Vicky with that drug list.
1) Digoxin can become problematic when used with calcium channel blockers, and pacerone.
http://www.medicinenet.com/digoxin/article.htm
"mental changes" include delirium
2) the Combivent inhaler has an anticholinergic in it, and while most is not absorbed, it could be a bit additive with the nortriptyline. It is the Iprat portion.
3) furosemide seriously depletes Thiamine and magnesium. The potassium is well known, but the other two are critical in the elderly. Low Thiamine over time leads to a form of dementia...and also affects the nerves. So a thiamine supplement is a really good idea. Very low magnesium eventually impacts the heart, and rhythm. I would ask for a serum mag level. Esp with cancer. Chemo lowers mag significantly
4). Pacerone creates hypothyroidism, and a new test should be done.
The elderly can have sudden changes in thyroid function anyway, with trauma and stress. So hypothyroid effects would be "mental" as well.
Quote:
1: Endocr Rev. 2001 Apr;22(2):240-54.Click here to read Links
The effects of amiodarone on the thyroid.
* Martino E,
* Bartalena L,
* Bogazzi F,
* Braverman LE.
Dipartimento di Endocrinologia e Metabolismo, University of Pisa, Ospedale de Cisanello, via Paradisa, 2, 56124 Pisa, Italy. e.martino@endoc.med.unipi.it
Amiodarone is a benzofuranic-derivative iodine-rich drug widely used for the treatment of tachyarrhythmias and, to a lesser extent, of ischemic heart disease. It often causes changes in thyroid function tests (typically an increase in serum T(4) and rT(3), and a decrease in serum T(3), concentrations), mainly related to the inhibition of 5'-deiodinase activity, resulting in a decrease in the generation of T(3) from T(4) and a decrease in the clearance of rT(3). In 14-18% of amiodarone-treated patients, there is overt thyroid dysfunction, either amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH). Both AIT and AIH may develop either in apparently normal thyroid glands or in glands with preexisting, clinically silent abnormalities. Preexisting Hashimoto's thyroiditis is a definite risk factor for the occurrence of AIH. The pathogenesis of iodine-induced AIH is related to a failure to escape from the acute Wolff-Chaikoff effect due to defects in thyroid hormonogenesis, and, in patients with positive thyroid autoantibody tests, to concomitant Hashimoto's thyroiditis. AIT is primarily related to excess iodine-induced thyroid hormone synthesis in an abnormal thyroid gland (type I AIT) or to amiodarone-related destructive thyroiditis (type II AIT), but mixed forms frequently exist. Treatment of AIH consists of L-T(4) replacement while continuing amiodarone therapy; alternatively, if feasible, amiodarone can be discontinued, especially in the absence of thyroid abnormalities, and the natural course toward euthyroidism can be accelerated by a short course of potassium perchlorate treatment. In type I AIT the main medical treatment consists of the simultaneous administration of thionamides and potassium perchlorate, while in type II AIT, glucocorticoids are the most useful therapeutic option. Mixed forms are best treated with a combination of thionamides, potassium perchlorate, and glucocorticoids. Radioiodine therapy is usually not feasible due to the low thyroidal radioiodine uptake, while thyroidectomy can be performed in cases resistant to medical therapy, with a slightly increased surgical risk.
PMID: 11294826 [PubMed - indexed for MEDLINE]
|
Your MIL is on what we call a polypharmacy regimen. It is very hard to
control issues in someone so light in weight, and so old. I think at this time
the nortriptyline is really not that necessary.
You can also change the antacid drug to a proton pump inhibitor, and that might be better for her. Prilosec is OTC now, but it interferes with some drugs.
Prevacid would be a better choice, but some insurances won't pay for it now.
Vicky, you know me from SG--Belladonna
I am a pharmacist you know. So you can trust me.
__________________
All truths are easy to understand once they are discovered; the point is to discover them.-- Galileo Galilei
************************************
.
Weezie looking at petunias 8.25.2017
****************************
These forums are for mutual support and information sharing only. The forums are not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. Always consult your doctor before trying anything you read here.