Category: overmedication

Supplements that can mess up your meds

Posted on March 22, 2023 by - #caregivers, Medications not working, overmedication, too many meds

Supplements and Medications Interactions

At your last checkup, your doctor told you to take calcium 500 – 600 mg twice a day because your bone density tests indicate that you have osteopenia. Osteopenia is a decrease in bone mineral density below normal reference values, but not low enough to meet a diagnosis of osteoporosis.

Ok, no big deal. You pick some up and begin taking them. Wait, there could be a big deal. Do you take medication for your thyroid, such as levothyroxine? Are you taking doxycycline or ciprofloxacin for an infection? If yes, you cannot take the calcium supplements with the thyroid medication or the antibiotic. They need to be separated by two hours. There are other medications that are made less effective by calcium. 

March 22, 2023

Calcium effects – Medication interactions

Calcium binds up the medications (those that are affected by it) and makes them less available for absorption and may decrease the effectiveness of your medications. Some of your medications may increase the absorption of calcium causing too much calcium in your body. Kidney problems or serious side effects of calcium may occur.

You may have tolerated problems in your earlier years, but now you are 60 or older and things are changing. Your kidneys don’t filter as well. Your liver may not be able to metabolize things as well as it once did, causing an increase in side effect problems or adverse drug events.

Be more aware of supplements and drug interactions

I want you to be more aware of what can impact your medications. Some things cause too little of your medication to be absorbed. Some things cause too much of your medication to be absorbed. If you are taking supplements, find out what you can and cannot take with your current meds. Find out the best time to take your supplements.

Iron, Potassium, Vitamin K

Over-the-counter Iron supplements, potassium supplements, or vitamin K supplements can cause problems too. St. John’s wort is another supplement that may cause problems. A lot of folks are on medications that are used to treat high blood pressure medications, heart medications, antidepressant medications, and blood thinners such as warfarin, or antiviral medications.

It matters!

You need to know what can and can’t be taken together. You need to know when to take what. You need to know that the fat-soluble vitamins A,D,E,K can build up in your body. Some of you have been told that you “pee out what your body doesn’t absorb” which is not entirely true. Did you know that your body can only absorb 500 – 600 mg of calcium at a time?

PPI’s and Medication interactions

Even gastric acidity affects some medications. Are you taking a proton pump inhibitor (PPI) such as Prilosec® (omeprazole), Nexium® (esomeprazole), Prevacid® (lansoprazole), etc.? If you have to take an iron supplement and you take a PPI, your iron is probably not being absorbed as the gastric acid is “less acidy.”

Certain foods can also interfere with medication absorption. Examples include Grapefruit, Kale, Dairy, Yogurt, Alcohol, and Tyramine-rich foods.

Common things that we don’t think about that affect medications:

  1. ·       Nicotine use
  2. ·       Alcohol
  3. ·       Caffeine
  4. ·       Our diet
  5. ·       Changes in medical conditions
  6. ·       Changes in illness (usually a decline)
  7. ·       Infections

Aging and what the body does to drugs

With aging comes changing pharmacokinetics. Pharmacokinetics is what the body does to drugs. These changes include Absorption, Distribution across body compartments, Metabolism, and Excretion. The metabolism and excretion of many drugs decrease, which means your dosage probably needs to decrease as well. Absorption is not usually a clinically significant problem unless other factors come into play. As we age body fat usually increases and total body water decreases. This can affect the distribution of drugs that are lipophilic (dissolves in lipids or fats). Hepatic (liver) metabolism through the cytochrome P-450 system, decreases with age. Renal (kidney) elimination. This one actually begins to decline at about age 40.

As you can see, there are a lot of factors that can impact your medication’s ability to do its job. Your pharmacist can help you with these issues. 

Pat

Is it a psychiatric illness, psychosis, or a drug-induced problem?

Posted on May 12, 2022 by - #alzheimers, #caregiver, #caregivers, #dementia, overmedication

First, what is psychosis? Psychosis is a term used to describe when a person interprets or perceives reality in a different way than those around them. Psychosis may be a symptom of mental illness, but that is not always the case. Nobody knows exactly what causes psychosis. May 11, 2022 Observations

