Welcome to the Pennsylvania Dual Diagnosis Direct Support ... · manage. Sometimes side effects can be prevented by taking action, such as taking a medication with food, if the medication

Welcome to the Pennsylvania Dual Diagnosis Direct Support Curriculum training on Common Medications and Side Effects.

The Commonwealth of Pennsylvania’s Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP) have undertaken a joint initiative to address the needs of people who have an Intellectual Disability as well as Mental Health challenges. People who have both of these challenges are commonly referred to as those who have Dual Diagnosis. For the purpose of this training, Dual Diagnosis is not referring to co-occurring mental health challenges and substance abuse or dependence, although people can have substance abuse or dependence issues as well as a Dual Diagnosis of an Intellectual Disability and Mental Health challenges. The curriculum was designed for Direct Supporters, Supports Coordinators and others who work in either the Intellectual Disability field or the Mental Health field. The ultimate goal of this training curriculum is to provide information that can aid in the understanding of the struggles and the triumphs of those you support or will support. This curriculum was designed to demonstrate the complexity of Dual Diagnosis and the factors that need to be considered to best support those with whom you come into contact. The Pennsylvania Dual Diagnosis Direct Support Curriculum was also designed to demonstrate that all people in this world, regardless of their challenges, are much more alike than they are different.

The information presented to you today is to increase your awareness. It is not intended to replace medical advice. The information presented here is not intended to replace information or training related to the Department of Human Services’ Medication Administration trainings. If you believe you or someone you support has a medical condition or concern, please seek the advice of a physician.

By the end of this training you will: • Understand the importance of observing, documenting and

reporting • Understand three reasons why it is imperative to understand the

effects of medication and • Be provided with two reputable sources of information for

medication

People with Dual Diagnosis are more likely to take multiple medications. It is the responsibility of the team, which may include anyone who supports the individual, to be knowledgeable in all aspects of the individual’s holistic care. The individual’s health and safety depends on what is seen, shared and reported.

Let’s start at the beginning! It should not be assumed that a physician knows and has read all of the important medical history and the patient’s file, so it is important to share all information on the individual’s medical situation, including all relevant family health history. This would also include a complete medication history, current medications (which can be found in the medication administration record or “MAR”) and a discussion of what has worked and what has not. Medication history should include supplements, vitamins and herbal remedies. All medical conditions should be mentioned even if they have already been resolved, so that a physician gets a clear picture of patterns and the overall medical issues to consider. People meeting with a physician should not hesitate to ask questions; that is part of the reason for the interview with the medical provider. One way you can share information is through the use of a medication history. Information about accessing information on the Health Information Recording System, or HIRS system, developed by Philadelphia Coordinated Health Care, is included in the resource section of this presentation. The Health Information Recording System (HIRS) is an example of how all this information can be documented to avoid any misunderstanding about the facts. The use of a face sheet is important in sharing current demographic information; this should

only be given to pertinent medical providers.

When a new medication is prescribed, it is a good idea to ask the doctor questions. Some examples include: • What diagnosis or symptom is the medication being ordered for • Can this medication be taken with other medications and what are the

possible drug interaction signs that an individual should know about • Should the individual taking the new medication do anything different

with daily routines. This would include whether any food, beverages or other products need to be avoided

This information may be very useful in avoiding medical emergencies.

Some additional questions for anyone taking prescribed medications are: • What are the side effects of the medication that has been ordered • How can we plan ahead for how this drug will affect the individual • Where can I find more information about this medication • Where could I find more information about the individual’s condition It is important to learn as much as you can about an individual’s medications.

With so many medications available for use today, it is difficult to keep track of them all. You must be aware of reputable sources for information on medication. Besides the physician, the pharmacist is an excellent source of information. It is important to ask the pharmacist questions when a new medication is prescribed or a dose increased. The pharmacist is also a good resource regarding dietary supplements and herbal medications. Pharmacists are available during regular pharmacy hours, making them a more accessible resource during off-hours or weekends. There are many other resources and a pharmacist may be able to direct you to credible websites. The drug pamphlets that are included by the pharmacy with each prescription are another great resource of information on prescription medications, providing all of the information about the medication in a simple and easy-to-understand format.

