September 2003
Basic Pharmacology and Medication Side Effects
GOAL: This training will provide you with an understanding of Basic Pharmacology and Medication Side Effects.
I. General Information Regarding Basic Pharmacology
Pharmacology studies the effects of a drug on the body in general, as well as the drug’s effects on each organ, organ system and individual cell.
This section of your training will introduce you to concepts of Pharmacology as it relates to clients/consumers at the Burke Center. The training will further acquaint you with some of the medications most often prescribed by Burk Center physicians, effects of medications prescribed, and ways you can assist the medication process by knowing adverse effects associated with those drugs, including signs indicating medical emergencies.
II. Direct Care Worker’s Role
Direct care workers have the most time with clients of any Burke Center professional. The direct care worker is often asked drug name, dosage, time to take the medication, expected or intended effect, side effects and any special instructions relating to the prescribed medications. It is important, therefore, for non-medical direct care workers to know their roles. The role of the physician is to determine a psychiatric diagnosis, prescribe medication, dispense medication (samples) and in certain cases, administer medication. The nurse’s role is to administer prescribed medications. The non-medical direct care worker’s role is to observe effects of medication, document reported and observed effects and communicate client concerns or observed adverse reactions to medical staff.
III. Drug Effects
The “intended effect” of medication is the effect the physician intends when prescribing medication. The intended effect of medication can be altered by anything that slows absorption, metabolism or excretion. Factors contributing to altering the intended effect include (but not exclusive to): a persons age, weight, health, history and drug interactions.
Direct care staff are often faced with evaluating the side effects or adverse effects of medication prescribed by Burke Center physicians. Two (2) types of adverse effects are IDIOSYNCRATIC (unusual for the individual) and PARADOXICAL (reverse from the intended reaction). Some adverse reactions can be life threatening; therefore, direct care staff should always take client/consumer reports and observations seriously.
Life threatening side effects include (but are not limited to):
ü Severe allergic reactions (hives, anaphylactic shock, respiratory collapse, cardiovascular)
ü Difficulty breathing
ü Lips swelling
ü Choking
ü Difficulty swallowing
ü Profuse sweating
ü Seizures
Non-life threatening side effects are undesirable and often uncomfortable to the client/consumer. These include short-term side effects and long-term side effects.
Short-term side effects may include:
ü Headache
ü Nausea
ü Stomach irritation
ü Localized swelling
Long-term side effects may include:
ü Liver damage
ü Enlarged thyroid
ü Hair loss
ü Mental changes
ü Physical dysfunction
Potential side effects of medication prescribed by the Burke Center should be explained to the consumer at the time the medication is prescribed. Some mental healthcare centers provide the consumer with handouts or offer medication education training for potential side effects of the medications prescribed.
V. Medications Most Often Prescribed
Antidepressants: Antidepressants are used to biochemically change a person’s abnormal mood state of depression. Some common antidepressants prescribed by Burke Center physicians include Prozac, Celexa, Lexapro, Elavil, Norpramine, Paxil, Pamelor, Zoloft, Effexor and Desyrel. The intended effect of the antidepressant is to sleep better, stabilize abnormal appetite patterns, become more active, improve memory and concentration diminished by depressive episodes, feel more hopeful, give up suicidal ideas and develop a more stable, positive mood. It may take 2–8 weeks to determine the benefit.
Some side effects of antidepressants include non-threatening effect of dizziness, sedation/drowsiness, constipation, dry mouth and/or blurred vision. Life threatening potential
side effects of antidepressants may include unusual tiredness, extreme sedation, irregular heartbeat, vomiting or rapid breathing.
Antipsychotic (Major Tranquilizers, Neuroleptic): Antipsychotics are used to treat people diagnosed with Schizophrenia or other psychotic symptoms/conditions. They provide relief of certain symptoms of chronic/acute psychosis including thought disorders, delusions, hallucinations, aggression/self-abusive behavior and relief of anxiety.
Some antipsychotics cause more sedation (Mellaril, Thorazine, Serentil) than others (Haldol, Prolixin). New generation antipsychotics (Risperdal, Seroquel, Zyprexa, Abilify) may cause generally fewer side effects.
The short-term side effects of antipsychotics include:
ü Lowered blood pressure
ü Dry mouth
ü Drowsiness
ü Increased weight gain
ü Photosensitivity (at risk for sunburn)
The long-term side effects of antipsychotics include:
ü Dystonia (abnormal muscle tone/stiffness, tongue and mouth spasms, eyes roll up into head)
ü Akathisia (constant restlessness)
ü Parkinson’s like effects (robot shuffle walk, pill rolling, tremors, mask-like facial expression, generalized muscular stiffness)
ü Tardive Dyskinesia (syndrome caused by long-term administration of psychotic meds). Characterized by abnormal movement or twitching of mouth, tongue thrusts, chewing movements, sucking, pursing and/or blowing of lips. These symptoms may clear up if medication is discontinued early enough. If side effects are left unnoticed, it may result in permanent problems. Burke Center clients are screened every 6 months by the physician to detect tardive dyskinesia by administering the Abnormal Involuntary Movement Scale (AIMS).
Antianxiety Medication: Antianxiety medications are prescribed to reduce tension, relieve agitation and promote sleep. Antianxiety medications are most commonly used for Generalized Anxiety Disorder and Panic Disorders. The most commonly prescribed antianxiety medications are: Xanax, Librium, Buspar, Ativan, Vistaril and Klonopin.
The most common side effects of antianxiety medications is drowsiness. The life threatening side effects include:
ü Slurred speech
ü Severe weakness
ü Slowed pulse
Antianxiety medications (except Buspar, Vistaril) may be addictive. Antianxiety medications are considered to have an addictive effect and interact with some other drugs to increase the drug effects. Clients being prescribed antianxiety medications are strictly advised not to consume any form of alcohol as alcohol may contribute to accidental death.
Bipolar (Anti-manic) Medications: Bipolar medications are prescribed to treat manic mood disorders. A manic disorder is characterized by irritability, grandiose thoughts/statements, restlessness, ability to remain awake for extended periods of time, loss of inhibitions and alterations between manic state and periods of depression.
Medications used in the treatment of Bipolar disorder may include Lithium, Depakote and Tegretol.
The side effects of Lithium include:
ü Upset stomach
ü Diarrhea
ü Dry mouth
ü Fine tremor
The toxic (adverse reactions) to Lithium include:
ü Weakness
ü Vomiting
ü Dehydration
ü Death (if Lithium reaches toxic level)
The side effects of Depakote include:
ü Upset stomach
ü Diarrhea
ü Sedation
The toxic (adverse reactions) to Depakote include:
ü Liver damage
ü Low platelet count
ü Low white blood cell count
The side effects of Tegretol include:
ü Sedation
ü Nausea
ü Unsteady gait
The toxic (adverse reactions) to Tegretol include:
ü Low white cell count
ü Liver damage
Clients/consumers who are prescribed Lithium are required to have routine Lithium levels checked to avoid toxic reactions. Lab work is also required for Depakote and Tegretol.