Typical story of a psychosis

Suzi visited her mom, Val Thursday after work. Suzi checks in on her about twice a week. Val is 70, active with high cholesterol, high blood pressure. arthritis, and mild depression. Val takes her medication regularly and as directed. Suzi notices that her mom is not quite herself. Val cannot follow the conversation and does not seem to be able to concentrate. The first thing Suzi thinks is, an UTI. Possible dehydration. They go to the Dr., but the urine test comes back clean. No infection and her electrolytes are all in the normal range. Hmm. Now what? Nobody seems to know what to do next, but wait and see. It is now a week later and Val is not better and in fact she is a little worse. She cannot remember if she has taken her meds or not. She is unsure of what has happened over the last three days. Suzi is getting more and more concerned. This is not normal and her mom has never been this way before. Suzi wonders if her mom is developing dementia, Alzheimer’s disease or mild cognitive impairment. In this particular case, her physician looked at her medications and had a consult with her pharmacist. They determined that most likely it was her blood pressure medication and/or her arthritis medication. Outside chance it could be anti-depressant med, but not likely. They began a withdrawal of HBP medication and started a different one. Val was some better, but not back to normal. It was not her arthritis medication; it was her anti-depressant medication. She was slowly weaned off of that and they did a wait-and-see approach to see if she needed to be on an anti-depressant anymore. Her mind cleared and she was back to her normal self.

Too often, we fail to look for signs and symptoms of drug-induced psychosis

While this case was a success, many more are not. No one thinks to check the medications. Why? Well, their thought processes go along these lines – She has been on these meds for three years or more. It came on suddenly, it must be a UTI or dehydration or she does indeed have the beginnings of mild cognitive impairment or a dementia. Medications are not without risks and problems over time. As we age, our metabolization and kidney function decrease. We cannot clear meds as quickly or as easily as we once did. You know when your loved one is “not right.” You may not know what it is, but you know that something is wrong. Push for answers, never accept it is “just old age,” dementia, or other assumptions. Blood tests and urine tests need to be done. Medications need to be checked. Hydration and nutrition need to be addressed. We want to rule out any fixable problems.

Psychosis can be:

    • Due to stressful life experiences or trauma
    • Part of a neurological condition such as dementia. Alzheimer’s disease, or Parkinson’s disease
    • Triggered due to a brain injury
    • Medication side effects
    • Effects of illicit or illegal drugs such as marijuana or cannabis
    • Effects of alcohol withdrawal
    • Triggered by menopause
    • Triggered during times of severe stress or anxiety
As you can see, it is not black and white. Many things can trigger a psychosis. By the way, marijuana is not the gateway drug to addiction. Trauma is the gateway to addiction. The self-medication, whether it is alcohol, marijuana, cocaine, hydrocodone, heroin, etc., becomes the problem due to another problem. We have to deal with the primary problems first! Yeah, I know, we chased a rabbit there. We don’t think about medications as causing a psychosis or a psychotic episode, but they sure can. Too often, we assume that it is a mental health issue. Maybe it is, but, we need to find out and rule out other fixable causes. Understand that some classes of drugs can cause psychosis.

Classes of meds that may cause psychosis:

    • Muscle relaxants
    • Antihistamines
    • Antidepressants
    • Cardiovascular medications
    • Antihypertensive medications
    • Analgesics
    • Anticonvulsants
    • Antiparkinsonian medications
    • Chemotherapy agents
    • Corticosteroids
    • Stimulants
From the list above, you can see that the possibility is real that the psychosis is from a medication and not mental illness. Alcohol abuse or misuse is another inducer of psychosis. Drug-induced psychosis usually only lasts until the medication/drug has cleared the body. Depending on the drug, the metabolization and clearing may take from 1 day to several weeks (if it is from a stimulant medication). A healthcare professional needs to be contacted. They can decide where the safest place to “come-off” the medication will be. Drugs can affect different people in different ways. What causes a psychotic episode in one person may not cause a psychotic episode in another person. Genetics plays a part. Life experiences play a part. Pre-disposition to mental illness plays a part. Remember, mental health disorders can cause substance use or misuse on its own. The mental health disorder can be exacerbated or intensified by medication use, abuse or misuse, but it is not caused by the meds. We should note that schizophrenia is not caused by drug use, abuse or mis-use. It may trigger schizophrenia symptoms in those people susceptible to schizophrenia.

