Safe Haven at Lenox Park – Luxury Assisted Living in Atlanta, Georgia with care for seniors, elders, and nursing those with Alzehiemer's and Diabetes.

safe haven atlanta at lenox park for seniors who want assisted living and independent care from nurses professionally trained to handle diabetes alzheimer and dementia

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MEDICATION MANAGEMENT

Medication Management

Medication management for elders can be a minefield. Elders are often treated by several doctors, and each doctor may have prescribed medications. In combination, all of the prescriptions from all of the doctors produce a complex daily medication schedule. The situation also raises thorny issues like these:

Does each doctor know about all of the prescriptions written by all of the other doctors?
Have the prescriptions been researched for possible adverse drug interactions and side effects?
Are all of the prescriptions being filled?
Are the medications organized in a weekly pillbox so that the elder gets the proper medications at the proper times?
Is the elder actually taking the medications?
If Medicare and supplemental insurance are available, are claims and other issues being resolved?

It’s no wonder that many elders need help in keeping everything straight. In addition, some elders try to economize by taking reduced doses of prescribed medication or by deciding not to take it at all.

If your elder needs medication support or supervision that you can’t provide yourself, you should know that you have options to consider. Many assisted living facilities, for example, offer help with basic healthcare needs, including medication management. For more active elders, some senior housing communities provide medication management. These are all living arrangements in which caring healthcare professionals are responsible for making sure that medications are taken as prescribed. That’s good for your elder’s health and good for your own peace of mind.

77.5% of residents needed assistance with medications

Residents were taking an average of:

10 routine medications

3 PRN medications

13 total medications

Medication Admin Process

Always prepare and administer medication(s) to clients in a safe, effective and ethical manner. Making sure that all of the necessary steps are taken to ensure that there are no errors in the medications are made.

a) ensuring that the client receives appropriate education about the treatment plan and current medication;

b) ensuring that the client or the client’s substitute decision-maker has given consent12 to administer the medication;

c) preparing and administering the medication according to an evidence-based rationale;

d) obtaining a new supply of medication if there are concerns about how the medication has been maintained;

e) applying principles of infection preventionand control when administering medication;

f) verifying:

- the right client,

- the right medication,

- the right reason,

- the right dose,

- the right frequency,

- the right route,

- the right site, and

- the right time;

g) ensuring that the client receives appropriate monitoring during and after administering the medication, and intervening if necessary;

h) documenting, during and/or after medication administration, in the client’s record according to documentation standards;15 and

i) advocating for appropriate environmental supports to ensure clients receive safe, effective and ethical care.

Employees also need to evaluate after resident has taken medication. This is just to ensure that the resident does not have an adverse result. Even if resident is self administer this steps still need to be followed.

a) recognizing client outcomes following medication administration, including effectiveness, side effects, signs of adverse reactions and/or drug interactions;

b) following up with the prescriber regarding any concerns or questions about the medication;

c) referring clients to the appropriate care provider for further assessment and follow-up when necessary (for example, when the underlying problem persists despite PRNmedication);

d) documenting actions taken or advice given and client outcomes according to documentation standards;

e) documenting, when appropriate, if the client is capable of self-administering the medication, including the type of assistance the client requires, if any, and the ongoing nursing assessment of the client’s capacity to continue self-administration; and

f) advocating for adequate resources and systemsthat facilitate safe, effective administration according to standards.

Enhancing Client Safety

Employers have a shared responsibility to create safe practice environments. Quality practice settings include appropriate staff, medication systems (for example, delivery, administration, policies, procedures) and environments to facilitate safe, effective and ethical care. The following section provides information and resources to help employers work together to prevent and resolve medication issues.

Safe medication practices

To support safe medication practice, systems need to be in place to track, address and learn from any medication errors that occur in the practice environment.

Medication errors

A medication error is defined as any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer. Such events may be related to professional practice, health care products, procedures and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring and use.

Medication errors can be further classified into errors of commission (for example, giving the wrong medication) and errors of omission (for example, not administering an ordered medication), which can result in an adverse drug event resulting in harm, injury or death. Or, it could result in a “near miss.” In this situation, an error does not reach the client, but had it, the client could have been harmed. (For example, a wrong dose is prescribed but is intercepted before administration.) When an error is made, the employee must ensure the well-being of the client and limit the client’s exposure to any potential harm. The plan of action will depend on the problem(s) identified. Some strategies to address problems are system modifications, in-service education, individual assistance and potential performance management.

