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She has Dementia but these are not Dementia drugs per-se. I am my Mother's Primary and only caregiver. Mom has Dementia... to the point of not talking much, not eating much, drinks a little tea and chocolate milk. She is starting to have a hard time swallowing her pills. Chocolate Milk works better than water, and breaking up 4 pills into having her take two pills at a time seems to help. None of the pills are very large. She is 80 and started to have a large decline this past November (2015). She is physically weak and needs help getting up the 8 steps to the level of the house the bedrooms are on (The house is a Tri-level). She is shaky and she is frail. She was NOT this way until she had her first fall, in the bathroom on Saturday December 12th. I did have a Hospice RN come to help me get her up. This is the first fall and I don't have a medical background. The Hospice RN and I got her to bed. The RN checked her over and said nothing was broken- she would be sore but should be OK. The RN took her BP- was 112/42, the RN did not like the 42 said it was low. She also took a pulse ox reading the O2 was in the mid 80's. She said it should be 90 or better. She ordered a walker and a wheel chair. Mom used the walker on Thursday but seems to be a bit stronger these last couple days and doesn't use the walker. Mom really needed it on Thursday.

Mom has Vertigo and can no longer express when she is dizzy. She has taken a med called Meclizine for years and it always works great. Mom also has had high blood pressure that is in the normal range with medications and has been stable since January 2014. She takes Atenonol, Lispironil and Hydrochlorothaizide. She has been taking Diazepam at bedtime for a few years... it DID help with sleep. Early last month she started to go to bed earlier and then get up a few hours later and think it was the next day (even though it was dark outside). After awhile this happened every night. Her PCP (a very good Hospice MD that deals mostly with the elderly) started her on Trazodone (a SNRI Antidepressant) 50 mg to be given at 8 pm.. this was to help with the waking up and thinking it was daylight when it was dark. This has worked very well.
Mom has been on Aricept since June of 2013 - she had a different PCP then- There was trouble increasing her Aricept from 5 to 10 mgs. She had physical side effects. Eventually she was getting very aggressive with me and finally went to 10 mgs. That helped with the aggression. Next she was to start Namenda XR (for the PCP she had - that PCP left the clinic to work in a hospital setting this past fall). Namenda XR was not a good med for her- once again the side effects. She had bad side effects so she was taken off of it.

The Aricept was recently stopped as the Hospice RN that came the night of Mom's Fall discussed it with Mom's Hospice Dr who is also her PCP. Our Weekly Hospice RN came last Wednesday and said we can stop the Aricept.
So her meds right now are in the AM Atenonol, Lisinopril, Hydrochlorothiazide, 1 Tylenol, and 1 Meclizine. In evening by 8 PM she has Diazepam, Trazodone, 1 Tylenol and 1 Meclizine. Note: I started giving her 1 Meclizine AM and PM since she fell. Prior to her fall she did not take Meclizine on a regular basis -it is written "as needed".

There are to be two new prescriptions written that will be filled tomorrow. As Mom ages she is very physically touchy with new meds.
1 med is Remeron (a SNRI Antidepressant that usually leads to weight gain) to help with her appetite. I think this may be alright - as she does not want to eat much ever. The 2nd med is the one that I wonder about-- which is Norco for pain. Mom has not been grimacing, verbally saying oww, or moaning. She is not laying in bed for hours and never getting up. I think Norco might have been helpful for the day's immediately following her fall (December 12.) It's been 9 days since she fell so why Norco now- sounds like she will be taking them everyday. Had her PCP or an RN did a through examination and saw evidence (things an non-medical person could not see) I would be more confident about the Norco. Norco is a narcotic med for moderate to severe pain....
On the other hand she has lost the ability express pain to me verbally either - although I have heard an oww in the past.

Anyone have any thoughts? Am I just being hyper-vigilant about this?