Common signs and symptoms of psychosis includes:

Hallucinations – when you see, hear, feel or taste things that other people don’t
    • Hearing voices or sounds that others don’t
    • Seeing things that others do not see
    • Tasting things when you haven’t had or eaten anything
    • Feeling someone touching you who is not there
    • Smelling things which other people cannot smell
Delusions – unusual beliefs that other people in your “community” do not share, even though they feel real to you You may worry:
    • That you are being followed by secret agents or members of the public
    • People are out to get you or to kill you (may be strangers or people that you know)
    • That a chip has been implanted in your brain to monitor your thoughts
    • That your food or water is being poisoned
    • That you are a powerful person or God
Cognitive impairments – these relate to mental action (learning, remembering, functioning)
    • Problems concentrating
    • Memory problems
    • Difficulties understanding new information
    • Having a difficult time making decisions
Alcohol, amphetamines, phencyclidine (PCP), cocaine, and hallucinogens are among the most common causes of drug-induced psychosis. Symptoms of drug psychosis include:
    • Hallucinations. A person might see, smell, or hear things that aren’t there.
    • Delusions. A person may adopt demonstrably false beliefs, such as that a demon is pursuing them.
    • Dangerous behavior. A person might attempt to fly, harm themselves because a voice told them to do so, or become a danger to others. Some people who experience psychosis become aggressive.
    • Disconnection from other people or from reality. A person may appear catatonic or totally withdrawn.

Drug-related psychosis is distinct from other forms of psychosis in a few ways:

    • It appears while under the influence of or withdrawing from a drug.
    • It comes on suddenly.
    • It is typically more intense than other forms of psychosis.

Illicit/Illegal Drugs that most commonly cause substance-induced psychosis:

Methamphetamine Cocaine Marijuana LSY Peyote Mushrooms Ketamine (this is a Rx drug, but is used illicitly) PCP Ecstasy This overview is so that you know and understand that medications can cause psychotic episodes. What signs and symptoms to look for? Contact your healthcare provider for withdrawal and monitoring needs. Pat

Medication Overload – Another Drug Problem

Posted on May 4, 2022 by - overmedication, problems, too many meds

Too much medication, too many medications (polypharmacy), overprescribing, inappropriate prescribing, & the body’s decline in metabolization and excretion. Whew! It is a lot, isn’t it? May 4, 2022 Medications will not fix everything. Medications are not without risks. Over-the-counter medications are not always safe. Vitamins, supplements, herbs, or essential oils are not without risks and they are not always safe either.

What I look for is medication overload

I am on the lookout for unnecessary medications, potentially inappropriate use of medications., or multiple medications used for the same thing. I look for appropriate medication usage and benefits vs risks treatment regimens. Just because a medication may help, does not mean it should be used because the risks or side effects will be worse than the treatment. Treatment may be indicated, but it will not be beneficial. A medication may no longer be necessary. Medication is not necessary at all. We have to get over this, “a pill for every ill,” kind of thinking. Let’s be honest, a lot of folks want “my rights” or “my choices,” but they do not want the responsibilities that come along with those things. It is each of our responsibilities to take care of our bodies, as best we can. Eating better, drinking our water, doing physical activity, taking care of our mental health, and even sleeping well. Progress over perfection. Be consistent. Then if you need meds, take only what you need in the lowest amount you need. Medication overload isn’t really talked about very much. When 750 people aged 65+ are admitted to the hospital Every Day, due to medication problems … that is significant. Not all of these folks survive. 7,000 people die every year due to preventable adverse drug events. It is unknown how many dies, due to worsening of their current diagnoses.

If you are 65+ and take 5 or more prescription medications, you are at risk of an adverse drug event.

Possible side effects of overmedication include:
    • Mental health concerns
    • Addiction
    • Substance misuse or abuse disorders
    • Drug reactions that are dangerous
    • Adverse side effects
    • Increase in physical health problems

Common signs of overmedication in seniors include:

    • Fatigue and energy depletion
    • Pressure in the abdomen
    • Aches and pains in the body
    • Problems with balance and motor skills
    • Fatalities and falls
    • Rashes and flushing of the skin on a regular basis
    • Weight gain or loss that is not clarified
    • Mood swings are frequent, and there is a lack of personal hygiene.
    • Concentration problems
    • Impairment of memory
    • Confusion or cloudiness of mind
    • Delayed decision-making
    • Inability to think rationally
    • Psychosis, hallucinations, and delusions
    • Symptoms of withdrawal when not using

How can we decrease or eliminate medication overload in the older adult?

Take time to discuss medications during office visits. Find out what is still necessary and needed. Find out what can be stopped or tapered off. Work with your physician. Discuss the benefits vs harm and what are the alternatives. You doctor will probably be thrilled that you want to decrease the number of medications that you are taking. Be open to the possibility that your medications are hurting you rather than helping you. Maybe, you feel so bad, not because of your diagnoses, but because of some of your medications. Your goal is to reduce medication overload. Could you be on a potentially inappropriate or harmful medication for you? One or more medications that you are taking may cause you to feel bad or may even cause a hospitalization. You are the one inside your body and you are the expert on how you feel and how you are really doing. Consider, just consider, that taking less medication (in number or dosage) may benefit you. Pat