Safe medication practice includes:

■ advocating for setting-specific, accessible, current medication information, such as drug formularies;

■ evaluating the need for a colleague to conduct an independent double-check on a prepared medication; meeting and being aware of the facility’s expectations on independently double-checking preparations;

■ advocating for written policies and supporting processes when the practice setting requires independently double-checking preparations;

■ having knowledge of high alert medications for the practice setting (for example, chemotherapeutic agents);

■ avoiding the use of error-prone abbreviations, dose designations and symbols, and advocating for a policy on the use of acceptable abbreviations;

■ reporting all errors and near misses using formal practice-setting communication mechanisms; advocating for organizational systems and policies that promote continuity and safety of client medication administration during transfer of care and at transition points;

■ ensuring that the client or the client’s substitute decision-maker has the most complete and accurate list possible of all medications currently being taken;

■ communicating to the client and appropriate caregivers the current list of medications during transfer of accountability;

■ addressing system issues that contributes to medication errors;

■ advocating for and/or participating in interdisciplinary error-reporting and root cause system analysis;

■ advocating for facility policies and/or procedures regarding disclosure of adverse events; and

■ following legislation and/or advocating for practice setting policies and procedures regarding the storage, counting, administration and disposal of medication

Know Important Terms

Adverse reaction. Undesirable physical reactions to health products, including drugs, medical devices and natural health products. Drugs include prescription and non-prescription pharmaceuticals; biologically derived products such as vaccines, serums and blood derived products; cells, tissues and organs; disinfectants and radiopharmaceuticals.

Authorizing mechanism. An order, initiation, directive21 or delegation – it is a means specified in legislation or described in a practice standard or guideline through which nurses obtain the authority to perform a procedure or make the decision to perform a procedure.

High alert medications. Drugs that bear a heightened risk of causing significant client harm when they are used in error.

Independent double-check. A process that ensures that a second practitioner conducts a verification, either in the presence or absence of the first practitioner. For example, a nurse may use this process to verify a dosage calculation. The most critical aspect is to ensure that the first health care provider does not communicate what he or she expects the second practitioner to find; this would reduce the visibility of a mistake.

Medication information. Information about a specific drug such as indications, appropriate dose, precautions, contraindications, drug/food interactions, expected outcomes, potential adverse reactions, side effects and how to minimize and treat them, high alert medications, special consideration, storage and administration.

Telephone order. An order communicated via telephone by an authorizer who is not physically present to write the order. The person accepting the order must have knowledge of the client, including his or her health history and treatment plan. Ultimately, the person implementing the order is accountable for ensuring that the order is appropriate. Practice settings should establish procedures for timely sign-off by the authorizer of the telephone order.

Transfer of accountability. An interactive process of transferring client-specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity of care and the safety of the client.

Verbal order. An order that is communicated by an authorizer who is present in the practice environment but is unable to document the order. Verbal orders must only be used in emergency situations or when the prescriber is unable to document the order, such as in the operating room.

Controlled substance. Any type of drug that the federal government has categorized as having a higher-than-average potential for abuse or addiction. Such drugs are divided into categories based on their potential for abuse or addiction. Controlled substances range from illegal street drugs to prescription medications.

When using medication brought from home.

In some settings, such as geriatric daycare centers, clients bring their medications from home. Nurses may administer these medications if they are in their original dispensing containers (that is, not in an envelope or assistive device for self-administration). If the information provided by the client or the client’s representative is different from that on the dispensing label, the nurse needs to use her or his judgment about the appropriateness of following the directions and follow up with the prescriber when required. The nurse should document the discrepancy and her or his rationale for following the chosen directions.

Over-the-counter (OTC) medication without an order. Medications and preparations that do not require a prescription; for example, herbal therapies and acetaminophen. OTC medications are not part of the act of prescribing. In some situations, however, the nurse’s role may include administering or recommending OTC medications to clients. Employee’s can not recommend any OTC with out talking to the clients Doctor to verify that the client is will be safe taken the OTC. Every one must have the knowledge, skill and judgment about the client’s situation; the client’s condition and medication profile; and the medication. Legislation or organizational policies may require an order from an authorized prescriber.

Placebo. A pharmacologically inert substance that has no physiological effect. Administering placebos to clients without their knowledge and informed consent is inappropriate and unacceptable.

Placebos may be administered:

When prescribed with client consent because the client experiences a placebo effect; and/or as part of a double-blind research study in which the client has been informed, as part of the consent process, that he or she may receive a placebo.

PRN medication(s). Medications that are prescribed and administered as needed. The order includes the frequency, such as Q4H, and the purpose (for example, sleep, pain or nausea). Employee’s must have current knowledge of the use and action of PRNs, as well as the competence to assess the need for PRNs and whether to administer them to a client.

Range doses. Dosages, frequencies or routes that are prescribed in ranges (for example, Gravol 50–100 mg for nausea). Most medications are not prescribed in range doses; however, range doses are used in situations in which the need for the amount of a drug varies from day to day or within the same day. Range doses give the flexibility to administer the dose that best suits the assessment of the client.

Self-administration. Administrating one’s own medication. Clients may self-administer their medications at home and in some agencies to develop or maintain an optimal level of functioning and independence. Clients who self-administer may be completely independent, or may require some assistance, such as reminders, help opening containers or assistive devices (for example, dosettes), or help in filling assistive devices. Employee must ensure that medications are securely stored.