(PS She has Hospice for Palliative care-- she is not to the point of needing Hospice yet- she has a very non-aggressive Ovarian Cancer- has not changed in size or spread since it was found on a CT Scan in February of this year. Took us totally by surprise as she was very vocal then and never had pain. She refused to have surgery for the cancer. Its her body and her life.. I respect her choice)

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Do you know why she's taking Lispinoril and Hydrochlorothiazid, if her blood pressure is so low? The nurse noted her BP at 112/48. Does she need both? My cousin came off one of these when her blood pressure started showing up low.
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Most of the drugs she is taking are constipating which will back up feces in her colon and make her uncomfortable as well as decrease her appetite. They also will contribute to dizziness causing falls. The SSRI antidepressant you mentioned will definitely give her constipation. Her blood pressure is too low and perhaps the med for lowering it should be discontinued. There is NO drug that will slow, diminish or change this dementia progression and is always fatal. As the disease progresses her ability to speak will stop due to the brain not getting signals from neurons. Do what you can, but in my opinion you are fighting a losing battle. Love her for the time she has left and know you tried your best. None of us caregivers win the dementia battle.
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As I understand it, the care she is getting now is for comfort, not really for curing anything. A pain pill is certainly for her comfort. Since she cannot verbalize her pain levels I would err on the side of over-treating, unless and until the pain pill proves to have unacceptable side-effects. If it turns her into a zombie, then I'd object and ask for something else. But if the doctor thinks this is prudent, I'd go along with it and see how she reacts.

It sounds like Remeron is being suggested the same way Trazodone is -- for its side-effects rather than its primary purpose. Would eating a bit more and gaining a little weight add to her comfort level?

I have no medical training. Most of us on this board do not. (A few do.) I am reacting just from my own experience. I see no harm in trying these two medications and watching carefully for side effects. (For that reason I would NOT start the two at the same time. How would you know which one caused a side-effect?) If they don't work or cause side effects, just ask the doctor to stop them.

If swallowing pills is difficult for Mom, you really don't want to add anything that doesn't contribute to her comfort. But how will you know without trying.
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I would be keeping a log of the BP, HR and O2 saturation. If the BP is low I would skip the BP meds dose and make a note of that. I would also pinch up the skin on her hand to check for dehydration. If the skin stays up, I would hold the diuretic and enter that in the log. Be sure you go over the logs with the nurse. Norco I would start, but if it makes her too sleepy or constipated, I would space the doses further apart, log it and alert the nurse.
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Thank You jeannegibbs.. great idea about starting one med at a time to see if it gives bad side effects.. then we know which med is the culprit. Talked to her RN and we are starting the Norco first then the Remeron. Filled both scripts and have them at home now. Thanks for your response
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Northwoods, sunnygirl brought up a very good point. People's bp often drops as they near the end of their lives and the medications are no longer needed. In fact, they may make the bp too low. Ask your mother's doctor what he thinks about getting her off of them. They could be added back on if the bp begins to get too high.
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BTW, are you open to having hospice put in a hospital bed downstairs? You will probably find it much easier than getting her upstairs as she becomes weaker. (I guess OTOH you could have her spend her days upstairs. That would work, too.)
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Remeron is used to help with sleep just like trazodone. If she combines these two she'll sleep for days. I'd check with a pharmacist before combining.
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If she's not drinking well, that HCTZ (hydrochlorothiazide) is the LAST blold pressure med she needz. HCTZ is a diuretic...meaning that it reduces blood pressure by pulling excess fluid off through the kidneys, ie. they pee more. Trouble is, HCTZ continues to do its job whether the person is taking in sufficient fluids or not. In your Mom's case, sounds like not. That would certainly contribute to a low blood pressure and/or mild to moderate dehydration, both of which can cause or add to dizziness.

Considering your Mom is still at least somewhat ambulatory, I'm surprised they're adding the Norco. That will DEFINITELY add to her dizziness!!! If it were me, where she's not showing any clear signs of discomfort, I'd be inclined to give Tylenol & Motrin on an alternating schedule...Tylenol every 4 hours & Motrin every 6 hrs. Both are available in liquid form, too, which would be easier for Mom to take...and neither one has sedating effects or would increase her vertigo.
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Trazadone is a VERY old tri-cyclic antidepressant, rarely, if ever used as an antidepressant because therapeutic doses are so high you'd be a zombie on it. It's used now almost exclusively to help with sleep. Again, 50 mgs is a very small dose. Of all the drugs she taking, the trazadone would be the very least of my concerns. Just my opinion.
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