scallywag's Dad

[scallywag]

Sweet scallydaddy is in the hospital after falling then being confused. He is uninjured but has been hospitalized for several weeks because recovery from the fall is complicated by previously diagnosed early or middle stage dementia. While in the hospital, the dementia sometimes results in confusion about where he is and he gets "agitated." The first instance of agitation resulted in the "as needed" administration of zopiclone and trazodone. After an extremely unproductive cycle of late night PRN dosing that left him slurring his words well into the next day and too weak to do the brief physio recommended exercises, I asked that they pick one medication and provide it regularly. Thank you to all here at SA who helped me educate myself about this. 

 

Somebody (I've yet to find out who <grrr> ) started him on trazodone with dinner and citalopram with breakfast. WTAF?? Major interaction effects which include confusion, fever (dangerous for someone with a diagnosed arrhythmia), and increased risk of arrhythmia.  Fortunately he's been stable on that for 10+ days until a confused agitation episode today. 

 

After the early "cocktail," I knew enough to ask about PRN (as needed) meds in the event of agitation.  The PRN med that will be administered is halo-effing-peridol which, imagine your surprise, interacts in major ways with both trazodone and citalopram. It's beyond me how anyone thinks that's going to help him recover to a condition for safe discharge. I anticipate talking with his doctor about next steps and will ask, "Sometimes medications interact with each other. Are there effects we should be concerned about with Dad's prescribed meds?" 

 

Not sure what I need from other members of SA or the moderators. I guess the good news is that I've learned a few things and that it's early enough to interrupt predictable negative outcomes. Teasing out which symptoms are dementia progression and which are iatrogenic might not be possible until he's off all the meds.

 

[Rosetta]

I’m so sorry, Scallywag.

[Altostrata]

This must be terrible for both of you, @scallywag 

 

Why citalopram on top of trazodone, they're both antidepressants? Can you complain to the authorities?

 

The hospital pharmacist may be a deprescriber, deprescribing is based at McMaster University.

[scallywag]

Thanks Rosetta & Alto.

 

He's out of the hospital now and in a dementia care community. No more calls for security guards to hold him down while haldol is injected. So some good news.

 

@Altostrata :

• My best guess on why citalopram was added was typical polypharmacy -- he was a bit dopey from the traz so instead of reducing the traz dose, (he's only taking the minimum "baby dose") let's give him a "baby dose" of cit to "brighten him up a little." 
• Thanks for mentioning the practice of "deprescribing". A quick search yields something from Université de Montreal at deprescribing.org, with info in English and French; I'll keep looking for the McMaster info.

Since my initial post in this thread, I discovered that he was prescribed risperidone 0.5 mg twice a day as well as as .5 mg "as needed." FFS. Settle his emotions my fat-a$$ (I do have one, a notorious one at that -- it once was the cause of a fight in a dive bar).

 

Current psych med list:

Trazodone 25 mg with dinner 

Citalopram 10 mg with breakfast/lunch

Risperidone 0.5 mg x 2 ("q12" - every 12 hours )

 

Fortunately the community doctor thinks the risperidone is unnecessary. I need to find out when that off-label prescription was first administered before anyone yanks that from the CNS of a man over 80 years old.

 

When I let myself, I feel very guilty for not asking questions, for not pushing for answers about how he would ever improve cognition and mobility while being administered drugs that affect cognition and mobility, and for not getting him out of the hospital once infections causing delirium were resolving with antibiotics. This screwup is going to take some time to unscrew.

[Rosetta]

Thanks for letting us know.  I know it’s hard to not blame yourself, but the doctors would not have listened to you.  What you do now is most important, and thank goodness you know about this issue! - Rosetta

[Frogie]

I'm sending lots of prayers/good vibes for you and your dad.

 

It sounds like hopefully things are looking up.

 

Please don't blame yourself for any of this. 

 

Just take care of yourself.

[Ariel]

@scallywag

How are things?