Following tables describe certain drugs and their side effects:

ANTI-ASTHMATIC MEDICATIONS

Brand Name/Brand Name equivalent	Generic Name	Side Effects
Accolate	zafirlukast	SIDE EFFECTS: Headache, nausea and diarrhea may occur. If these continue or are bothersome, notify your doctor promptly. Rarely, serious liver disease may occur. If you notice any of the following highly unlikely but very serious side effects, seek immediate medical attention: persistent nausea, stomach pain, dark urine, fatigue, yellowing eyes or skin. If you experience any of the side effects mentioned above, use of this drug may need to be stopped. If treatment is stopped due to those effects, never take this drug again. There is an increased risk of liver problems occurring in females. Very unlikely but notify your doctor promptly if you develop: sore throat, bleeding, bruising, muscle aches, unusual weight loss. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
Advair Diskus	fluticasone propionate and salmeterol	SIDE EFFECTS: Hoarseness (dysphonia), throat irritation, headache, cough, dry mouth or throat may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Tell your doctor immediately if any of these serious side effects occur: white patches on tongue or mouth, swollen/painful mouth or tongue. Tell your doctor immediately if any of these unlikely but serious side effects occur: weight gain, vision changes, trouble sleeping, tremors. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: seizures, severe muscle weakness or cramping, fast/irregular heartbeat, numbness/tingling of the hands or feet, chest pain, worsening of breathing symptoms (e.g., wheezing, coughing). An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. Rarely, your wheezing might actually increase immediately after using this medication (paradoxical bronchospasm). If this occurs, use your "quick relief" inhaler (such as albuterol). Seek immediate medical attention if your breathing does not improve at that time. If you notice other effects not listed above, contact your doctor or pharmacist.
Atrovent	ipratropium inhalation aerosol	SIDE EFFECTS: The most commonly noted side effects associated with inhaled ipratropium bromide are flu-like symptoms, tremor, sleeplessness, nervousness, constipation, sore throat, chest pain, and difficulty in breathing. These side effects occur in one of every 10 to 20 persons who takes ipratropium bromide
Azmacort	triamcinolone inhalation aerosol	SIDE EFFECTS: The most commonly noted side effects associated with inhaled triamcinolone acetonide are mild cough or wheezing; these effects may be minimized by using a bronchodilator inhaler (e.g. albuterol or Ventolin) prior to triamcinolone acetonide. Oral candidiasis or thrush (a fungal infection) may occur in 1 in 20 to 1 in 10 persons who use triamcinolone acetonide, the risk being higher with higher doses. The risk in children is lower than in adults. Hoarseness also may result from the use of triamcinolone acetonide. Using a spacer device and washing the mouth out with water following each use reduces the risk of thrush and hoarseness. Hoarseness also may occur. High doses of other inhaled glucocorticoids may decrease bone formation and increase bone breakdown (resorption) leading to weak bones and fractures. Very high doses may cause suppression of the body's ability to make its own natural glucocorticoid in the adrenal glands. It is possible that patients with suppression of their adrenal glands may need increased amounts of glucocorticoids by the oral or intravenous route during periods of high physical stress.
Flovent	fluticasone propionate inhalational aerosol	SIDE EFFECTS: Dry or irritated throat, stuffy nose, hoarseness, or coughing may occur as your body adjusts to this drug. A bad taste in the mouth or flu-like symptoms may also occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Tell your doctor immediately if any of these serious side effects occur: white patches in your mouth or on your tongue, persistent coughing, increased wheezing/trouble breathing. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: vision changes, increased thirst or urination, unusual or persistent headaches, chest pain or discomfort, numbness/tingling of the hands/feet. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist
Pulmcort Respules	budesonide inhalation suspension	SIDE EFFECTS: The most commonly noted side effects associated with inhaled budesonide are mild cough or wheezing; these effects may be minimized by using a bronchodilator inhaler, for example, albuterol (Ventolin) , prior to the budesonide. Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25 persons who use budesonide without a spacer device on the inhaler. The risk is even higher with large doses but is less in children than in adults. Hoarseness or sore throat also may occur in 1 in 10 persons. Using a spacer device on the inhaler and washing one's mouth out with water following each use reduces the risk of both thrush and hoarseness. Less commonly, alterations in voice may occur. High doses of inhaled glucocorticoid steroids may decrease the formation and increase the breakdown of bone leading to weakened bones and ultimately osteoporosis and fractures. High doses may suppress the body's ability to make its own natural glucocorticoid in the adrenal gland. It is possible that these effects are shared by budesonide. People with suppression of their adrenal glands (which can be tested for by the doctor) need increased amounts of glucocorticoid steroids orally or intravenously during periods of high physical stress, for example, during infections, to prevent serious illness and shock.
Serevent	salmeterol inhalation aerosol	SIDE EFFECTS: Side effects include palpitations, fast heart rate, elevated blood pressure, tremor, nervousness, and headache. Throat and upper airway irritation can occur.
Singulair	montelukast sodium	SIDE EFFECTS: The most common side effects with montelukast are headache, dizziness, abdominal pain, sore throat, and rhinitis (inflammation of the inner lining of the nose). These side effects occur in 1 in 50 to 1 in 7 persons who take montelukast. Rarely, patients may experience nose bleeds.
Ventolin	albuterol inhalation aerosol	SIDE EFFECTS: Side effects include nervousness, tremor, headache, palpitations, fast heart rate, elevated blood pressure, nausea, dizziness, and heartburn. Throat irritation and nosebleeds can also occur. Allergic reactions may rarely occur and may manifest as rash, hives, swelling, bronchospasm, or anaphylaxis (shock). Worsening of diabetes and lowering of potassium have also been reported. In rare patients, inhaled albuterol can paradoxically precipitate life-threatening bronchospasm.