Medication pamphlets can also be accessed on the internet at Dailymed. Information on how to access Dailymed is located in the Resource section. Some other reputable resources include the National Institute of Health, the Centers for Disease Control and Prevention and Medline. There are also many internet sources that can provide information about medications, but it is essential to know that, when consulting an internet site, it is a reputable site known for providing accurate and up-to-date information. Ask if your agency has a policy about where to obtain information. Information to look for should also include counter effects, as well as side effects. Remember that any additional information you obtain about medications, should not be used to replace information and orders given to you by the doctor, but used as a source for questions to ask the doctor.

A medication is any chemical substance that has an effect on a living organism. A medication can be a substance that is available by prescription or over the counter. Dietary supplements, which include vitamins, minerals and herbal products, are considered medications because they also affect a living organism. Medications may be given for different reasons. One example is the use of flu, pneumonia, or hepatitis B series vaccines used to prevent diseases. Examples of medications used to treat disease processes and decrease symptoms associated with those diseases include antiepileptic medications for seizures, diuretics for swelling and antibiotics for infection. Medications might also be used to restore normal function to a certain body process. Examples of this include the use of insulin in treating diabetes, thyroid hormones in treating hypothyroidism and antihypertensive agents in helping to maintain blood pressure within a normal range. Medications might also be used to diagnose disease processes. For example, barium is used to enhance x-ray images so the doctor can see the area better. A medication may have more than one use depending on its strength or timing of administration. For example, aspirin, taken daily in low doses, may prevent a stroke or heart attack. Aspirin, taken daily at higher doses, can treat rheumatoid arthritis, or taken short term, may be used to treat pain.

Every medication taken affects the body in some way, and sometimes in more than one way. Medication has an intended or therapeutic effect, such as relief of pain or decrease in blood pressure. Medication can also have unwanted effects, also known as side effects, such as causing a skin rash or ringing in the ears. Side effects are defined as effects of medication that are known to happen, but are not the intended effect of the medication. For example, the antihistamine, diphenhydramine (Benadryl), is often used to relieve the symptoms associated with an allergic reaction. A common side effect of this medication is drowsiness. Therefore, drowsiness is a well-known side effect of diphenhydramine, but it is not the intended effect, if the medication is taken to relieve itching from an allergic reaction. Because a medication is unable to target only the area of the body it is intended for, other body tissues or systems may respond to it’s presence by producing side effects. Side effects are generally predictable and are therefore easy to recognize and manage. Sometimes side effects can be prevented by taking action, such as taking a medication with food, if the medication is known to cause nausea. Side effects can occur at any time during the administration of the medication, although they are more likely to occur when a medication is new or when the dose is changed. Side effects may be mild, or life-threatening, ranging from a mild headache to the failure of a body organ. Allergic reactions differ from side effects, because they are caused by the person’s body reacting negatively to the presence of a particular substance. Allergic reactions may appear right away, or after several days or weeks of taking the medication. Skin rashes, or hives, are a common allergic reaction. The factor that makes allergic reactions different from side effects is that they occur because of a reaction in a individual’s own system or genetic make-up.

A medication interaction may occur when a medication reacts with another medication, food or beverage, or with a pre-existing medical condition. When a medication interacts with another medication, the effects of one or both can be changed. Sometimes the result of medication interactions may be harmful, at other times a physician may intentionally prescribe medications that are known to work well together in order to get the maximum benefit of each medication. Medications can also interact with food and cause an increase or decrease in the medication’s effectiveness. Information related to dietary concerns for medications can usually be found on the labels of the medication or in the literature that accompanies the product. There may also be recommendations to avoid certain foods while taking a particular medication. Also, it is important to pay attention to the time when medications are administered in relation to eating. If a label on the medication reads, “Take on an empty stomach”, giving the medication with food or right after a meal will most likely make it less or ineffective. Medication to be taken on an empty stomach should be taken an hour before meals or two hours after a meal. Pre-existing medical conditions, such as thyroid, kidney, liver, or gastrointestinal disease, may change the way the body uses medication, how fast the medication is absorbed and how effectively the medication is eliminated from the body. Medication doses may need to be adjusted in individuals with these conditions to prevent the effects of overmedication. Medication interactions may lead to an increase or decrease

