The Whitworths of Arizona, bringing science to you in everyday language.

Wednesday, July 17, 2013

Lewy Dangerous Drugs

LBD caregivers generally know their loved one should be careful about drugs. However, with all the scientific terms and definitions, learning about which drugs are safe and which aren’t can seem daunting. It doesn’t have to be. While it is true that the more you know the better you can be sure of the right treatment, the bottom line is fairly simple:

Be wary of any drug used to sedate or to treat anxiety or behavior related problems. If given, report any heavy sedation, increased LBD symptoms or muscle problems.

Ask about possible side effects of a drug given for any other problem such as bladder control and monitor closely. Report any odd reactions, especially those that cause or increase LBD symptoms, muscle problems or heavy sedation.

Ask about possible non-drug solutions to the problem. Many behavior issues respond well to easily learned non-drug anxiety and stress management.

Any drug dangerous for someone with LBD may also be dangerous for someone at risk for LBD. Once a person has another Lewy body disorder like Parkinson’s or other risk factors, be concerned. The likelihood of problems may not be as high, but it is there.
    For those who want to know more, read on.

    The three drug properties especially troublesome with LBD are:

    Anticholinergic: The drug blocks acetylcholine, a neurotransmitter needed for cognition. When Lewy bodies have already depleted this chemical, the drug may cause or increase confusion and other dementia symptoms.

    Extrapyramidal: The drug blocks dopamine, a neurotransmitter needed for mobility. When Lewy bodies have already depleted this chemical, the drug causes or increases muscle stiffness, tremors, cramping, and constrictions.

    Sedative: The drug slows the central nervous system (CNS), which includes the autonomic nervous system (ANS). When Lewy bodies have already comprised the ANS, this causes over-sedation.

    The stronger these properties are and the more of them present in a drug, the more likely that drug will be dangerous for a person at risk for LBD. For example, Atropine is a very strong anticholinergic while Haldol has all three properties. Both are quite likely to be dangerous with LBD.

    These drug classes are of special concern:

    Anticholinergics: This huge class of acetylcholine blocking drugs is used to treat a variety of symptoms from anxiety to bladder control. They should be used with caution, if at all, by the elderly and anyone at risk for dementia. The Therapeutic Research Center posted this list of anticholinergic drugs. Download it and keep it handy for a reference.

    Antipsychotics: This class of medicines are approved by the FDA to treat psychoses such as schizophrenia. Although they have never been approved to treat dementia, doctors may prescribe them to treat LBD’s delusions, hallucinations, combativeness or acting-out behaviors.
    • Traditional antipsychotics (TAs): Drugs developed in the 1950’s to treat severe psychosis. They have strong sedative and extrapramidal properties and mild anticholinergic properties, making these drugs quite dangerous when Lewy bodies are present. With the exception of haloperidol (Haldol) these drugs are seldom used anymore. However, it is still commonly used in hospital emergency rooms for to calm down disruptive patients.
    • Atypical antipsychotics: Also called second generation antipsychotics. These drugs don’t cause the muscle problems that TAs do, but they have strong sedative and anticholinergic properties. Even so, many Lewy-savvy physicians still prescribe these drugs, especially quetiapine (Seroquel), as the best of the limited choices available for otherwise uncontrollable acting out.
    Benzodiazepines: A family of sedative drugs used to treat anxiety. These drugs also have anticholinergic properties. This combination makes them so potentially dangerous when Lewy bodies are present that they should almost always be avoided. In fact, recent research finds these drugs potentially dangerous for the elderly in general. The Wikipedia has an extensive list of these drugs along with their half-lives. The longer the half-life, the longer the drug will stay in the body, although Lewy bodies tend to slow down the process and extend that time.

    Inhaled Anesthetics: These extra strong sedative drugs used to induce a controlled coma to allow surgery can make any elderly person confused for several months afterwards. The confusion may last much longer or be permanent if Lewy bodies are present. Some surgeries can be done with less dangerous drugs and some condtions can also be treated without surgery. Ask the physician about alternative choices when considering surgery for anyone with or at risk for LBD.

    More about drugs next week!

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