ANTI-DIABETIC MEDICATIONS

Brand Name/Brand Name equivalent	Generic Name	Side Effects
Amaryl	glimipiride	SIDE EFFECTS: Low blood sugar can occur during glimepiride therapy. Symptoms of low blood sugar include hunger, nausea, tiredness, perspiration, headache, heart palpitations, numbness around the mouth, tingling in the fingers, tremors, muscle weakness, blurred vision, cold temperature, excessive yawning, irritability, confusion, or loss of consciousness. Other side effects include dizziness (1 of every 60 persons), headache (1 of every 75), and nausea or vomiting (1 of every 90). A rash occurs in fewer than 1 of every 100 persons who receive glimepiride.
Avandia tablets	rosiglitazone maleate	SIDE EFFECTS: The most common side effects seen with rosiglitazone alone or in combination with metformin are upper respiratory tract infection, headache, back pain, hyperglycemia, fatigue, sinusitis, diarrhea, and hypoglycemia. Rosiglitazone has been shown to cause mild to moderate accumulation of fluid (edema) and can lead to heart failure. Patients who already have heart failure may develop worsening symptoms with rosiglitazone. In addition, anemia may occur with rosiglitazone alone or combined with metformin. Rosiglitazone also causes increasing amounts of weight gain with increasing doses.
Glucotrol	glipizide	SIDE EFFECTS: Side effects include headache, dizziness, diarrhea, and gas. Skin rashes can occur and cause itching, hives, or a diffuse measles-like rash. Rare but serious side effects include hepatitis, jaundice, and a low sodium concentration. Glipizide may also cause hypoglycemia. The risk of hypoglycemia increases when glipizide is combined with other glucose reducing agents.
Glucophage	metformin	SIDE EFFECTS: The most common side effects with metformin are nausea, vomiting, gas, bloating, diarrhea and loss of appetite. These symptoms occur in one out of every three patients. These side effects may be severe enough to cause therapy to be discontinued in one out of every 20 patients. These side effects are related to the dose of the medication and may decrease if the dose is reduced. A serious but rare side effect of metformin is lactic acidosis. Lactic acidosis occurs in one out of every 30,000 patients and is fatal in 50% of cases. The symptoms of lactic acidosis are weakness, trouble breathing, abnormal heartbeats, unusual muscle pain, stomach discomfort, light-headedness and feeling cold. Patients at risk for lactic acidosis include those with reduced function of the kidneys or liver, congestive heart failure, severe acute illnesses, and dehydration
Humulin, Humalog	insulin	SIDE EFFECTS: Hypoglycemia is the most common side effect that may occur during insulin therapy. Symptoms of hypoglycemia include confusion, nausea, hunger, tiredness, perspiration, headache, heart palpitations, numbness around the mouth, tingling in the fingers, tremors, muscle weakness, blurred vision, cold temperature, excessive yawning, irritability, and loss of consciousness. Patients may experience blurred vision if they have had elevated blood sugar levels for a prolonged period of time and then have the elevated levels rapidly brought to normal. This is due to a shift of fluid within the lens of the eye. Over time, vision returns to normal. Other possible side effects that may occur include skin reactions (redness, swelling, itching or rash at the site of injection), worsening of diabetic retinopathy, changes in the distribution of body fat (lipodystrophy), allergic reactions, sodium retention, and general body swelling.
Nolog, Novolin	insulin	SIDE EFFECTS: Injection site reactions (e.g., pain, redness, irritation) may occur. If any of these effects persist or worsen, notify your doctor. Tell your doctor immediately if any of these serious side effects of low blood sugar (hypoglycemia) occur: fainting, cold sweats, shaking/tremor, unusually fast heartbeat, headache, slurred speech, seizures. Tell your doctor immediately if any of these serious side effects of high blood sugar (hyperglycemia) occur: unusual drowsiness, confusion, rapid breathing, fruity breath odor, increased urination, unusual thirst. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.

