Parkinsons and Haldol

  1. 5 Hi all, a elderly PD patient goes to ER for a trip and fall on a wednesday everything is fine, thursday 1 hour hip surgery went great, gets demerol in the PACU, becomes confused, late thursday, friday and saturday gets a IV push with Haldol, sunday crashes with respiratory failure, mild heart attack, arrhythmia and is developing aspiration Pneumonia taken to ICU, advances his PD to stage 5, gets dysphagia dies 5 days later with fatal heart attack, advanced pd, aspiration Pneumonia and dysphagia.
    Patient lived alone with stage 2 pd, drove a car, took walks, shopped prior to incident.

    Haldol is contradicted in PD, PDR says don't take Haldol if allergic or have PD, FDA says no IV haldol let alone to push it, patient was on parcopa which is adverse with Haldol. also no informed consent on the Haldol, california law says informed consent for Haldol and the elderly. I cant see a doctor telling the patient/guardian I would like to give a med contradicted in your illness and push it, which is not approved either, so I can calm you.
    After the guardian heard of the Haldol signed a physical restraint consent form, then came the Ativan

    Questions:
    1. Should the RN catch the medication error? should the RN check to make sure informed consent is in place.
    2. Why would a internal med doctor order Haldol for a PD patient if the outcome is to calm him? and signs off on med eval that the patient has PD, does not consult neurologist.
    3. The Haldol induced everything research said it would in a none PD patient, 10 fold in the PD patient who already lacks dopamine.

    A. Who is at fault the Doctor for the order or the RN for following it?
    B. No one, he would have died anyway elderly get aspiration Pneumonia often from surgery.
    C. No matter what else the Haldol did as it said and advanced the PD and froze the patient

    And finally many of you are RN's if a doctor tells you to push a drug IV and you know it is contradicted would you do it anyway?
    Can a nurse tell a doctor he is wrong?
    Someone had to hit "Ignore" or "Override" on the MC-1 when it flagged parcopa/levodopa and Haldol.
    And the levaquin he was given is adverse with the Haldol

    I attended a dinner meeting where a prominent Toledo Doctor spoke and I [chatted] at length with him following the presentation. He urged EVERYONE diagnosed with Parkinsons Disease to contact EVERY doctor they see and add HALDOL (Haloperidol is a typical antipsychotic drug) to the list of meds they are allergic to. He said when asked what the side effects are, tell them "IT WILL KILL ME" and that should get medical staff attention. Said it 'blocks' the dopamine and the patient "FREEZES", among other life-threatening reactions.


    A very nice RN stated this:
    I am an RN and I have had PD for 5 years.

    It is unfortunate how misinformed and uneducated many healthcare professionals are regarding PD. Steps are being taken to improve this by developing continuing education for nurses.

    It is so important that we as patients and caregivers arm ourselves with as much knowledge as possible because we are often the ones who must educate the staff who are caring for us or our loved ones.

    It is important to note that while Haldol is contraindicated for PD so are many other antipsychotics as well as other commonly used medications. Below is a list of drugs contraindicated in PD. It is by no means a comprehensive list but the best one I have found online. It is from the pdasd.org website (PD Assoc of San Diego). APDA also has a nice pamphlet which also includes other drugs that interact with PD meds. Please obtain a copy from APDA or other PD organization or print this list and carry it with you.

    ANTI-PSYCHOTIC
    Haldol
    Trilafon
    Thorazine
    Stelazine
    Prolixin, Permitil
    Navane
    Mellaril (High-Dosage)
    Loxitane

    ANTI-DEPRESSANTS
    Triavil Combination of Perphenazine & Amitriptyline
    Ascendin
    *Nardil
    *Parnate

    ANIT-VOMITING
    Compazine
    Reglan
    Torecan

    BLOOD PRESSURE; POST-OPPERATION
    Serpasil
    Raudixin
    Rauverid
    Wolfina
    Harmony-1
    Moderil
    Rauwiloid

    NARCOTIC/ANALGESIC
    *Demerol

    OTHER MEDICATIONS
    Aldomet
    Dilantin
    Lithium
    BuSpar

    *Eldepryl should never be taken with Demerol or any other opiod, MAI, or elective
    serotonin reuptake inhibitor such as Zoloft, Paxil, Prozac, or tricyclic antidepressants.



    Thank You All So Much For Your Comments and Insight...

    I am a PD advocate and want to help PD sufferers when they enter the hospital and I realize in some deceases our doctors and nurses cannot possibly know everything about certain afflictions, the more we all know the better we can all heal the ill, both patient and caregiver..........
  2. Visit  Pd Advocate profile page

    About Pd Advocate

    Joined Oct '10; Posts: 12; Likes: 12.

    17 Comments so far...

  3. Visit  merlee profile page
    0
    Thank you for all this info.
  4. Visit  tyvin profile page
    1
    I was taught in nursing school not to give Haldol to any elderly patient. Also; never give elderly people Demerol; it has a live metabolite that can have catastrophic effects on the elderly.

