion, can’t assist in care A: none known M: Wife hands you his bag ‘o meds P: “Demented” L: Hours ago E: Violent behavior, worsening confusion His bag ‘o meds included: •Aricept
48 yo female, with confusion and fever, found on the floor of her house, drooling. S: Confusion, fever, vomiting A: none known M: Patient’s meds are sprawled all over the floor P: unknown L: unknown E: Found by neighbor confused and ill on floor
Her bag ‘o meds included: Atenolol Humalog Symlin Lisinopril Pepcid Synthroid
Lipitor Aspirin Claritin Singulair
What is most likely in her PMH?
Source: http://www.emsedsem.org/Conference%20Handouts/2006/PHM_Dont_Forget_the_Bag_O_Meds_(McCoy-Freeman).pdf
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