CARDIOVASCULAR & ANTI-HYPERTENSIVES

Brand Name/Brand Name Equivalent	Generic Name	Side Effects
Aceon	perindopril erbumin	SIDE EFFECTS: Headache, dry cough, nausea, unusual weakness, back pain or diarrhea. If these persist or worsen, notify your doctor. Very unlikely but report immediately: unusual muscle weakness or cramps, chest pain, one-sided arm or leg weakness, vision changes, tingling of the hands or feet, fever, persistent sore throat, dizziness, fainting, unusual change in amount of urine. This drug may rarely cause serious (possibly fatal) liver problems. If you notice any of the following highly unlikely but very serious side effects, seek immediate medical attention: yellowing of the eyes or skin, dark urine, stomach/abdominal pain, persistent fatigue, persistent nausea. In the unlikely event you have a serious allergic reaction to this drug, seek immediate medical attention. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist
Accupril	quinapril HCI	SIDE EFFECTS: Quinapril is generally well tolerated, and side effects are usually mild and transient. A dry, persistent cough has been reported with the use of quinapril and other ACE inhibitors. Coughing resolves after discontinuing the medication. Other side effects include abdominal pain, constipation, diarrhea, rash, dizziness, fatigue, headache, loss of taste, loss of appetite, nausea, vomiting, fainting and numbness or tingling in the hands or feet. Quinapril and other ACE inhibitors may also cause kidney failure and increased levels of potassium in the blood. The most serious but very rare side effects are liver failure and angioedema (swelling of lips and throat).
Accuretic	quinapril and hydrochlorothiazide	SIDE EFFECTS: Nausea, diarrhea, cough, increased urination, headache, and sun sensitivity may occur. If any of these effects persist or worsen, contact your doctor or pharmacist promptly. Tell your doctor immediately if any of these serious side effects occur: dizziness, lightheadedness. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: difficulty swallowing/ tightness in the throat, decrease in the amount of urine, unusual weakness, muscle pain or cramps, persistent sore throat or fever, unusual bleeding or bruising, chest pain, irregular pulse, seizures, tingling or numbness of the hands or feet. If you notice the following unlikely but serious side effect, stop taking this medication and seek immediate medical attention: fainting. This drug may rarely cause serious (possibly fatal) liver problems. If you notice any of the following highly unlikely but very serious side effects, seek immediate medical attention: yellowing of the eyes or skin, dark urine, stomach/abdominal pain, persistent fatigue, persistent nausea. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling (especially of the face, lips, tongue, or throat), dizziness, trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
Calan	verapamil	SIDE EFFECTS: Side effects from verapamil generally are mild and transient. It can cause dizziness, weakness or fainting because of a slow heart rate or low blood pressure. Other side effects include swelling of the lower extremities, rash, headache, and constipation. Verapamil also can cause mildly abnormal liver tests that usually return to normal with discontinuation of the medication.Verapamil may reduce the heart rate. Verapamil also can cause excessive lowering of blood pressure in rare instances. Verapamil can aggravate heart failure, especially in patients with poor function of their heart muscle.
Capoten	captopril	SIDE EFFECTS: Captopril generally is well tolerated, and side effects are usually mild and transient. A dry, persistent cough has been reported commonly with the use of captopril and other ACE inhibitors. Coughing resolves after discontinuing the drug. Other side effects include abdominal pain, constipation, diarrhea, rash, dizziness, fatigue, headache, loss of taste, loss of appetite, nausea, vomiting, fainting and numbness or tingling in the hands or feet. Captopril and other ACE inhibitors also may cause kidney failure and increased levels of potassium in the blood. Serious but, fortunately, very rare side effects are liver failure and angioedema (swelling of lips and throat that can obstruct breathing).
Cardizem	diltiazem	SIDE EFFECTS: Side effects include constipation, nausea, headache, rash, edema (swelling of the legs with fluid), low blood pressure, drowsiness, and dizziness. Liver dysfunction and overgrowth of the gums also may occur. Diltiazem can cause mildly abnormal liver tests that usually return to normal with discontinuation of the medication. When diltiazem is given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood. Like other drugs for high blood pressure, diltiazem is associated with sexual dysfunction.