    I worked in an Alzheimer's unit years ago and almost every elderly resident had a PRN Haldol order. I got every order d/c'ed or switched to Ativan. I would also like to bring up the med Darvocet and the elderly, yes it is contraindicated with them and there is plenty of research to back it up; it also has a live metabolite. I got all those orders changed as well at that place and any other place I've ever worked I have refused to take orders for Haldol, Darvocet, and Demerol when it is ordered for an elderly person. Also with Darvocet when one has to crush it for the person to swallow the taste is so nasty I consider it extremely cruel to do that to a person.

    All the docs that have ever tried to order any one of these 3 meds for an elderly person I've got orders changed or had them make another choice. All the docs were very receptive to my information about what these certain meds can do to our older people.

    To conclude I would never push anything "just" because there is an order for it and as an RN I must take full responsibility with the med orders meaning I will catch it if the doc messes up. And if I don't then we both go down. As with any order that I have a concern with it doesn't get filled until I am satisfied about the parameters, populations etc...
    Pd Advocate likes this.
  5. Visit  elkpark profile page
    4
    I used to work on the psych consultation-liaison team in a large urban teaching hospital, and it drove us (the team) crazy that the ICU attendings and residents looooved to use haloperidol (Haldol) IV push as their "sedative" of choice for agitated clients. We tried very hard over time to convince them that was a really bad idea, for any kind of client, and there were much better choices available, but they just laughed us off. It was v. frustrating. I was horrified. I don't know where this idea came from, among "medical" (non-psychiatrist, I mean) physicians that Haldol is some kind of "wonder drug," generic tranquilizer. A shocking number of them seem completely unaware that it can be very dangerous and has many possible untoward, even life-threatening, effects (even in people without PD).
    NRSKarenRN, Nascar nurse, tyvin, and 1 other like this.
  6. Visit  wtbcrna profile page
    1
    Just to add a couple of drugs to the list of not to give:

    Antiemetics:

    Phenergan
    Droperidol


    The only safe antiemetic specific drugs to give to Parkinson patients is Zofran/Anzemet (Serotonin Reuptake inhibitors).
    Esme12 likes this.
  7. Visit  Pd Advocate profile page
    0
    Quote from merlee
    Thank you for all this info.
    You are welcome, I have lots of info to post and hopefully we can discuss, this at greater lengths
  8. Visit  Pd Advocate profile page
    0
    Quote from tyvin
    I was taught in nursing school not to give Haldol to any elderly patient. Also; never give elderly people Demerol; it has a live metabolite that can have catastrophic effects on the elderly.

    I worked in an Alzheimer's unit years ago and almost every elderly resident had a PRN Haldol order. I got every order d/c'ed or switched to Ativan. I would also like to bring up the med Darvocet and the elderly, yes it is contraindicated with them and there is plenty of research to back it up; it also has a live metabolite. I got all those orders changed as well at that place and any other place I've ever worked I have refused to take orders for Haldol, Darvocet, and Demerol when it is ordered for an elderly person. Also with Darvocet when one has to crush it for the person to swallow the taste is so nasty I consider it extremely cruel to do that to a person.

    All the docs that have ever tried to order any one of these 3 meds for an elderly person I've got orders changed or had them make another choice. All the docs were very receptive to my information about what these certain meds can do to our older people.

    To conclude I would never push anything "just" because there is an order for it and as an RN I must take full responsibility with the med orders meaning I will catch it if the doc messes up. And if I don't then we both go down. As with any order that I have a concern with it doesn't get filled until I am satisfied about the parameters, populations etc...
    Thank You Tyvin, thats great info and I am glad to see you are caring and concerned for your patients well being, a 20 year RN told me this (bless her soul) " I don't care what the doctor says or orders, I am not going to do anything to you, that I would not want done to myself".

    Your comment about taking responsibility is very interesting, as I thought that as well, one would think someone should have caught the fact Haldol is contradicted for PD.
    Last edit by sirI on Oct 19, '10 : Reason: posting TMI
  9. Visit  OttawaRPN profile page
    0
    At a psych emerg in a large urban hospital, many uncontrollable psychos would be brought through those doors.

    The drug of choice?

    "10 and 2"

    Haldol 10 mg and Ativan 2 mg

    It could literally take down an elephant.
  10. Visit  nminodob profile page
    0
    Not sure if this has already been mentioned, but Haldol is never given IV push because it prolongs the QT interval and there is a risk of sudden death. This is verified in a number of studies, the stepdown unit I work at is also telemetry and we are not allowed to give Haldol IV push, only IM.
    On the other hand, we regularly see EtOH w/d patients of all ages, and Haldol is frequently given for hallucinations, although we rarely see alcoholics that live into their 70s and beyond. I guess their livers are shot by then.
  11. Visit  Pd Advocate profile page
    0
    Quote from nminodob
    Not sure if this has already been mentioned, but Haldol is never given IV push because it prolongs the QT interval and there is a risk of sudden death. This is verified in a number of studies, the stepdown unit I work at is also telemetry and we are not allowed to give Haldol IV push, only IM.
    On the other hand, we regularly see EtOH w/d patients of all ages, and Haldol is frequently given for hallucinations, although we rarely see alcoholics that live into their 70s and beyond. I guess their livers are shot by then.
    That is so true and did you also know that patients who do not have PD, develop PD symptoms when taking Haldol.
    A nurse told me Haldol will make a insane person sane and a sane person insane
  12. Visit  Pd Advocate profile page
    0
    I also mentioned the drug alert system check this out.............

