MEDICATIONS AND PEOPLE WITH DEVELOPMENTAL DISABILITIES
The human body is a complex chemical organism. Medications/drugs are chemicals which are prescribed to assist the body’s natural chemical system. They produce actions that modify or change particular bodily function, allowing the body’s natural defense system to restore health.
The success of drug treatment depends on the physician’s ability to select the right drug for the individual and the illness. However, the physician can never be sure that the prescribed drug will act in the way it is intended. For this reason, careful monitoring is important. One should understand what desired effect is hoped to be obtained with the drug. Also, know what possible side effects to watch for.
Response time varies with different classifications of medications. It may vary from less than an hour, to several hours or days, or 30 day to produce the desired effect. One should anticipate how long it might take to get a desired effect.
If an individual takes more than one medication, there is always a chance of a drug interaction, even between prescription and over the counter medications.
Approximately 50% of all people with mental retardation tkae one or more drug routinely. Medications most commonly prescribed for this population include anti-psychotic, anti-anxiety, anti-depressant, stimulant and anti-epileptic drugs.
ANTI-PSYCHOTIC & ANTI-ANXIETY DRUGS are used to chemically alter the person’s behavior, especially inappropriate, aggresive, destructive, and self-abusive/injurious behaviors. These psychotropic medications (drugs that affect behavior) are never to be used as the intervention of first choiice in the treatment of behavioral disorders. The interdisciplinary team should first investigate environmental factors that could be influencing the individual’s behaviors. Some behavioral outbursts can be due to inability of the individual to communicate verbally. It should be determined if they are trying to tell something. Increased behaviors can be menses related, or due to hunger, tiredness, or dislike for someone. If the underlying problem can be corrected, behaviors may be diminish or disappear. Behavior modification interventions should be tried prior to medical treatment. Choosing a medication that works is frequently trial and error on the part of the physician.
Anti-psychotic agents are called major tranquilizers, stronger than the anti-anxiety agents, and are prescribed more frequently. They are used for relief of severe anxiety or agitation, restoration of emotional calm, relief of psychotic behavior. Response time is delayed, up to approximately one month. Examples are: Mellaril, Seroquel, Risperdal, Haldol, Thorazine.
Anti-anxiety agents are called minor tranquilizers. It is used for relief of mild to moderate anxiety and nervous tension. Much shorterr response time. Examples are: Tranxene, Ativan, Librium, Buspar, Atarax, Valium.
SIDE EFFECTS: Short and long term.
Short term: Drowsiness, apathy, lethargy. Can also cause dry mouth, blurred vision, urinary retention, abdominal pain, constipation. Some may experience motor restlessness, abrupt spasms of head, neck, upper back muscles, or body rigidity and shuffling gait.
Long term: Weight gain and constant motor tremors, possible affect on learning, performance and adaptive behaviors. Can develop psychological and/or physical dependency from use fo minor tranquilizers.
These are prescribed for individuals with signs of depression, such as psychomotor retardation, sleep disorders, loss of appetite, weight loss, constipation. Anti-depressant can be helpful for children with bed-wetting, hyperactivity, head banging. It is prescribed for people with mental retardation for hyperactivity and aggressive behaviors. Examples are: Prozac, Zoloft, Luvox, Paxil, Desyrel, Elavil, Remeron, Celexa, Lexapro.
Short term: weight loss, insomnia, headaches, rapid or irregular heartbeat, drowsiness, dizziness, increased verbal behavior, drug-induced psychosis.
Long term: possible suppression of growth in children.
Used for the treatment of seizure disorders. Only about 50% of individuals with epilepsy in the general population achieve complete control of seizure through the use of medications. Examples are: Dilantin, Phenobarbital, Tegretol, Depakote, Neurontin, Topamax, Felbatol, Gabitril, Trileptal.
Side effects vary between individuals, but most common are decreased attention span, decreased motor performance, increased hyperactivity, drowsiness, loss of appetite, unsteady gait, slurred speech, and/or irritability.
A major goal in the use of antyi-convulsant drugs is to find the correct drug and dosage which controls seizures but is not so heavy as to produce side effects which interfere with general functioning. One way to determine proper dosage in some of the drugs is to monitor blood levels of the drug. Many drugs have an established therapeutic range. Blood levels that are higher than this range are in the toxic range and cause more side effects, and even more seizures. Blood levels that are lower than this range are in the subtherapeutic range. There is not enough medication to have a therapeutic effect of diminishing seizures. The physician adjusts the dosage based on the level and the effect on the resident and the seizures. Because the physician’s choice of drug is determined by type and frequency of seizures, it is important that an accurate record of the number and description of seizures is maintained. If the individual has more than one seizure type or if one drug does not control seizures, then more than one anti-convulsant drug may be required.
In order to maintain anti-convulsant blood levels within range, it is extremely important that the individual receives the correct dose of medication at the specific time ordered by the physician. If the dose is given too early, signs of toxicity may appear. If given late, or missed, seizures could increase. Different anti-epileptic medications are given at different frequencies based on the length of time the drug remains active in the body.