Catapres	Clonidine HCL	SIDE EFFECTS: The most common side effects noted with clonidine are tiredness, lethargy, drowsiness, constipation, and dry mouth. Headache, dizziness, fatigue, and weakness also occur with clonidine. Most persons who experience one of these side effects will usually note that the effects subside with more prolonged therapy or if doses are reduced (approved by the physician). Skin reactions including redness, itching, and darkening of skin, have occurred with clonidine patches. Sexual dysfunction including impotence, decreased sexual desire, and ejaculatory dysfunction, have been reported with clonidine therapy. Such reactions also have been reported with other medications used to treat hypertension.Severe rebound high blood pressure can occur following withdrawal from clonidine. This reaction is more likely to occur if clonidine is stopped suddenly (without a gradual dose reduction). Symptoms can include increased salivation, nervousness, headache, heart palpitations, agitation, anxiety, sweating, nausea, muscle pain, and abdominal pain. Slowly reducing the dose of clonidine over several days will prevent this problem.
Lipitor	atorvastatin calcium	SIDE EFFECTS: Atorvastatin is generally well-tolerated. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Atorvastatin may cause liver and muscle damage. Serious liver damage caused by statins is rare. More often, statins cause abnormalities of liver tests, and, therefore, periodic measurement of liver tests in the blood is recommended for all statins. Abnormal tests usually return to normal even if a statin is continued, but if the abnormal test value is greater than three times the upper limit of normal, the statin usually is stopped. Liver tests should be measured before initiation, at 12 weeks following initiation of therapy and dose changes, and periodically thereafter.Inflammation of the muscles caused by statins can lead to serious breakdown of muscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood, and myoglobin can cause kidney failure and even death. When used alone, statins cause rhabdomyolysis in less than one percent of patients. To prevent the development of serious rhabdomyolysis, patients taking atorvastatin should contact their healthcare provider immediately if they develop unexplained muscle pain, weakness, or muscle tenderness.
Lotensin, Lotensin HCT	benazepril (and benazepril HCT)	SIDE EFFECTS: Benazepril is generally well tolerated and side effects are usually mild and transient. A dry, persistent cough has been reported with the use of benazepril and other ACE inhibitors. Coughing resolves after discontinuing the medication. Other side effects are rare and include abdominal pain, constipation, diarrhea, dizziness, fatigue, headache, loss of taste, loss of appetite, nausea and vomiting, easy bruising or bleeding, chest pain, chills, difficulty breathing, severe dizziness or fainting, fever, numbness or tingling in the hands or feet, rash, and a sore or swollen throat. In rare instances, liver dysfunction and skin yellowing (jaundice) have been reported with ACE inhibitors.
Monopril	fosinopril	SIDE EFFECTS: Fosinopril is generally well tolerated. The most common side effects are headache, cough, dizziness, diarrhea, fatigue, nausea, vomiting, complaints of sexual dysfunction, and abnormal liver tests. Impairment of kidney function has been reported with ACE inhibitors, especially in patients with severe heart failure or kidney disease. In rare instances, low white blood cell counts have been reported with the use of captopril, another ACE inhibitor. (Low white blood cells increase a patient's risk of infections.)
Mavik Tablets Tarka Tablets	trandolapril tablets	SIDE EFFECTS: Trandolapril is generally well tolerated. The most common side effects are headache, cough, dizziness, diarrhea, fatigue, nausea, vomiting, complaints of sexual dysfunction, and abnormal liver tests. Impairment of kidney function has been reported with ACE inhibitors, especially in patients with severe heart failure or pre-existing kidney disease. In rare instances, low white blood cell counts have been reported with the use of captopril, another ACE inhibitor. Low white blood cells increase the risk of infections.
Mevacor	lovostatin	SIDE EFFECTS: The most common side effects of lovastatin are headache, nausea, vomiting, diarrhea, abdominal pain, muscle pain, and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown. Lovastatin is a statin. Therefore it shares side effects, such as liver and muscle damage associated with all statins. Serious liver damage caused by statins is rare. More often, statins cause abnormalities of liver tests, and, therefore, periodic measurement of liver tests in the blood is recommended during treatment with all statins. Abnormal tests usually return to normal even if a statin is continued, but if the abnormal test value is greater than three times the upper limit of normal, the statin usually is stopped. Liver tests should be measured before lovastatin is started, at 6 and 12 weeks after initiation of therapy, with an increase in dose, and periodically thereafter or if there is a medical concern about liver damage.