Live Training Version

in both intended and/or unwanted effects of the medication. You should learn as much as you can about a medication, so that you understand what the intended effects of the medication are, what side effects to look for and how to report any symptoms that cause concern. The best sources for information about the effects of combining medications and/or the effects of combining medications and food is from the individual’s physician, the pharmacist, and/or in the pamphlet of information that is provided with the medication.

Because most medications can have a variety of effects, it is important for you to familiarize yourself with the medications taken by the people you support. You should know how long it will take for the medication to work, what the intended effect is and what the possible side effects are. After administering medications, you should observe the individual to see what effect the medication is having on that individual. • Does the individual appear to be receiving the intended effect or

benefit of the medication • Is there any evidence of the common side effects of the medication? Individuals with an intellectual disability may lack the verbal skills to communicate the effects of medication, both intended and unintended. Closely observe the individual after medication is given and report what you see.


It is very important to know an individual’s baseline functioning to determine if there are changes in their baseline behavior that could be related to the effects of medication. For example, if someone usually asks for seconds at mealtimes, but since starting a new medication has barely eaten anything, it is possible that the medication is causing nausea. The change in the individual’s eating habits is a clue to a potential problem with the medication. Information about an individual’s baseline functioning may be obtained from people who are familiar with the individual, such as experienced staff, coworkers, house managers, program specialists, friends and family members. A new employee should make it a point to learn as much as possible about each individual supported. A more experienced employee should make it a point to relay this information to new employees and temporary staff. When looking for clues about changes in behavior, consider how the individual usually interacts with others and the environment and the quality of those interactions. Ask these types of questions: Is there the same level of interest or eye contact. Are established routines being followed or is the individual doing something not previously seen. Does the individual appear healthy or ill. Changes in a individual’s baseline functioning should be reported as per agency policy and consideration should be given to the possibility that these changes may be related to the effects of medication. Side effects of medication can occur at any time, and caregivers should be monitoring the individual at all times, especially with each medication administration. When someone is prescribed a new medication, it is important to observe them for possible side effects or interactions with other medications or diet. It is also a good idea to monitor for side effects when the doctor increases the dosage of a current medication, as the higher dose may not be tolerated as well as the previous dose. Medication doses are often based on a individual’s weight and


severity of symptoms. It is important to discuss any weight changes with the individual’s doctors. An increase or decrease in weight may lead to over or under dosages of medications and an increase in side effects.

It is important for you to be aware that just because a medication is over-the-counter, such as a vitamin, mineral, or herbal supplement, you should not assume that they are safe. Let’s look at some over-the-counter medications. Acid reducers are drugs that prevent or relieve heartburn associated with acid indigestion. Interactions may occur with medications, such as certain blood thinning drugs, some antifungal medications, certain asthma medications and some seizure medications. Always remember to share with the physician about any medications that the person is currently taking, their medical conditions, allergies and known side effects. Antacids are drugs that are used for relief of acid indigestion. Anyone who is lactose intolerant, or has a history of kidney disease, should ask the doctor before taking antacids. Antiemetics are drugs that are prescribed for prevention or treatment of nausea, vomiting or dizziness. Anyone who takes sedatives or tranquilizers, consumes alcohol, has glaucoma, an enlarged prostate, emphysema or chronic bronchitis, should discuss the use of these medications with the doctor before taking them.


Antihistamines are drugs that temporarily relieve a runny nose or reduce sneezing, itching of the nose or throat and itchy watery eyes due to hay fever or other upper respiratory problems. If the individual is taking sedatives or tranquilizers, a prescription drug for hypertension or depression, has glaucoma or an enlarged prostate, the doctor should be consulted before taking an antihistamine. Antitussive drugs temporarily reduce cough due to minor throat and bronchial irritation. Anyone taking a sedative or tranquilizer, or who has glaucoma or an enlarged prostate, should ask their doctor before taking these medications.