    Drug safety alert generation and overriding in a large Dutch university medical centre.
    van der Sijs H, Mulder A, van Gelder T, Aarts J, Berg M, Vulto A.

    Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, the Netherlands. i.vandersijs@erasmusmc.nl
    Abstract
    PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre.

    METHODS: A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months.

    RESULTS: In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug-drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium-level seriousness were overridden more often (55%) than low-level (22%) or high-level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides.

    CONCLUSIONS: Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.

    2009 John Wiley & Sons, Ltd.
  13. Visit  Esme12 profile page
    1
    Quote from pd advocate
    that is so true and did you also know that patients who do not have pd, develop pd symptoms when taking haldol.
    a nurse told me haldol will make a insane person sane and a sane person insane

    that is called tartive dyskinesia and in rare instances become permanent. you seem to have a lot of information about this patient, his family, and his care.

    many drugs have serious side effects that can lead to death. all professionals involved are responsible to check and recheck to prevent these type of unfortunate events. haldol is contraindicated in other disease entities. not all states require informed consent for restraint or drug administration. the md should be aware of what they are ordering. the pharmacist should also be aware of the pt's disease process before filling the order and the nurse is responsible for everything she does.

    i have bore witness to a md screaming at a nurse to give a drug she should not give......."i'll have your job i'm the md i said give it" she gave it....she should not have given it......she lost her job and liscense. if they want it give i had them the syringe and suggest they give it themselves.


    here is the fda warning
    gov/cder/drug/infosheets/hcp/haloperidol.htm>.
    leslie :-D likes this.
  14. Visit  Pd Advocate profile page
    1
    Quote from Esme12
    That is called Tartive dyskinesia, You seem to have a lot of information about this patient, his family, and his care.

    Many drugs have serious side effects that can lead to death. All professionals involved are responsible to check and recheck to prevent these type of unfortunate events. Haldol is contraindicated in other disease entities. Not all states require informed consent for restraint or drug administration. The MD should be aware of what they are ordering. The pharmacist should also be aware of the pt's disease process before filling the order and the nurse is responsible for everything she does.

    I have bore witness to a MD screaming at a nurse to give a drug she should not give......."I'll have your job I'm the MD I said give it" She gave it....she should not have given it......she lost her job and liscense. If they want it give I had them the syringe and suggest they give it themselves
    Thank You Esme and God Bless you for your efforts on your patients behalf, I can't help but chuckle on your comment you hand them the syringe, a very admirable approach to what sounds like a self righteous MD, all patients need caregivers such as yourself that are not simply cashing a check, but have a genuine concern for their patients, and as you bond with your patients, I do too with the PD patients and families that I educate on their affliction and for some reason doctors don't relay the information that I do to them. and getting on board after the fact some families seek answers that go beyond the blind trust they bestowed on their MD's.
    To see the grief on the faces of families who all share the "If I Only Knew, They Would Still Be Alive" syndrome is actually heart breaking, so on their behalf, yes I take their pain very seriously, as we all know some folks get the best of care and just die, others have foreseeable errors take place and die, it is the loved ones of those folks that deserve closure as well. and in most cases I am the first one to say "I'm sorry they did all they could" but in this case I just don't have that opinion.

    It's ironic that you mentioned dyskinesia, that can and will become present in PD patients with long term Parcopa/Levodopa intake, before I reviewed the charts I thought to myself, maybe just maybe the MD was ordering haldol, because he mistook typical tremors for dyskinesia and thought haldol might back some dopamine out of his system but currently, amantadine is the only drug that reliably reduces dyskinesia without worsening the motor symptoms of PD, but the drug has other side effects that are undesirable and its motor benefits do not last long, allot of folks see PD suffers shaking and think they need meds, when in actuality it is the meds making them shake, pd patients without meds "Freeze" thats why stage 5 PD is so terrible to watch the patient no longer responds to his meds and becomes frozen in his bed.
    You mentioned the pharmacist in this case the daughter brought his meds from home day 1, and as you all know meds brought into the hospital must go to the pharmacist first for approval.

    It seems like one of the post's stated Haldol just seems to be a prerequisite to being on the floor
    And like one of the post's says to "Push" such a nasty drug to a elderly patient lying in bed with a broken hip with his arms shaking from his PD just seems irreproachable.
    Its seems harsh for me to say but sometimes is the sad truth, a patient is given a drug that causes agitation, then is given a worse one to calm it.
    When the laymen looks at that scenario it does not make sense.
    Esme12 likes this.


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