Norvasc	amlodipine besylate	SIDE EFFECTS: The most common side effects of lovastatin are headache, nausea, vomiting, diarrhea, abdominal pain, muscle pain, and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown. Lovastatin is a statin. Therefore it shares side effects, such as liver and muscle damage associated with all statins. Serious liver damage caused by statins is rare. More often, statins cause abnormalities of liver tests, and, therefore, periodic measurement of liver tests in the blood is recommended during treatment with all statins. Abnormal tests usually return to normal even if a statin is continued, but if the abnormal test value is greater than three times the upper limit of normal, the statin usually is stopped. Liver tests should be measured before lovastatin is started, at 6 and 12 weeks after initiation of therapy, with an increase in dose, and periodically thereafter or if there is a medical concern about liver damage.
Plendil	felodipine	SIDE EFFECTS: Peripheral edema (swollen ankles and feet) and headache are the most common side effects of felodipine. Dizziness also may occur.
Prinivil	lisinopril	SIDE EFFECTS: First doses of lisinopril can cause dizziness due to a drop in blood pressure. Lisinopril can cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction. Lisinopril should be stopped if there are symptoms or signs of an allergic reaction including feelings of swelling of the face, lips, tongue or throat. Severe allergic reactions (anaphylaxis) and hives occasionally occur. Rarely, lisinopril may cause a drop in red blood cells, white blood cells, and platelets.Lisinopril can impair the function of the kidneys, and every person taking this medication should have their kidney function checked.
Procardia XL	nifedipine ER	SIDE EFFECTS: Side effects of nifedipine are generally mild, and reversible. Most side effects are expected consequences of the dilation of the arteries. The most common side effects of nifedipine include headache, dizziness, flushing, and edema (swelling) of the lower extremities. Less common side effects include dizziness, nausea and constipation.
Tenormin	atenolol	SIDE EFFECTS: Atenolol is generally well tolerated, and side effects are mild and transient. Rare side effects include abdominal cramps, diarrhea, constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence, lightheadedness, slow heart rate, low blood pressure, numbness, tingling, cold extremities, and sore throat. Atenolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), atenolol can cause dangerously slow heart rates, and even shock. Atenolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure. In patients with coronary artery disease, abruptly stopping atenolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue atenolol, its dosage can be reduced gradually over several weeks.
Timoptic	timolol maleate	SIDE EFFECTS: Ophthalmic timolol can cause irritation to the eye which may manifest as pain or dryness in some people. Rarely, timolol eye drops can result in side effects that are seen with other oral beta adrenergic blockers. For example, persons can experience fatigue, insomnia, nausea, slow heart rate, low blood pressure, cold extremities, and shortness of breath or wheezing.
Vasotec	enalapril maleate	SIDE EFFECTS: Enalapril is generally well tolerated, and side effects usually are mild and transient. A dry, persistent cough has been reported with the use of ACE inhibitors. Coughing resolves after discontinuing the medication. Other side effects include abdominal pain, diarrhea, dizziness, fatigue, headache, loss of appetite, nausea and vomiting, chest pain, dizziness or fainting, numbness or tingling in the hands or feet, rash, and a sore or swollen throat. In rare instances, liver dysfunction and skin yellowing (jaundice) have been reported with ACE inhibitors. In susceptible individuals ACE inhibitors may reduce kidney function.
Zetia	ezetimide	SIDE EFFECTS: Ezetimibe is well-tolerated. The overall rate of side effects with ezetimibe in clinical studies were similar to that reported with placebo (an inactive sugar pill). Diarrhea, abdominal pain, back pain, joint pain, and sinusitis were the most commonly reported side effects, occurring in one in every 25 to 30 patients. Hypersensitivity reactions, including angioedema (swelling of the skin and underlying tissues of the head and neck that can be life-threatening) and skin rash rarely occur. Nausea, pancreatitis, muscle damage (myopathy or rhabdomyolysis) and hepatitis have been reported in post-marketing studies.
Zocor	simvastatin	SIDE EFFECTS: The most common side effects of simvastatin are headache, nausea, vomiting, diarrhea, abdominal pain, muscle pain, and abnormal liver tests. Hypersensitivity reactions have also been reported. The most serious potential side effects are liver damage and muscle inflammation or breakdown

