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Deborah J McCoy-Freeman, BS, RN, NREMT-P Objectives
• Discuss a variety of commonly prescribed medications • Discover the relationship between certain medications and their indication leading to more information of the past • Describe interviewing techniques for achieving better assessment results 70 yo female, C/O dizziness and light headedness. Poor historian. S: dizziness, confusion A: none known M: Patient hands you her bag ‘o meds P: unknown L: unknown E: dizziness, called 911 Additional information will be difficult to obtain Without family or bystander input, this may be all you get The information you get in a patient’s past medical history (PMH) may be crucial to your treatment What to do
• Many medical conditions/diseases are treated with a single med or a group of meds • Certain meds can point to definite diagnoses Solution?
• … to take a close look at the “bag ‘o meds”! 3 Simple Rules
• The medication list should never replace a good interview or assessment • Is an augmentation of your history and physical How to learn to be a Bag ‘o Meds
Private Eye
• Review the most common medications prescribed for that problem • Take a look at the “multi-taskers” • Drugs used for more than one medical malady Pulmonary
• *Albuterol: Ventolin, Proventil, Combivent
• *Metaproterenol: Alupent
• Salmetrol: Serevent, Advair
• Ipratoprium: Atrovent, Combivent
TheoDur

*rescue inhalers
• Fluticasone: Advair, Flovent
• Triamcinolone: Azmacort
• Flunisolide: Aerobid
• Budesonide: Pulmicort
• Methylprednisolone: Medrol
• Cromolyn: Intal
• Nedocromil: Tilade
• Montelukast: Singulair
• Zafirlukast: Accolate
Allergies
• Loratidine: Claritin, Alavert
• Fexofenadine: Allegra
• Cetirizine: Zyrtec
• Fluticasone: Flonase
• Budesonide: Rhinocort
• Triamcinolone: Nasacort
• Beclomethasone: Beconase, Vancenase
Allergies
Non-Steroidals
• Cromolyn: Nasacrom
• Montelukast: Singulair
Hypertension
• Propranolol: Inderal
• Atenolol: Tenormin
• Carvedilol: Coreg
• Metoprolol: Lopressor
• Acebutolol: Sectral
• Labetalol: Normodyne
Hypertension
• Clonidine: Catapres
• Methyldopa: Aldomet
• Terazosin: Hytrin
• Prazosin: Minipres
• Doxazosin: Cardura
• Hydrochlorothiazide (HCTZ): Thiazide • HCTZ/Triamterene: Maxide, Dyazide
• Indapamide: Lozol
Hypertension
• Diltiazem: Cardizem, Dilacor, Tiazac
• Verapamil: Isoptin, Calan, Verelan, Covera
• Amlodipine: Norvasc
• Felodipine: Plendil
• Isradipine: DynaCirc
• Nicardipine: Cardene
• Nifedipine: Procardia, Adalat
Hypertension
• Benazepril: Lotensin
• Captopril: Capoten
• Enalapril: Vasotec
• Fosinopril: Monopril
• Lisinopril: Prinivil, Zestril
• Moexipril: Univasc
• Quinapril: Accupril
• Ramipril: Altace
• Trandolapril: Mavik
• Losartan: Cozaar
• Valsartan: Diovan
• Irbesartan: Avapro
Hypertension
• Atenolol/chlorthalidone: Tenoretic
• Bisoprolol/HCTZ: Ziac
• Metoprolol/HCTZ: Lopressor HCT
• Propranolol/HCTZ: Inderide
• Benazepril/HCTZ: Lotensin HCT
• Captopril/HCTZ: Capozide
• Enalapril/HCTZ: Vaseretic
• Lisinopril/HCTZ: Prinzide, Zestoretic
• Losartan/HCTZ: Hyzaar
• Amlodipine/benazepril: Lotrell
Congestive Heart Failure
• Carvedilol: Coreg
• Nadolol: Corgard
• Labetalol: Normodyne
Congestive Heart Failure
• Nitroglycerin: Minitran, Nitro-DUR, Nitrolingual,Transderm-Nitro, Nitrostat
• Isosorbide mononitrate: Imdur, Ismo
• Isosorbide dinitrate: Isordil
Congestive Heart Failure
• Furosemide: Lasix
• Metolazone: Zaroxolyn
• Bumetanide: Bumex
• Torsemide: Demadex
• Potassium Replacement: KDur, KLyte
• Digoxin: Lanoxin
Vascular Diseases
Vascular Disease
• Warfarin: Coumadin
• Enoxaparin: Lovenox
Vascular Disease
• Rosuvastatin: Crestor
• Fluvastatin: Lescol
• Atorvastatin: Lipitor
• Lovastatin: Mevacor
• Pravastatin: Pravachol
• Simvastatin: Zocor
• Cholestyramine: Questran
• Colestipol: Colestid
• Nicotinic Acid: Niacin
• Fenofibrate: TriCor
• Gemfibrozil: Lopid
Cardiovascular Disease
•Diltiazem: Cardizem, Dilacor, Tiazac
•Verapamil: Isoptin, Calan, Verelan, Covera
•Amlodipine: Norvasc
Cardiovascular Disease
• Amiodarone: Cordarone
• Procainamide: Procan
• Mexiletine: Mexitil
• Quinidine: Quinidex
• Flecainide: Tambocor
• Clopidogrel: Plavix
Peripheral Vascular Disease
• Pentoxifylline: Trental
• Cilostazol: Pletal
Cerebrovascular Disease
• Ticlopidine: Ticlid

