Medications:
Promoting Safe
and Appropriate Use
Prepared and funded through collaboration between:
The Developmental Disabilities Council of
Washington,
The University of Washington
Center on Human Development and Disability,
Northwest Center,
and Washington State
Division of Developmental Disabilities
Project Staff

Sharan Brown, JD, EdD
Principal Investigator

Kathleen Watson, PhD, RN
Project Director/Trainer and Parent

Esther Moloney
Project Assistant and Parent
Basic Assumptions
 YOU,
as the caregiver, have the opportunity to
improve the quality of life for each of the
participants with whom you work.
 YOU
can do this by assuming that it is all up to
you and therefore being pro-active, assertive and
behaving like a detective.
 Professional
responsibility in a home-like setting.
What Is Causing the Behavior?
 Pain
or discomfort?
 Emotional distress due to situation or
environment?
 Symptom of a mental health problem?
 Side effect or adverse effect of a medication?
 Just the person’s normal state?
 Just a “behavior”.
Being an Informed Consumer
Have one staff member who is the health advocate for
each client: develop relationship with providers.
 Use websites by reputable organizations such as
universities.
 Keep reference books such as those designed for nurses.

Drug guides
 Encyclopedia/dictionary

Safety
Medication Rights+
 The
right Drug
 in the right Dose
 by the right Route
 at the right Time
 to the right Person.
 For the right Reason
Medication ErrorsWhere Might They Happen?
 Physician
 Pharmacy
 Person
transcribing to recording sheet
 Person administering.
Physician Errors
Incorrect dose or regimen
 Incomplete dosage or unavailable dosage form or strength
 Quantity or duration of treatment not specified
 Dose or regimen not specified
 Incorrect drug for the therapeutic indication
 Drug interactions
 Allergy or sensitivity
 Duplicate therapy

Pharmacy Errors
 Reads
prescription incorrectly.
 Dispenses drug with similar name.
 Types label wrong.
 Mixes up labels.
 Wrong strength.
 Wrong amount.
 Forgets to put special instructions on bottle.
At-Home Errors
MAR incorrect.
 Forget a dose or give a dose twice.
 Give to wrong person.
 Give wrong amount.
 Give earlier or later than ordered.
 Not following instructions.
 Given in spite of indications there might be a problem.
 Give for the wrong reason.

Reasons for Concern and Questioning
 The
pills are a different color, shape or size.
 The directions for the drug are different.
 The label directions don’t make sense.
 The person is behaving differently or has new or
unusual symptoms.
 The drug is one you think the person is allergic to.
Safety Tips
If directions on the label are not clear, ask the
pharmacist or call the prescriber to clarify them.
Always use the same pharmacy so they will have a
record of all current drugs and allergies for each
individual.
It helps to get to know the pharmacist.
Keep the medicine in the original container.
Always double check yourself.
Reading a Prescription Bottle
 Name
of pharmacy with phone number.
 Prescription number for refills.
 Name of doctor who prescribed it.
 Who the drug is for.
 Name of drug.
 Form and dosage of drug.
 When it should be discarded (thrown away).
Reading a Prescription Bottle
(cont’d)
Strength (how much of the drug in each pill or spoon full).
 Amount to take (how many pills or spoonfuls).
 How often to take it (once a day, every two hours, etc).
 By what route to take it (swallow, under tongue, in eyes or
nose, etc).
 Under what conditions to take it (after every meal, only
when in pain, etc).

Adverse Drug Effects
Adverse Drug Reactions
 Side
effects.
 Allergic reactions.
 Over-dosage.
 Unusual and unpredictable reactions.
Monitoring for Drug Effects
Very important to know the person’s normal baseline.
 Observe for anything out of the ordinary for that person.
 Not reasonable to remember all the side effects for every
drug residents take.
 Be familiar with the most likely side effects for long-term
drugs.
 Be proactive in contacting the pharmacist or health care
provider if you are concerned!

Record-Keeping
 Note
on calendar or on record:
 When
new drug starts
 When dosage changes
 When old drug stops
 When changes are made
 Keep
updated list of all current drugs to share with
health care providers.
Generic vs. Trade Names
A new drug has patent - only one company can
make it for several years.
 A new drug has both a generic and trade name.
 The generic name is the chemical name.
 The trade name is the same as the brand name.
 After the patent runs out, other companies can make
it under the generic name and may add their own
trade name.

Examples of Generic and
Trade Names
 ibuprofen
(Motrin, Advil)
 diphenhydramine (Benadryl, Compoz, Sominex 2)
 pseudoephedrine (Sudafed, Drixoral non-drowsy)
 phenytoin (Dilantin)
 acetominophen (Tylenol, Panadol, Datril, Tempra)
Combination Drugs
 Contain
more than one drug in the same pill or
liquid.
 The name doesn’t always tell you what’s in it.
 Important to know what’s there so clients don’t
receive a double dose.
 Most common in over-the-counter drugs such as
cold remedies.
Over the Counter (OTC)
 Same
as prescription drugs.
 Still have risk for side effects, overdosing, crossreactions and allergic reactions.
 Should be used carefully.
 Often combination drugs-know what’s in the ones
being used!
Drug Classes
 Based
on the main effects and actions of drugs
 Some drugs fit in more than one class
 Some drugs are used for other purposes than they
were originally intended.
 Drugs in the same class have some of the same
side-effects.
Examples of Drug Classes
 Antibiotic
 Anti-epileptic
 Anti-psychotic
 Antihistamine
 Decongestant
 Antidepressant
 Non-steroidal Anti-inflammatory
(NSAID)
Psychoactive Drugs
Also called psychopharmacologic or psychotropic.
 Drug classes:

Anti-anxiety (Xanax, BuSpar, etc)
 Antidepressant (Elavil, Prozac, etc)
 Anti-psychotic (Risperdal, Zyprexa, Haldol, etc)
 Anti-mania (lithium)
 Sedative/hypnotic (Restoril, Noctec, etc)
 Stimulant (Ritalin)
 Anti-seizure or Anti-epileptic (Tegretol, Neurontin)

Psychoactive Drugs
 Intended
to treat psychiatric conditions, but often
given to control behavior.
 Taken long term.
 May have lots of side effects.
 Must balance usefulness against side effects.
 Doctor does the balancing based on the
information we give her or him!!
 Record-keeping helps a lot!
Principles to Remember
Monitor the condition or behavior the drug is being given
for (eg., seizures, depression)
 Be especially alert when a new drug is added, a drug is
stopped or tapered off, or dosage is changed.
 Set up a record-keeping system for behavior and side
effects.
 Make sure the participant gets to appointments for lab
work.

Quality of Life
Medications should improve the quality of life for
participants, not make it worse.
 Begin with the primary health care provider.
 If quality of life seems to be declining rather than
improving, seek help from local mental health center.
 If this isn’t working, ask DDD Case Manager for
assistance.
 Be proactive and persistent!

Typical Antipsychotics
 Chlorpromazine
 Haloperidol
 Fluphenazine
 Thioridazine
 Loxapine
 Perphenazine
Atypical Antipsychotics
 Aripiprazole
 Ziprasidone
 Quetiapine
 Olanzapine
 Risperidone
 Clozapine
AbilifyR 2002
GeodonR 2001
SeroquelR 1998
ZyprexaR 1996
RisperdalR
1994
ClozarilR 1990
Anti-epileptic Drugs (AEDs)
Some old standard ones and lots of new ones.
 Some of the newer ones are also used for controlling
behavior.
 Important to monitor for side effects and keep seizure
record.
 Some require the provider to do periodic laboratory work
to monitor for side effects.

Anti-Epileptics
1912 Phenobarbital
1993 Felbamate
1938 Phenytoin
1993 Gabapentin
1960 Ethosuximide
1994 Lamotrigine
1974 Carbamazepine
1997 Topiramate
1978 Valproate
1997 Tiagabine
1999 Levetiracetam
2000 Oxcarbazepine
2000 Zonisamide
Anti-epileptics
Important things to report
 May
affect level of alertness, balance, muscle tone,
appetite, weight, mood.
 Report any increased bruising or bleeding.
 Any yellowing of skin or eyes.
 A rash that gets worse or won’t go away.
 Any fever or signs of infection.
Anti-epileptics:
Usual side effects
• Usually short-term:
• Skin rashes
• Loss of co-ordination
• Nausea or vomiting
• Effects on thinking (could be long-term)
• Most common: dizziness, headache, double vision,
sleepiness
Antibiotics
 Some
taken with food to avoid stomach upset.
 Some foods or medicines may interfere with
absorption.
 Watch for stomach upset or rashes.
 Stop the drug immediately if rash, itching or
difficulty breathing occurs.
 Call 911 for problems with breathing or acute
distress.
Important Side Effects
To Observe and Report
 Sudden
or unusual skin color or temperature:
 Bluish,
red, pallor, yellow.
 Rash or other unusual markings.
 Feels hot or cold to the touch.
Important Side Effects
To Observe and Report
 Sudden
or unusual bowel or urinary change:
 Diarrhea
or constipation.
 Frequent or infrequent urination.
 Urination difficult, delayed or painful.
 Bedwetting.
Important Side Effects
To Observe and Report
 Sudden
or unusual walking or gait changes:
 Falling
down.
 Slow or shuffling walk.
 Stumbling, poor balance, unsure of footing.
Important Side Effects
To Observe and Report
 Sudden
or unusual change in movement level or in
muscles.
 Seems
slow, moves in slow motion, trouble getting
started.
 Jittery, antsy, pacing, can’t sit still, constantly jiggling
or pumping legs, has to get out of chair after short
period of time.
 Muscle rigidity or stiffness.
 Nausea, vomiting or gas.
Important Side Effects
To Observe and Report
 Sudden
or unusual change in sleep:
 Sleeps
longer or shorter.
 Trouble getting to sleep.
 Nightmares or bad dreams.
Important Side Effects
To Observe and Report
 Sudden
or unexpected change in eating or
drinking:
 Eating
more or less.
 Drinking more or less.
Important Side Effects
To Observe and Report
 Sudden
or unexpected change in speech.
 Drooling
or dry mouth.
 Seems to be slurring speech.
 Doesn’t seem to be talking much any more.
Important Side Effects
To Observe and Report
 Sudden
or unexpected fatigue.
 Suddenly
does not want to get up in morning.
 Tired, day-time sleeping.
 Sedation, lethargy, malaise.
 Grogginess.
Important Side Effects
To Observe and Report
 Sudden
or unexpected mood changes:
 Grouchy,
irritable, hard to get along with.
 Explosive behavior out of character.
 Crying, tearful, sad, withdrawn.
 Personality change.
Important Side Effects
To Observe and Report
 Sudden
and unexpected trouble concentrating:
 Trouble
paying attention.
 Trouble remembering things.
 Trouble performing activity, work or play.