Hi, My mom is 70. Always known to be Eccentric..but diagnose about 2yrs ago with Alzhiemer's/Schizophrenia/Dementia, after an episode of falling asleep & NOT waking up. After the 911 call which too her to the hospital, she remained asleep for 2 weeks. Her Body temp was 95, & she needed to be put on a resperator. When she woke she was a mess. TOTALLY out of it. Thru many meds & time, I now have her with me.

My question is this: Is this list of meds safe or "normal"? I have read up on each one but get so confused. Her weight is 130 & she is 5' if that helps....

THIOTHIXENE 2MG 2X DAILY....................Schizophrenia
EXELON PATCH 4.6 MG 1X DAILY................Alzhiemers
TRAZODONE 50 MG 3X DAILY....................Anti depr. & pain?
AMANTADINE 100 MG 1X DAILY..................Parkinson "Like" side effects
BENZTROPINE 1MG 2X DAILY.....................Parkinson "like" side effects
IMIPRAMINE 30 MG 1X EVENING.................Anti-depr. & Incontinence?
PERCOCET 325 3X DAILY...........................Back & neck pain
OMEPRAZOLE 20MG 1X DAILY......................Reflux
LISINIPRIL 10MG 1X DAILY.........................Blood pressure
GLIMEPRIRIDE 1MG 1X DAILY......................Blood sugar
LYRICA 50MG 2X DAILY.............................Fibromyalgia
CLARINEX 5MG 1X DAILY...........................Allergies
DIPHENHTDRAMINE 50MG 2X DAILY..............Allergies
ASPRIN 81 MG 1X DAILY............................
DUCOLAX SOFTNER 2X DAILY........................Stool softener
FLONASE NASAL AS NEEDED .........................Allergies

I know that no one can really answer 100% but if someone see's anything Bad, please let me know! Thanks so much...

Here is a list if drug interaction checkers, I'd put her list of meds thru a few of them and see what comes up.

Medication & Drug Interaction checkers


http://www.drugs.com/drug_interactions.html

http://www.drugdigest.org

http://www.healthsquare.com/drugmain.htm

http://www.drugs.com/

When the elderly get to this type of drug list there are many potential problems. They have problems younger patients do not.

1) Clarinex is useless....the diphenhydramine is probably the best. BUT it is anticholinergic.
A better choice might be Zyrtec (has a generic).
But it is not covered on insurance.

2) Trazadone is typically only used at night (it helps sleeping and is an antidepressant). Don't see why imipramine is needed? It is ANOTHER anticholinergic and duplicates the diphenhydramine actions in this regard.

3) Benztropine is an anticholinergic too. It is typically used to offset the effects of antipsychotics. (the thiothixene-Navane)

4) The omeprazole prevents B12 absorption from the GI tract.
Many elderly develop low B12 and this gives symptoms of Alzheimer's and other psychiatric problems, nerve pain.
She should be tested for B12 levels ASAP...treatment with this if it is low, may reverse some of the neuro-psychiatric symptoms and then the drugs could be lowered or discontinued.

Drugs that are anticholinergic are very hard on the elderly.
A younger person may be able to tolerate this issue, but not older patients.

You must read this article:
http://www.medscape.com/viewarticle/522882
This article lists the agents that may cause problems:
http://74.125.47.132/search?q=cache:...lnk&cd=2&gl=us

Delirium in the elderly can resemble psychosis/schizophrenia/Alzheimer's

Also to consider is that if Alzheimer's is advanced there may be damage to the brain and temperature regulation may be
damaged too.

Another thing that will LOWER body temp is hypothyroidism, and this occurs very often in the elderly, and also can cause cognitive impairment.

So there are medical and disease state potentials to
consider.

First off for me if I were consulting on a nursing home order would be the many drugs with anticholinergic effects.
Doctors can be clueless about this issue in my experience.

Ohhh than you so much! I will research all you suggested!

On your B12 issue, If this omeprazole blocks absorbtion from the GI tract, then suppliments will Not work? Or will shots be better?

B12 requires intrinsic factor for absorption from food. The amounts in food are really small...like 2 micrograms a serving or less. The ACID from the stomach is the first step..breaking the protein apart so the rest can happen.

Acid blocking drugs stop this...so any B12 in food cannot be broken down for further absorption.

So taking a very large relative amount of it in an oral tablet,
bypasses the need for the stomach to break down protein.
(in fact people using acid blockers also lose absorption of
calcium, zinc, magnesium, iron and folic acid as well).
Out of a 1000 microgram dose (1milligram) about 10% is
PASSIVELY absorbed and instrinsic factor is not needed either.
So oral has to be daily in order to work. Because so little is absorbed,
it has to be given on an empty stomach, because food will act like a
sponge in the GI tract and prevent it from getting into the blood stream.

