Medication taking

Before administering any medication, take a thorough drug history to establish any past allergic or adverse reactions experienced by the patient. 

A number of medications used in the treatment of anxiety have effects on serotonin neurotransmission (Ch. 13). These medications include tricyclic antidepressant medications, SSRIs, and monoamine oxidase inhibitors (MAOIs). However, because these medications take weeks to exert their full anxiolytic effects, it is unlikely that blocking the reuptake (and thus increasing synaptic levels) of either serotonin or norepinephrine selectively is responsible for their anxiolytic properties — rather it is suspected that the therapeutic effects are due to changes in gene expression, protein levels, and eventually changes in synaptic connections between neurons. 

Elliott RA and Stewart DC (2008) A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging 25 307-324 Epstein RM, Alper BS, Quill TE (2004) Communicating evidence for participatory decision making. JAMA 291 2359-2366... 

Before a medication can be of any help, it has to get to where it can act to prodnce its benehcial effects. For psychiatric medications, the action is, of conrse, in the brain. The problem is that it is relatively difhcnlt for medications to get there. This is no accident. Onr bodies are designed to protect onr most vital organs. Onr rib cage snrronnds onr heart and Inngs. The sknll encloses the brain, and the brain is also protected by the so-called blood-brain barrier from invaders that enter the bloodstream. In this section, we will describe the steps yonr medication takes to get to yonr brain and the hurdles it encounters along the way. 

There are three steps that a medication takes during its travel through the body. First, the medication must somehow travel from outside the body and enter the bloodstream. Second, the medication is escorted while it is circulating in the bloodstream. Third, the medication must exit the bloodstream. We ll now describe each of these three steps in a little more detail. 

Whenever possible, anticholinergic medications should be avoided or kept to a minimum. This is an important consideration because a wide variety of medications, psychiatric and otherwise, possess some acetylcholine-blocking properties. When a patient is using several medications, it is important to review the relative anticholinergic contribution of each medication. Taking one mildly anticholinergic medication may not be a problem, but taking three or four can have additive effects that do become problematic. 

It is necessary to taper clonidine rather than abruptly discontinuing it to decrease the risk of rebound hypertension (Leckman et ah, 1986). Hunt et al. (1990) recommend that if the medication has been used for only 1 week, it can be discontinued immediately. If it has been prescribed for 1-4 weeks, it can be tapered by 0.05 mg daily and if it has been prescribed for over 4 weeks, it should be tapered by 0.05 mg every third day. The possibility of rebound hypertension should also be evaluated in patients on clonidine who are not consistent in their medication-taking behavior. Eess is known about the likelihood of rebound hypertension following discontinuation of guanfacine. Although the PDR lists this as possible, one study found this not to be the case (Wilson et ah, 1986), possibly because of its longer duration of action. 

Patient demographics Aging population Females as decision makers Ethnic composition of patients Attitudes and belief systems Beliefs about disease, sick role, and medication-taking... 

Reproduced by permission p. 227 Man, writing, being flanked by two other men watching. AP/Wide World Photos. Reproduced by permission p. 228 Army medic, taking an x-ray of a fellow soldier simulating an injury, photograph. 

In the same way, the mechanism of action of drugs and coagulant and anticoagulant medication takes place through the variation of surface charge in the blood vessels. 

Panic attacks must be either eliminated or greatly reduced in the initial phase of treatment. Some behavioral and cognitive techniques have been developed to reduce panic attacks, although antipanic medications take effect more rapidly and have a solid track record as safe and highly effective drugs. Antipanic medications fall into three groups ... 

F Despite the rapid absorption, the effects of antidepressant medications take two to three weeks to become apparent. 

The patient may not be able to afford the medication and therefore either refuse the medication or, if self-medicated, take less than the prescribed dose. Medical insurance may cover the cost of a similar but less expensive medication and the healthcare provider may be able to prescribe the less costly medication. 

Pharmacists can generally obtain reliable information on medication-taking behaviors from the patient or a family member or caregiver. The interview should be systematic and include specific questions on forgetfulness, the patient s understanding of medication instruc-... 

Treatment requires significant behavioral changes Actual or perceived unpleasant side effects Regimen complexity and duration Medication takes time to take effect Patient-related factors... 

Avoid fear tactics. Scaring patients or giving them dire warnings about the consequences of less-than-perfect adherence can backfire and may actually worsen adherence.A more constructive approach is to help the patient focus on ways to integrate medication taking into their daily routine. 

An army medic takes an x ray of a simulated injury during a field test of an atom-powered portable x-ray unit. Portable x-ray units are powered by thulium, obviating the need for electricity. 

All activities during the centralized preparation of medications take place under constant supervision of the responsible specialist workers. Before commencing the preparation, cleanliness and proper functioning of the instruments and installations used and the essentia) measures to prevent contamination and mix-up must be ensured. 

Muscle cramps and twitches sometimes occur She must inform you if she anticipates using other medications Taking the drug in the evening will ensure a good night s sleep The drug may require 2 weeks or more to become effective... 

Liquid medication takes one of three fonns elixirs, emulsion, and suspensions. An elixir is a sweet, pleasant-smelling solution of alcohol and water used as a vehicle for medicine. Robitussin, a commonly used cough preparation, is an elixir. An emulsion is a suspension of small globules of one liquid in a second liquid with which the first will not mix, such as milk fats in milk. And a suspension is a preparation of finely divided, undissolved particles dispersed in a liquid, such as bismuth subsalicylate (Pepto-Bismol). 

The medication takes 6-12 months to have a full effect. There is no reason for the client to be seen in 1 week. 

The nurse should teach the client how to minimize the side effects of the medication. Taking the medication with milk or crackers will reduce the gastrointestinal effects. The HCP can prescribe small doses of atropine to connteract the side effects if this snggestion is not snccessful, but the client must take the medication. 

The medication takes 3-6 montiis to achieve the desired response, and many clients do not experience significant benefits. 

All antidepressant medications take at least 14 to 21 days to become effective. 

Antidepressant medications take at least 3 weeks to become effective therefore, when the client is first admitted to the psychiatric department and prescribed an antidepressant, evaluating for the effectiveness of the medication is not an appropriate intervention. 

The nurse should realize this medication takes at least 3 weeks to work therefore, this question is not helpful to the client. 

SSRIs can be used to treat panic attacks, but the medication takes weeks to work therefore, it would not be helpful in an acute panic attack. 

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