Groups of Medicines

On completion of this section you should have a general understanding of:

Uses of commonly prescribed medicines
Medicines and their names
High risk medicines
Risk reduction

Uses of commonly prescribed medicines

Statins: help lower the level of cholesterol in the blood e.g. simvastatin, atorvastatin

Proton Pump Inhibitors (PPIs): reduce the amount of acid made by the stomach. They are commonly used to treat acid reflux and stomach ulcers e.g. omeprazole, lansoprazole.

Analgesics: used to relieve pain e.g. paracetamol, co-codamol.

Thyroid: used to treat conditions of the thyroid gland e.g. Levothyroxine for underactive thyroid.

Carbimazole for overactive thyroid.

more information can be found here

Living with thyroid disorders | British Thyroid Foundation (btf-thyroid.org)

Cardiovascular: treat conditions affecting the heart or blood vessels e.g. ramipril, aspirin.

Antidepressants: used to treat clinical depression. They can also be used to treat a number of other conditions, including: OCD, Anxiety disorders, PTSD. Antidepressants are also used to treat people with chronic pain e.g. amitriptyline, citalopram

Diuretics: are sometimes called "water pills/tablets" because they make you pee more. They are used to treat high blood pressure, heart failure, and oedema (a build-up of fluid in the body). E.g furosemide

Antibiotics: used to treat or prevent some types of bacterial infection. They work by killing bacteria or preventing them from spreading e.g. penicillins, amoxicillin.

Dementia: There is currently no cure for dementia, but there are medicines and other treatments that can help to temporarily reduce symptoms e.g donepezil

Bronchodilators: are a type of medication that makes breathing easier by relaxing the muscles in the lungs and widening the airways (bronchi). They are often used to treat long-term conditions where airways may become narrow or inflamed, such as asthma and COPD e.g salbutamol

Diabetes: Used to treat diabetes which is a condition that causes a person's blood sugar levels to become too high. e.g insulin, metformin

Antihistamines: often used to relieve symptoms of allergies, such as hay fever, hives, conjunctivitis, and reactions to insect bites or stings.

antacids: are medicines that counteract the acid in the stomach to relieve indigestion and heartburn.

Anti-Parkinson's: These medicines cannot cure Parkinson's disease but they can help relieve symptoms and maintain quality of life. These medicines are often time-critical.

Cytotoxic medicines describe a group of medicines that contain chemicals that are toxic to cells preventing their replication or growth, and so are used to treat cancer. They can also be used to treat several other disorders such as rheumatoid arthritis and multiple sclerosis e.g, methotrexate

Laxatives are a type of medicine that can treat constipation e.g lactulose, senna, fibre gel

Psychotropic medication is any medication capable of affecting the mind, emotions, and behaviour.

Steroids

Steroids also called corticosteroids, are anti-inflammatory medicines used to treat a range of conditions.

Steroids come in many different forms.
The main types are:
• tablets, syrups and liquids - such as prednisolone
• inhalers and nasal sprays - such as beclometasone and fluticasone
• injections (given into joints, muscles or blood vessels) - such as methylprednisolone
• creams, lotions and gels - such as hydrocortisone skin cream

If you support service users who are prescribed high doses of steroids for 4 weeks or longer it is likely they’ll have a Medical emergency identification bracelet or something similar, and steroid cards, these help healthcare staff to identify these people in an emergency.

If you are unsure if a patient should have a steroid card or you think a patient requires a steroid card, seek advice from the Pharmacy or GP surgery.

It is important that all service users receive their medicines as prescribed, this is especially important for steroids, because missing a dose can be dangerous and cause Adrenal Crisis, click here for more information: Adrenal Crisis

Medicines and their names

Understanding generic and brand names

What's in a name?

More about medicines and their names

Click the buttons to reveal more about medicines and their names:

Compound Drugs

Some medicines have two or more active ingredients. It is important that you know what they contain (check the medication box, Patient Information Leaflet, or contact the pharmacy if unsure).

For example: Co-amoxiclav contains two ingredients, amoxicillin and clavulanic acid. The first ingredient, amoxicillin, is a penicillin antibiotic.

Risk of not knowing:
A patient with known and documented allergy to penicillin could be given Co-amoxiclav.

Modified Release Medicines

These are sometimes called long acting, slow release, prolonged release, sustained release, controlled release. Look out for drugs names with the addition of XL, LA, SR, enteric coated (e/c) on the packaging.

Modified release tablets and capsules will have special coatings that change the rate that the drug is released into the body. Always seek advice from a Health Care Profession (HCP) before opening capsules or crushing tablets.

If the patient is choosing to chew or suck their medicines, check if this is safe by looking at the Patient Information Leaflet. If the leaflet doesn’t clarify that it is safe, check with a HCP.

Look and Sound alike Medications

Just some examples where medicine names have been confused. However, be aware that there are many more similar sounding, spelling and packaging examples:

Chlorpropamide / Chlorpromazine
Lorazepam / Lormetazepam
Clobazam / Clonazepam
Atenolol / Amlodipine
Propranolol / Prednisolone
Risperidone / Ropinirole
Sulfadiazine / Sulfasalazine
Amlodipine / Nimodipine

Consequences
Pregnancy following administration of Depo-Medrone(r) (a steroid injection) instead of Depo-Provera(r) (a long-term female contraception injection)

When you are responsible for administering medicines ALWAYS cross check the information on the medication (pharmacy label, packaging and contents) against the MAR to confirm patient name, medication, strength, dose and route of administration.

