The Safety Net

Medication Safety for Clinical Staff: Psycho-Active Medications


I. General Role in Medication Safety
A clinical professional who works with persons with developmental disabilities must help ensure that the consumer receives rational pharmacotherapy. Although it is the discretion of the treating physicians to make the actual determinations, it is appropriate to ask questions on behalf of the consumer and act as the consumer's advocate. Fostering relations with many different community health care providers through various networks may improve quality of care and increase understanding

II. Some General Safety Precautions with Psycho-active Medications
Following are questions to be asked whenever a consumer is prescribed or is about to be prescribed psycho-active medications:

  1. Is there an appropriate indication for the medication?
  2. Is there is a primary mental health disorder?
  3. If the consumer has a primary mental health disorder, is drug therapy complemented by non-drug, mental health support interventions?
  4. Has there been a thorough medical evaluation?
  5. Have psycho-social factors been explored?
  6. Has there been a functional analysis to determine if the behavior/symptoms, or components have, an ecological etiology?
  7. Is there a support plan that identifies target behaviors and a behavior plan that includes teaching or reinforcing replacement behaviors and other support strategies?
  8. Is there a medication titration plan related to changes in target behavior/symptoms?
III. Mono-therapy vs. Poly-pharmacy
At this time, current guidelines recommend mono-therapy compared to poly-pharmacy as the initial intervention. The rationale for this approach is 1) to increase compliance, 2) less adverse drug effects, 3) reduced drug/drug interaction, and 4) increased ability to evaluate the effectiveness of the treatment, and 5) lack of clinical evidence to suggest improved efficacy with multiple medications from the same drug class. Theoretically, since medications from the same treatment class may have different mechanisms of action, a combination may work on more receptors such as with antidepressant medications. However, this is recommended only after multiple trials with single medications. Examples of situations when poly-pharmacy may be indicated:
  1. Refractory seizure or mental health disorder (e.g. bipolar disorder).
  2. Multiple treatment failures on single agents at maximum tolerable dose.
  3. In general, the therapeutic endpoint is improved quality of life and daily functioning. For example, it is seldom acceptable when a consumer's target symptoms have been reduced but he sleeps most of the day or has unpleasant side effects.



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