Meeting of Southwood Group Sept 17/13
Guests: pharmacist from Calgary south cognitive clinic
Nurse, Calgary South Cognitive clinic
We had sent a list of questions for the pharmacist to consider. The following discussion took place.
Sleeping aids – sleep issues are common in the general overall population and drugs prescribed for the treatment of Alz can cause insomnia. 1st consideration is sleep hygene, which applies to everyone
· No exercise before bed
· No TV in the bedroom
· No caffeine late in the day
· Cooler temperature in the bedroom
· No light, even a nightlight can be a stimulant
· Bed s/b comfy, sheets/pillows etc.
· May try warm milk or decalf tea before bed.
· Warm bath before bed.
· Eat a number of hours before bed, a full stomach deters a good sleep
Still sleeping issues?
· Lots of people have success with Melatonin. Several people in the group said to be sure and look for “slow release” . Jamieson (London Drugs) produces. Can probably also find in health food stores. Need to use for a few day, perhaps a week before it is effective.
· Benadryl can also cause drowsiness but may have a “hangover effect” the next day. This also sometimes happens with prescription drugs.
· Generally noted that diff dosages work on diff people, and while some things may work for some people they don’t work for everyone.
Ativan – how strong is this as a drug? Should it be used on a daily basis? Is it addictive?
· Does not have an active metalite (?) so does not have a long term affect. Can be used as needed and people need not be concerned if used daily.
· Works very quickly to calm a person.
· Does not interact negatively with Alz drugs or with heart drugs.
Alz drugs – 3 major drugs: Aricept, Exelong and Reminyl. All are cholinesterase inhibitors which is supposed to help nerve ending transmit messages. www.alzheimers.ca has a lot of info. The drub Memantine or Ebixa is often prescribed in later stages to help with behavior. May decrease agitation or aggressiveness. Question – why do some doctors prescribe one over the other? Personal familiarity or success with other patients. All are the same, one is not stronger/better than the other.
Note that these drugs are specifically for Alzheimers and there are not any drugs currently available for either Frontrol Temporal or Posterior Cortical Atrophy. However Occupational Therapy or Physio are both to be considered to aid in function.
Someone asked about Haldol – if taken for an extended period of time what are the side effects? The conversation got a bit side-tracked. Discussion about “twitchiness” – involuntary muscle spasms. However, one of the other members looked up Haldol on the following websites – Medscape, National Library of Medicine (NLM) and National Institute of Health (NIH) and there were a number of warnings issued. Haldol is considered an older type of anti-psychotic and is NOT recommended for use with dementia patients. There apparently have been deaths recorded associated with the use of Haldol and dementia patients. If anyone is being prescribed Haldol, their caregiver should be researching the information and questioning its use.
Anti-diarrhea medication – over the counter drugs for diarrhea are not harmful. Using occasionally is fine (even every 5 to 7 days) but important to try and discern what is causing the issue. Try a food record for at least a week, see if certain foods affect. Make sure there is not blood in the stool, may be a more serious problem.
What about drugs that a person cannot swallow? Check with pharmacist. Some drugs it is ok to crush, but not all. Certainly none that have a coating, but may be able to order in drugs that dissolve on the tongue.