Bronchodilators are drugs that are prescribed for the temporary relief of shortness of breath, chest tightness and wheezing due to bronchial asthma. Anyone with heart disease, hypertension, diabetes, thyroid disease or an enlarged prostate should always speak to a doctor before using this type of medication. Bronchodilators should also be used with caution in someone who has diabetes or difficulty with urination due to an enlarged prostate. You should be aware if the individual taking these medications has ever been hospitalized for asthma or if they are taking prescription drugs for asthma at the present time. Nasal decongestants are drugs prescribed for temporary relief of nasal congestion due to cold, hay fever, or other upper respiratory allergies. People should always ask the physician before using these medications if they have a history of heart disease, high blood pressure, thyroid disease, diabetes or difficulty in urination due to an enlarged prostate.


Laxatives are drugs which are prescribed for the temporary relief of constipation. A doctor should be consulted before use by anyone with kidney disease or who is experiencing stomach pain, nausea or vomiting. In order to prevent constipation, it is important that you observe the individual’s intake of fluids and a healthy diet high in fiber rich foods is recommended. Tracking an individual’s exercise patterns and keeping a bowel movement record may also prove useful. There are some topical acne medications which are available over the counter, but many of the stronger medications need to be prescribed by a physician. Please observe the individual to determine if the medication is effective and if there is improvement. Adverse reactions which may occur include burning, itching, scaling, redness, swelling of the skin or photosensitivity (which is an increased sensitivity to ultra violet sunlight).


There are many classes of antihypertensive medications and each works in a different way to lower blood pressure. Different classes of antihypertensives include: beta blockers, alpha 1 receptor blockers, ACE inhibitors, calcium channel blockers and diuretics and each act differently. Beta blockers reduce workload on the heart and helps it to beat more regularly. Alpha 1 receptor blockers relax blood vessels, while ACE (angiotensin converting enzyme) inhibitors relax blood vessels and protect the kidneys. Calcium channel blockers cause decreased blood pressure by relaxing the heart and dilating the blood vessels. Diuretics reduce blood pressure by removing excess fluid to reduce blood volume. As with any medication prescribed, the use of over-the-counter medication with antihypertensives should always be discussed with a doctor, as there may be interactions.


Some of the common side effects of antihypertensive medications may include: dizziness, headache, palpitations, faster or slower heart rate and nausea. Another possible side effect is orthostatic hypotension. This happens when someone gets up too fast from sitting or lying down, causing their blood pressure to drop leading to lightheadedness. Be alert and observe for falls! Beta blockers can cause difficulty breathing and may be contraindicated in individuals with asthma or sexual dysfunction. Ace inhibitors can cause cough, dizziness, headaches, problems sleeping or fast heart rate. Diuretics can cause dehydration. These are just a few side effects. Remember: everyone may react differently to medications. Any changes from baseline need to be reported. The doctor may order periodic blood tests, It is important to follow the his/her orders regarding laboratory work.


There are many types of cholesterol medications which act differently to decrease cholesterol. Statins reduce the body’s ability to make cholesterol. Bile acid sequestrants absorb and bind with bile salts, which increase removal of cholesterol through the stool. Cholesterol absorption inhibitors block cholesterol absorption from the stomach. Fibric acid and Niacin both lower cholesterol and triglycerides. Omega 3 fatty acids lower triglycerides.


Some common side effects of cholesterol lowering medications may include muscle cramping, headaches or other types of pain. Gastrointestinal side effects may include: gas, abdominal pain, nausea, constipation and diarrhea. One class of cholesterol medications called statins may cause serious muscle disease or a breakdown in muscle tissue. When taking these medications, the consumption of grapefruit in any form should be avoided, as it may increase the development of these conditions. It is important, as always, to monitor any change from the individual’s baseline. Laboratory work needs to be done as ordered by the physician.