What are high risk medicines?

High risk medicines are medicines that are most likely to cause significant harm to the patient, even when used as intended.

One report found that within an 18 month period that 60,000 medication incidents were recorded and reported.

This report reviewed 92 of medication incidents which resulted in severe harm or death of the patient in detail:

54 resulted in severe harm to the patient
38 resulted in the patient's death

The report found was that the medicines most frequently associated with severe harm were:

You may not come across all of these in your role, but it is good to have an awareness of high risk medicines.

Example of High Risk Drug

One high risk medicine that you may come across in your role are Anticoagulants. These are medicines that help prevent harmful blood clots. They're given to people at a high risk of getting clots, to reduce their chances of developing serious conditions such as strokes.

Examples of anticoagulants include:
• warfarin
• apixaban, rivaroxaban, edoxaban and dabigatran (often referred to as DOACs or NOACs).
• injectable anticoagulants (also known as low molecular weight heparins)

A common side effect of all anticoagulants is bleeding.

People taking and carers administering anticoagulants should have enough information to use them safely and effectively.
You will find guidance from CQC on ‘High risk medicines: anticoagulants’ on the CQC Medicines: information for all adult social care services section of their website

More information can also be found here:

NHS Warfarin page
NHS anticoagulant page

Risk reduction

Be familiar with the abbreviations for routes.

Clarify illegible and ambiguous instructions.

Be aware of distractions / environment during administration.

Communicate effectively with the multidisciplinary team and patient.

When an error or near miss occurs it needs to be recorded and reported, so that we can learn from these incidents and try to prevent them happening again.

Fit for use – assess medicines before use; remove out of date and unsuitable medicines.

Keeping records – maintain up to date and accurate documentation.

Know your medicines – identify knowledge gaps.

Manipulation – seek advice before crushing medicines / mixing solutions.

There may be exceptional circumstances when staff are required to manipulate a medicine, for example crushing or splitting a tablet or opening a capsule.
This must not be done without written instruction from a pharmacist and authorisation form the prescriber e.g. the GP.
Anybody administering crushed tablets or opened capsules without written instruction and authorisation could be held liable for any harm caused.
Manipulation needs to be done safely in line with the Control of Substances Hazardous to Health Regulation. For more information see Module 2, Section 4: ‘Being careful when managing and handline medicines’

Be vigilant in checking medicines calculations, look out for decimal point errors.

Check that patient allergies are documented

Involve patients, family members and carers in treatment.

Know, understand and follow procedures in place.

Use of extra checks – ask for extra checks from colleagues if uncertain, stop and think

Be aware that verbal instructions carry high risks.

NICE SC1 says: ‘Care home staff should: ensure that any change to a prescription or prescription of a new medicine by telephone is supported in writing (by fax or email) before the next or first dose is given’

NICE NG67 says: ‘When social care providers have responsibilities for medicines support, they should have robust processes for handling changes to a person's medicines received verbally from a prescriber, including:

recording details of the requested change (including who requested the change, the date and time of the request, and who received the request)
reading back the information that has been recorded to the prescriber requesting the change to confirm it is correct (including spelling the name of the medicine)
asking the prescriber requesting the change to repeat the request to someone else (for example, to the person and/or a family member or carer) whenever possible’.

Administration risks in the elderly

Number of medicines

As people get older, their use of medicines tends to increase. Four in five people over 75 take at least one prescribed medicine, with 36 per cent taking four or more medicines.

Kidney and renal function

Loss of kidney and renal function increases as we get older affecting drug excretion and metabolism and making patients more susceptible to the effects of drugs.

Dehydration

Research has shown that older people living in care homes were five times more likely to be admitted to hospital with dehydration than patients who lived in their own homes1.

Dehydration can also lead to kidney injury if patients are taking drugs that could affect the kidneys. Approximately 70% of acute kidney injury (AKI) patients are aged 70 or over2

Administration risks in mental health

For details see CQC guidance for:
• High Risk medicines: clozapine
• High Risk medicines: lithium
Which can be found on the CQC Medicines: information for all adult social care services section of their website

Taking the medicine as prescribed (adherence)
Many psychiatric conditions require long term treatment and medication may take a long time to take effect. One of the Six Rights of Administration is the right to refuse. When patients refuse medicine, it is important that staff know who to contact for advice and support.

Changes
Any changes in medication dosage should be undertaken gradually. When switching medicines care staff should have clear direction if this has not been provided seek advice from the prescriber. Avoid abrupt discontinuation (stopping) of medicines.

Monitoring
Interactions with other medicines may be problematic. The importance of regular monitoring of patients for cumulative toxic effects of anti-psychotics is critical.

Extracts from National Patient Safety Agency reports:

Patient Safety Observatory Report 4: Safety in doses (published 2007)

Safety in doses: improving the use of medicines in the NHS (published 2009)

Administration of medicines in care settings

Click each image to find out more.

Let's remind ourselves of the ways which could help to keep patients safe when administering medicines.