Questions and Answers
My uncle is in his mid-forties and was suffering from emphysema and COPD. When he showed me his medication list, I was dumbfounded. He is taking over 50 pills per day. Over the past 6 months he has developed seizure-like activity, severe problems concentrating and short and long term memory loss (mostly short term), and severe bouts of diarrhea that last upwards of three weeks at a time, and he was recently diagnosed with diabetes.
Here is a list of his medications: Atenolol, albuterol, lanoxin, cimetedine, sulfamethoxazole, metaclopramide, klonopin, cardizem, triamterene, carafate, amitriptyline, tylenol with coedine, compazine, dilaudid, morphine and diabeta.
He is only being seen by a nurse practitioner who prescribes all of his meds except for the narcotics. She leaves the room and returns with prescriptions for the narcotics.
What is going on here? Could the seizures, memory loss, and severe bouts of diarrhea and diabetes be caused by the medications?
Hi Aaron. sorry to hear about your uncle.
Let's see if we can sort out this therapeutic cocktail. From the recommended use of each component, it seems he has several other medical conditions besides the respiratory problems, diarrhea and diabetes you mention.
RESPIRATORY :- albuterol, a selective beta 2 agonist, is standard approved therapy for emphysema and COPD.
G.I. TRACT :- diarrhea is possibly caused by the above. Cimetidine, widely used for the treatment of ulcers; - Carafate (sucralfate), an aluminum hydroxy complex used in G.I. disturbances. Can bind with other drugs given at same time and reduce their effectiveness; - metaclopramide is anti-emetic and anti-nauseant usually used after surgery where these may occur and be detrimental.
DIABETES :- Adult-onset diabetes is not uncommon and is usually treated with diet and, if necessary, with an oral hypoglycemic agent. Diabeta is one standard drug. Your uncle's condition is almost certainly not caused by the drugs he is given.
HEART :- atenolol, a beta blocker used in the management of hypertension, cardiac arrythmias and angina. should be used very carefully, if at all, in patients with COPD since it further constricts the bronchioles of the lung. In your uncle's case, it decreases, or even blocks, the action of albuterol: - Lanoxin (digoxin) is used in the treatment of congestive heart failure, and Cardizem for pulmonary hypertension. Before prescriptions were written for these, proper diagnoses must have been made and appear on his medical records. The use of atenolol should be seriously questioned.
KIDNEYS :- triamterene is an effective diuretic. Its primary use is in the management of congestive heart failure (see above).
CENTRAL NERVOUS SYSTEM :- Amitriptyline is a tricyclic antidepressant, it should be used with caution in patients with a history of seizures and cardiovascular disorders. It may itself produce seizures. Caution also required if taken with phenothiazines (see below). It interacts with cimetidine (see above). Compazine is a phenothiazine tranquillizer, also used as an anti-emetic. Klonopin is used in the control of seizures.
INFECTION :- sulfamethoxazole is a fairly wide-spectrum sulfonamide - a common use is in the treatment of urinary tract infections. Again before being prescribed, a proper diagnosis should have been made and show up on his medical record.
PAIN :- with the exception of Tylenol (acetaminophen) which is a common over-the-counter analgesic, codeine, Dilaudid (hydromorphone) and morphine are opioids and are all used for the same purpose, the control of pain. They all work in the same way but differ in potency and efficacy. Addiction can occur with injudicious use. One might question the use of three drugs where one might do. If used, they must be used with great caution in patients with such respiratory problems as emphysema since they have a depressant effect on respiration. This effect is increased with the concomitant use of phenothiazines and tri-cyclic antidepressants (see above). One puzzling thing is your uncle's diarrhea - all opioids are very potent constipating agents.
To answer your questions, the memory loss and diabetes are are almost certainly not caused by even this cocktail; the seizures and diarrhea quite likely are causally related.
It would not be untoward to request a review of his prescription list.
Best wishes to you and your uncle - let me knowhow he makes out.