• Meds for causative problems
Remember Case #1?
Gastrointestinal Disease
Peptic Ulcer Disease
• Sucralfate: Carafate
• Ranitidine: Zantac
• Cimetidine: Tagamet
• Nizatidine: Axid
• Famotidine: Pepcid
• Omeprazole: Prilosec
• Lansoprazole: Prevacid
• Pantoprazole: Protonix
• Rabeprazole: Aciphex
• Esomeprazole: Nexium
Gastroesophageal Reflux Disease
• Metoclopramide: Reglan
• Omeprazole: Prilosec
• Lansoprazole: Prevacid
• Pantoprazole: Protonix
• Rabeprazole: Aciphex
• Esomeprazole: Nexium
Renal Failure
• Phosphate Binders: Phoslo, Phosex
• Furosemide: Lasix (usually very high doses)
Diabetes Mellitus
• Ultrashort acting: Humalog, Novolog
• Short acting: Humulin R, Novolin R
• Long acting: Humulin N, Novolin N
• Mixed: Humulin 70/30, Novolin 70/30
• Longer acting: Lente, Ultralente, Lantus
• Pramlintide: Symlin
• Glipizide: Glucotrol
• Glyburide: Micronase, Diabeta, Glynase
• Glimepiride: Amaryl
• Metformin: Glucophage
• Metformin/Glyburide: Glucovance
• Acarbose: Precose
• Miglitol: Glyset
• Pioglitazone: Actos
• Rosiglitazone: Avandia
• Repaglinide: Prandin
• Nateglinide: Starlix
Parkinson’s Disease
• Amantadine: Symmetrel
• Levodopa/Carbidopa: Sinemet
• Bromocriptine: Parlodel
• Ropinirole: Requip
• Selegiline: Eldypryl
• Benzatropine: Cogentin
Alzheimer’s Disease
• Donepezil: Aricept
• Galantamine: Reminyl
• Rivastigmine: Exelon
Seizure Disorders
• Carbamazepine: Tegretol
• Gabapentin: Neurontin
• Levetiracetam: Keppra
• Lamotrigine: Lamictal
• Phenytoin: Dilantin
• Topiramate: Topamax
• Valproic Acid: Depakote
Migraines
• Non-specific: Inderal, Tenormin
• Valproic acid: Depakote
• Topiramate: Topamax
• Gabapentin: Neurontin
• Verapamil: Calan
• Amlodipine: Norvasc
• Amitriptyline: Elavil
• Fluoxetine: Prozac
• Ibuprofen: Motrin
• Ergotamine/Caffeine: Cafergot
• Sumatriptan: Imitrex
• Naratriptan: Amerge
• Almotriptan: Axert
• Zolmitriptan: Zomig
Psychiatric Diagnoses
Mood Disorders
• Nortriptyline: Pamelor
• Imipramine: Tofranil
• Fluoxetine: Prozac
• Sertraline: Zoloft
• Paroxetine: Paxil
• Bupropion: Wellbutrin
• Citalopram: Celexa
• Escitalopram: Lexapro
• Fluvoxamine: Luvox
• Trazodone: Desyrel
• Venlafaxine: Effexor
• Mirtazapine: Remeron
• Nefazodone: Serzone
• Diazepam: Valium
• Alprazolam: Xanax
• Lorazepam: Ativan
• Clonazepam: Klonopin
• Buproprion: BuSpar
• Lithium: Lithobid, Eskalith
Psychosis
• Chlorpromazine: Thorazine
• Fluphenazine: Prolixin
• Haloperidol: Haldol
• Thiothixene: Navane
• Trifluoperazine: Stelazine
• Perphenazine: Trilafon
• Thioridazine: Mellaril
• Risperidone: Risperdal
• Clozapine: Clozaril
• Quetiapine: Seroquel
• Ziprasidone: Geodon
• Olanzapine: Zyprexa
• Benztropine: Cogentin
Musculoskeletal Problems
• Ibuprofen: Motrin, Advil
• Naproxen: Naprosyn
• Diclofenac: Voltaren
• Flurbiprofen: Ansaid
• Ketorolac: Toradol
• Ketoprofen: Orudis
• Etodolac: Lodine
• Nabumetone: Relafen
• Oxaprozin: Daypro
• Piroxicam: Feldene
• Sulindac: Clinoril
• Celecoxib: Celebrex
• NSAIDs- Indomethacin: Indocin
• Allopurinol: Zyloprim
Multi-Tasker Medications/Common Multi-Tasks
Other Multi-Taskers
• Prevention of movement complications • Testosterone Blocker in Transgender patients The MEGA Multi-Taskers
The MEGA Multi-Taskers
3rd PLACE
The MEGA Multi-Taskers
2nd PLACE
The MEGA Multi-Taskers
THE #1 MULTI-TASKER

85 yo male, wife C/O “I can’t take care of him anymore”. Poor historian. S: Confusion, can’t assist in care A: none known M: Wife hands you his bag ‘o meds P: “Demented” L: Hours ago E: Violent behavior, worsening confusion His bag ‘o meds included: •Aricept 48 yo female, with confusion and fever, found on the floor of her house, drooling. S: Confusion, fever, vomiting A: none known M: Patient’s meds are sprawled all over the floor P: unknown L: unknown E: Found by neighbor confused and ill on floor Her bag ‘o meds included: Atenolol Humalog Symlin Lisinopril Pepcid Synthroid Lipitor Aspirin Claritin Singulair What is most likely in her PMH?

Source: http://www.emsedsem.org/Conference%20Handouts/2006/PHM_Dont_Forget_the_Bag_O_Meds_(McCoy-Freeman).pdf

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