ANTI-ANXIETY / ANTI-DEPRESSANTS

Brand Name/Brand Name Equivalent	Generic Name	Side Effects
Buspar	buspirone	SIDE EFFECTS: The most commonly noted side effects associated with buspirone are dizziness, nausea, headache, nervousness, lightheadedness, excitement, and insomnia. Symptoms of benzodiazepine withdrawal may occur when switching persons from antianxiety medications of the benzodiazepine class (see above) to buspirone since buspirone is not a benzodiazepine. Such a withdrawal reaction may include irritability, agitation, anxiety, insomnia, tremor, or even seizures.
Celexa	citalopram	SIDE EFFECTS: The most common side effects associated with citalopram are nausea, dry mouth, vomiting, excessive sweating, headache, tremor, drowsiness, and inability to sleep. Overall, between 1 in 6 and 1 in 5 persons experience a side effect. Citalopram is also associated with sexual dysfunction. Some patients may experience withdrawal reactions upon stopping citalopram. Symptoms of withdrawal include dizziness, tingling sensations, tiredness, vivid dreams, and irritability or poor mood. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of citalopram or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
Depakote	divalproex sodium	SIDE EFFECTS: The most common side effects with valproic acid therapy are drowsiness, dizziness, nausea, vomiting, indigestion, diarrhea, weight loss and tremors. Divalproex may have a lower incidence of stomach upset, and taking valproic acid or divalproex with food can reduce the stomach upset. Valproic acid also causes skin reactions such as alopecia (loss of hair), rash, itching and sensitivity to sunlight.The most serious side effects due to valproic acid are liver injury, pancreatitis and abnormal bleeding. Liver injury is most common in the first 6 months of treatment. It also is more common in children, especially children less than two years old. Persons taking more than one type of anticonvulsant seem to be at higher risk. Symptoms of liver damage include jaundice, malaise, weakness, swelling in the face, loss of appetite and vomiting. Pancreatitis due to valproic acid can occur early in treatment or after several years of use. Symptoms of pancreatitis are unexplained weight loss, nausea, vomiting and severe abdominal pain. Valproic acid inhibits the formation of blood clots by interfering with the clot-promoting effects of platelets. This can cause abnormal bleeding.
Effexor Effexor XR	venlafaxine	SIDE EFFECTS: Venlafaxine, like most anti-depressants, can cause nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite. Increased blood pressure can occur, and blood pressure should be monitored. Seizures have been reported. "If anti-depressants are discontinued abruptly, symptoms may occur such as dizziness, headache, nausea, changes in mood, or changes in the sense of smell, taste, etc. (Such symptoms even may occur when even a few doses of anti-depressant are missed.) Therefore, it is recommended that the dose of anti-depressant be reduced gradually when therapy is discontinued."
Klonopin	clonazepam	SIDE EFFECTS: The most commonly noted side effects associated with clonazepam are sedation, which is reported in approximately half of patients, dizziness which is reported in one-third of patients, weakness, and unsteadiness. Other side effects include a feeling of depression, loss of orientation, headache, and sleep disturbance. Like all benzodiazepines, clonazepam can cause physical dependence. Suddenly stopping therapy after a few months of daily therapy may be associated with a feeling of loss of self-worth, agitation, and insomnia. If clonazepam is taken continuously for longer than a few months, stopping therapy suddenly may produce seizures, tremors, muscle cramping, vomiting, and/or sweating. Therefore, discontinuation usually is accomplished by reducing the dose gradually.
Lexapro	escitalopram oxalate	SIDE EFFECTS: The most common side effects associated with escitalopram are agitation or restlessness, blurred vision, diarrhea, difficulty sleeping, drowsiness, dry mouth, fever, frequent urination, headache, indigestion, nausea, increased or decreased appetite, increased sweating, sexual difficulties (decreased sexual ability or desire, ejaculatory delay), taste alterations, tremor (shaking), weight changes. Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as a result of depression itself, they also may be a consequence of the drugs used to treat depression. In particular, about one in 11 men given escitalopram report difficulties ejaculating. Some patients experience withdrawal reactions upon stopping SSRI therapy. Symptoms may include dizziness, tingling, tiredness, vivid dreams, irritability, or poor mood. In order to avoid these symptoms, the dose of SSRI can be slowly reduced instead of abruptly stopped. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of escitalopram or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond 24 years of age. There was a reduction in risk of suicidality with antidepressants compared with placebo in adults 65 years of age and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients who are started on therapy with antidepressants should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
Paxil	paroxetine HCL	SIDE EFFECTS: Paroxetine can cause nausea, headaches, anxiety, insomnia, drowsiness, constipation, weakness, dry mouth, sweating, diarrhea and loss of appetite. Increased blood pressure can occur, and blood pressure should be monitored during treatment. Seizures have been reported. Sexual dysfunction has been associated with paroxetine. Some patients may experience withdrawal reactions upon stopping paroxetine. Symptoms of withdrawal include anxiety, nausea, nervousness, and insomnia. The dose of paroxetine should be gradually reduced when therapy is discontinued. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of paroxetine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
Prozac	fluoxetine HCL	SIDE EFFECTS: Fluoxetine, as with most antidepressants, can cause nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite. Fluoxetine has been implicated in serious skin rashes and vasculitis (inflammation of small blood vessels). Increased blood pressure can occur, and blood pressure should be monitored. Seizures have been reported as has sexual dysfunction. Some patients may experience withdrawal reactions upon stopping fluoxetine. Symptoms of withdrawal include anxiety, nausea, nervousness, and insomnia. The dose of fluoxetine should be gradually reduced when therapy is discontinued. Antidepressants increased the risk of suicidal thinking and behavior in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of fluoxetine or any other antidepressant in a child or adolescent must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.
Valium	diazepam	SIDE EFFECTS: The most frequent side effects of diazepam are drowsiness, fatigue, and ataxia (loss of balance). Rarely, diazepam causes a paradoxical reaction with excitability, muscle spasm, lack of sleep, and rage. Confusion, depression, speech problems, and double vision are also rare side effects of diazepam. Diazepam can lead to addiction (dependency), especially when higher dosages are used over prolonged periods of time. In patients addicted to diazepam or after prolonged use, abrupt discontinuation of the medicine may cause symptoms of withdrawal (insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, and fatigue). Seizures can occur in more severe cases of withdrawal. Therefore, after extended use, diazepam should be slowly tapered under a doctor's supervision rather than abruptly stopping the medication.
Wellbutrin	bupropion HCL	SIDE EFFECTS: The most common side effects associated with bupropion are agitation, dry mouth, insomnia, headache, nausea, constipation, and tremor. In some people, the agitation or insomnia is most marked shortly after starting therapy. Some patients may experience weight loss. Uncommonly, patients may experience manic episodes or hallucinations. Four of every 1000 persons who receive bupropion in doses less than 450 mg/day experience seizures. When doses exceed 450 mg/day, the risk increases ten-fold. Other risk factors for seizures include past injury to the head and medications which can lower the threshold for seizures. (See drug interactions.) Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of bupropion or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.
Zoloft	sertraline	SIDE EFFECTS: The most common side effects of sertraline are sleepiness, nervousness, insomnia, dizziness, nausea, tremor, skin rash, upset stomach, loss of appetite, headache, diarrhea, abnormal ejaculation, dry mouth and weight loss. Important side effects are irregular heartbeats, allergic reactions and activation of mania in patients with bipolar disorder. If sertraline is discontinued abruptly, some patients experience symptoms such as abdominal cramps, flu like symptoms, fatigue and memory impairment. Although this reaction is not well established, it is reasonable to gradually reduce the dose of sertraline when therapy is discontinued. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of sertraline or any other antidepressant in a child or adolescent must balance this risk with the clinical need for the antidepressant. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

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