Pd Advocate

LTC this is why I mentioned to take a "Less is More" approach t sedation in your PD and Elderly Folks The Role of Sedative and Analgesic Medications Psychoactive medications are the leading iatrogenic risk factors for delirium. Benzodiazepines, narcotics, and other psychoactive drugs are associated with a 3- to 11-fold increased relative risk for the development of delirium.In addition, the number and rate of adding psychoactive medications increase the risk of delirium by 4 to 10 times. Extreme variability exists in the pharmacokinetics of these agents according to age, ethnicity, drug metabolizing ability, and other factors. In fact, the half-life of narcotics can increase 6-fold in critically ill patients and the elderly. Although the use of sedatives and analgesics clearly has a major impact on length of stay and other outcomes (data presented in the following text),the impact on neuropsychological outcomes from these extremely commonly used medications in ICU patients is not known. The American Psychiatric Society has recently published its guidelines on delirium, which included a list of substances that can cause delirium through intoxication or withdrawal

Yer Welcome LTC and I take it most of your pd patients are elderly please remember the half time of the drugs you give, the dosage, an adult dose is way to much for elderly, think of them as infants, you can always give more, to much is to late, pd patients often develop "sundowners" don't let it alarm you often you can calmly talk them out of it, PD dramatically throws your orientation off, you become very confused and have great indecision, most elderly PD sufferers become "Hoarders" they think they are on track but can not make decisive decisions, calm relaxed talk does wonders for PD it causes them to focus, but of course that requires a nurse willing to sit with a patient and calm them, just a caring voice is soothing and of course so non invasive, sounds silly but if you have time give it a try, sure beats pumping them full of drugs:) but does require a loving caring approach, something 40 years of nursing school wont teach you

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.

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. [email protected] 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.

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

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.

You are welcome, I have lots of info to post and hopefully we can discuss, this at greater lengths

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..........