Lesson 1, Topic 1
In Progress

Closing Comments

April 11, 2024

Closing Comments

Patient Coaching

Patients often need to take medications daily or several times a day with neurologic diseases and disorders. Because of the symptoms of the disease, remembering can be difficult for some patients. The medical assistant may need to help patients figure out strategies to remember to take their medications. The following methods can be used:

• Placing medications near the kitchen table if they need to be taken with food. (Always remember to keep medications out of the reach of children.)
• Getting into a routine and always taking the medications after doing a specific task (e.g., feeding the pet, brushing teeth, taking a shower).
• Using an alarm on a phone, clock, or app to remind the patient about medication times.
• Having a family member call to check if the medication was taken.
• Crossing out the day on the calendar after taking the medication.
• Using weekly pill boxes. Some pharmacies will help set up pill boxes; otherwise, have a family member help set it up weekly if needed.

The medical assistant should also provide the patient with directions in writing about what to do if the medication was missed.

TABLE 22.6

Medication Classifications

ClassificationInformationGeneric Name (Trade Name)
AnalgesicIndications for use: Relieves pain.
Desired effects: Reduces the sensory function of the brain; blocks pain receptors.
Side effects and adverse reactions: Nonnarcotic: GI distress, liver and kidney disorders, and tinnitus.
Narcotic: hypotension, decreased respirations, agitation, blurred vision, confusion, constipation, sedation, restlessness.
Nonnarcotic over-the-counter (OTCs):
• Aspirin (Ecotrin, Bayer Aspirin, Bufferin)
• Acetaminophen (Tylenol, Tempra) (APAP)
• Ibuprofen (Advil, Motrin)
Narcotic (opioids):
• Oxycodone (OxyContin)
• Hydrocodone with acetaminophen (Lortab, Norco, Vicodin)
• Oxycodone with acetaminophen (Percocet, Oxycet, Roxicet)
• Tramadol (Qdolo, Conzip)
AnestheticIndications for use: Produces local anesthesia (no loss of consciousness) or general anesthesia (loss of consciousness).
Desired effects: Produces insensibility to pain or the sensation of pain; blocks nerve impulses to the brain, resulting in unconsciousness.
Side effects and adverse reactions: Hypotension, cardiopulmonary depression, sedation, nausea, vomiting, headaches.
Local:
• Lidocaine (Xylocaine)
General:
• Midazolam (Versed)
Anti-AlzheimerIndications for use: Treats Alzheimer disease
Desired effect: Treats dementia by increasing naturally occurring substances in the brain.
Side effects and adverse reactions: GI distress, frequent urination, muscle cramps, confusion, bradycardia, angina, bloody vomit, or stools.
• Donepezil (Aricept)
• Memantine (Namenda)
Anticonvulsant and mood stabilizerIndications for use: Treats epilepsy, trigeminal neuralgia, mania, and mixed episodes (mania and depression) with bipolar disorder
Desired effects: Reduces the frequency and severity of seizures by reducing excessive stimulation of the brain.
Side effects and adverse reactions: Sedation, vertigo, visual disturbances, GI disturbances, liver complications.
• Carbamazepine (Tegretol, Equetro)
• Lamotrigine (Lamictal)
• Topiramate (Topamax)
• Valproic acid (Depakene, Depakote)
• Gabapentin (Neurontin, Horizant)
Table Continued
ClassificationInformationGeneric Name (Trade Name)
AntidepressantIndications for use: Treats depression, anxiety, and other neurologic disorders.
Desired effect: Treats depression.
Side effects and adverse reactions: Anorexia, anxiety, sexual dysfunction, fatigue, drowsiness, vertigo, weight gain, confusion, blurred vision.
Selective serotonin reuptake inhibitors (SSRIs):
• Fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra)
• Citalopram (Celexa)
• Escitalopram (Lexapro)
• Sertraline (Zoloft)
Serotonin and norepinephrine reuptake inhibitors (SNRIs):
• Venlafaxine
• Duloxetine (Cymbalta)
Atypical antidepressants:
• Bupropion (Wellbutrin, Zyban)
Serotonin modulators:
• Trazodone (Oleptro)
Tricyclic antidepressants:
• Amitriptyline
Monamine oxidase inhibitors (MAOIs):
• Phenelzine (Nardil)
AntimigraineIndications for use: Treats or prevents migraine headaches.
Desired effect: Alters circulation to the brain.
Side effects and adverse reactions: Confusion, psychomotor slowing, difficulty concentrating, memory problems, rare but serious cardiac events.
• Sumatriptan (Imitrex)
• Zolmitriptan (Zomig)
Corticosteroid (oral)Indications for use: Treats chronic inflammatory diseases (e.g., arthritis) and acute conditions (e.g., poison ivy, asthma).
Desired effects: Reduces inflammation.
Side effects and adverse reactions: Headache, mood changes, difficulty falling asleep or staying asleep, increased sweating, vision problems, depression, and weight gain.
• Prednisone (Prednisone Intensol, Sterapred)
• Prednisolone (Flo-Pred, Orapred, Pediapred)
• Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol)

Legal and Ethical Issues

In neurology, you will be faced with a variety of behaviors and personality changes that frequently are a part of neurologic diseases and disorders. Often a patient is not aware of these changes and may act as though nothing is wrong. It is important for the medical assistant to remember to treat the patient with respect. All patient information, including pictures, audio recordings, and so on, is confidential. The medical assistant must also remember not to repeat information (gossip) to peers about the patient’s actions and behaviors. Only staff members immediately involved with the patient have a right to the information required for their care of the patient.

Patient-Centered Care

Providing patient-centered care extends to the caregiver of the patient. In many situations, the caregiver is the patient’s spouse or significant other; sometimes, it may be an adult child. With many chronic neurologic diseases, the patient may require a caregiver to assist with daily care (e.g., toileting, bathing, grooming), meal preparation, shopping, medical appointments, and so on. As the condition worsens, more burdens fall on the caregiver. Providing 24/7 care to a loved one is physically and emotionally stressful. With behavioral differences and increasing dependency, relationship roles may change, and the stress can affect the caregiver’s health.
The medical assistant needs to recognize the importance of the caregiver in the patient’s life. The caregiver’s concerns are important, as are the patient’s concerns. The medical assistant may need to provide the caregiver with emotional encouragement and resources for additional assistance, including in-home services, adult day care, support groups, and medical equipment.

Professional Behaviors

When you work with patients with dementia, communicating with them can be challenging. The medical assistant should remember the following:

• Speak clearly and use short sentences.
• Make eye contact.
• Give the patient time to respond. Do not pressure the person into giving a response.
• Allow patients to speak for themselves.
• Keep the tone of your voice friendly and positive. Remain calm.
• Do not patronize or ridicule the patient.