Diseases of the thyroid include: hypothyroidism, or thyroid hormone deficiency; hyperthyroidism, or over production of thyroid hormone; thyroiditis, or inflammation of the thyroid gland; and thyroid gland enlargement, also known as a goiter. Medication and treatment depends on the cause of the condition. It is important to note that, with certain syndromes, there is an increased risk of hypothyroidism or decreased levels of thyroid hormone. For example, individuals with Down syndrome are prone to thyroid disease. In general, women are more likely to develop hypothyroidism as they get older.


Some of the side effects of medications used to treat hypothyroidism may include: Nervousness, insomnia, chest pain, fast and/or irregular heart rate, heat intolerance, vomiting, diarrhea, weight loss and menstrual abnormalities.


Some medications used to treat hyperthyroidism may cause side effects such as : rashes, nausea and loss of taste also. It is important to be watchful for signs of, increase of an infection, and potential liver dysfunction.


There are six different classes of medications used in the stabilization of blood sugar. Each class works in a different way to decrease glucose levels. It is important to learn about the particular medication prescribed for the people who you support. Part of that knowledge includes finding out how those medications may interact with other medications.


Some side effects to be aware of, with oral medications used to treat diabetes, may include: hypoglycemia (low blood sugar), nausea, vomiting, diarrhea, or bloating. It is important that laboratory tests be done as ordered by the physician, along with any in-home testing ordered by the physician.


There are many medications/treatments to relieve pain. It is important to know that they are prescribed according to the type of pain. The physician relies on the description of the pain by the individual experiencing it. It is important to observe, document and report effectiveness of the medications. Many pain medications may cause gastrointestinal complications such as stomach distress, ulcerations and GI bleeding. Some other reported side effects include dizziness, headache and high blood pressure. A major concern with ongoing use of ibuprofen-based products is acute kidney failure.


As with all medical conditions, it is important to share all medical issues, medical history and medication information with the doctor regarding pain control. Although aspirin (ASA) is a common pain relief medication, there can be side effects which include hearing loss, ringing in the ears and nausea. Other side effects may include GI bleeding, prolonged bleeding time and bruising. The doctor may want to closely monitor Complete Blood Counts (CBC) and liver function tests. It is important to follow the physician's orders regarding laboratory work. Another common pain relief medication, acetaminophen (like Tylenol or APAP) may cause severe liver damage, low blood sugar and rashes. Again, it is important to follow the physician’s orders regarding laboratory work.


There are a multitude of antiepileptic medications used to treat seizure disorders. The type of medication ordered depends on the type of seizure the individual has. Some medications that are used to treat seizure disorders are also used to treat some psychiatric diagnoses. Therefore, it is important to be aware of what condition this medication is being used to treat and what is the intended effect or desired outcome. Many antiepileptic medications can cause toxicity and require periodic lab testing.


Possible side effects of antiepileptic medications may include: fatigue, dizziness, drowsiness, nausea, vomiting, slurred speech and ataxia, or a loss of body control movements. Many of these medications may also cause an increased risk for osteoporosis, dental issues or an abnormal condition/disease of the blood called a blood dyscrasia.


Some other important things to consider regarding medications include: What are some of the written medication policies at your agency. How do you do the research about details of medications, side effects and how they could affect the people you support. How is documentation completed at your agency about all aspects of medications. What is your agency procedure for reporting what you observe.


Medication can be useful in maintaining health and well being, but also has the potential to harm. It is important to be aware of a medication’s intended effect and potential side effects, and to monitor for side effects and interactions. You should also be committed to observing the effects of medication in the individuals you support, so that you can report if the medication is working. It is important to follow all dosing instructions and monitor side effects and interactions. Knowing a individual’s baseline behaviors is crucial when determining an individual’s response to medication. Responsible medication administration includes using reputable resources to learn about the medication. Increasing your knowledge of medication and being committed to safe medication practices can assure quality of life for the individuals in your care.


Congratulations, you have successfully completed the Common Medications and Side Effects training.

Thank you for participating in this presentation on Common Medications and Side Effects.


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Welcome to the Pennsylvania Dual Diagnosis Direct Support ... · manage. Sometimes side effects can be prevented by taking action, such as taking a medication with food, if the medication