Injections can be given. If a person is really low, they stack them at first like daily for a week, or whatever, then once a week or once a month. It is important to find out the NUMBER from the test. Anything below 500 should be treated.
The U.S. is way behind in this, and often very low numbers are called "normal"...200, 250, etc. I worked in long term care and just about every patient got B12.

Read these:
http://www.ncbi.nlm.nih.gov/pubmed/10448529

http://www.aging-parents-and-elder-c...eficiency.html

If the blood test is low, it is a good idea to do a MMA blood test. Some nursing homes are beginning to do this upon admission.

There are no risks with B12, and it has no toxicity that has ever been reported.

When elderly have so many drugs...you also need to keep getting kidney tests.
Any change in function, may cause the drugs to build up in the system and
then they cause all sorts of problems.
I hope you are testing her blood sugar regularly too.

You are of ENORMOUS help! I do try to check her BS but it's quite a chore. I have to bribe her with saying she will get some pastry if she lets me take it. But luckily she forgets sometimes....
Can you see ANY of these meds to cause symptoms of Extreme gagging, sneazing, coughing, dry heaving? It's like she has allergies but takes plenty of antihistamines....I did see that Lisinipril has some of these side effects. Could they cause such extreme, constant coughing, hacking, eyes always watery?
I take her to the Dr.s every month, they check her lungs & all is clear? She was a smoker for most of her life...quitting just 4 months ago...I just wan't her to feel good. THANKS for ANY ideas!

For Exelon:
http://www.rxlist.com/exelon-drug.htm

Dry unproductive cough can occur with ACE inhibitors like Lisinopril. It is called ACE cough.

The three meds I pointed out to you should cause dry mouth/dry eyes, etc. But Exelon is a CHOLINERGIC drug, which gives opposite side effects...nausea (gagging), increased saliva etc. The tearing might be due to it too.

Your mother is being given drugs to treat side effects of other drugs. This tends to get messy and unpredictable.

This book explains it:
http://www.enotalone.com/article/4624.html

For example, lisinopril over time will deplete zinc.
The omeprazole depletes B12, folic acid, calcium, zinc and
magnesium.

So what is happening is
1) she gets Navane (thiothixene) to cope with psychotic behavior (which may be B12 deficiency induced) or the result of multi-infarcts in the brain or whatever.

2) This lowers dopamine and gives Parkinsonian side effects so
added to the list are Amantidine, benztropine which have their own side effects, but partially help with the thiothixene.

3) Confusion from too many anticholinergics may result from imipramine, diphenhydramine, and benztropine. So she is given Exelon which is a CHOLINERGIC drug to offset those. When Exelon gives more cholingeric responses, then those side effects appear...watery eyes, excess saliva, etc.

4) a real allergy to lisinopril is a serious thing, not to be medicated for. It should be changed if implicated here. The dry cough is not considered "allergy". But some people are switched when it is really bothersome. Hives and swelling of the throat are the more serious signs. And allergy to this drug is not that common.

If you are serious about this list, I would start with the thiothixene. I'd see if a lower dose could be managed first.
Think of it as a net...pull one string and the net deforms one way, pull another string and it moves back. When drug lists like this get complex it is really hard to predict where to start.
And there are no books about this. Each patient gets a complex cocktail of drugs and those complex mixes don't have a "history" to refer back to for others. I can't think of another way of saying it...but the bottom line is that patients with
these long lists become "guinea pigs" of a sort. If something dramatic happens, they may end up in a research paper, but then they just may die because they are old, and it is expected, so knowledge does not accrue for the future patients.
This is an example of a PubMed paper abstract:
from http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

When you search PubMed, you use the generic name of the drug you are interested in, and a qualifier like "toxicity", side effects, etc. These papers appear in journals and often have specific anecdotal information about rare reactions. At the top of the page to the right here is the link to PubMed along with some others. It is right above the "Welcome".

Alot depends on how you can communicate with your mother.
If she can explain how she feels to some extent, that would be a big help. And also how responsive the doctor is...many get offended and arrogant when you approach their treatments and decisions. Many doctors HATE the internet and are biased against it.

You are Amazing! You have given me the MOST helpful info., all of which I carry FULL responsibility to make the decision to act upon or not to...If only the Dr.s would be so bold as to say the truths & not worry about malpractice...You are My HERO! Thank you...