All drugs come with side effects. Many are minor, some are just an inconvenience, a few are serious, and some are just plain strange.

Side effects fall into several categories:

• Allergic reactions – Reactions can happen with any drug and can range from itching and rash all the way up to a life-threatening anaphylactic reaction.
• Noticeable side effects – Some drugs trigger side effects because of their chemical structure.
• Rare side effects – Other drugs typically have barely noticeable side effects when dosed properly. For example, Warfarin (used to prevent blood clots) is usually well tolerated, but serious internal bleeding can occur.
• Drug interactions – Side effects may only occur when certain drugs are mixed with certain other things. These might also be considered drug interactions. Drinking alcohol with narcotic painkillers can cause accidental overdose deaths. Drinking grapefruit juice can affect the blood levels of several drugs, including some blood pressure and cholesterol medicines.

Whenever a new medication is being prescribed for a patient I always keep an eye of the overall well-being of the person and try to detect early side effects. One night I come on duty and one of my patients had severe diarrhoea, very agitated unable to sleep. Because he just had his first dose of the new medication prescribed, this was the first thing that come into my mind: side effects. I phoned the ambulance, and the crew came and checked over my patient. They decided that it was safe to remain in the home but discontinued the new medication and advised that the GP needed to review the medication the following day and consider prescribing an alternative.

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There are certain medications categories that require greater attention when this is administered.

Anticoagulant medication

When administering anticoagulants, especially Warfarin you have to check always the yellow book/ anticoagulant clinic report as dose may vary from a day to another. Regular INR blood check as per anticoagulant clinic recommendation. Always inform the Anticoagulant Clinic when a patient is on an antibiotic as they may ask a sooner INR blood test.

Medication classed as cytotoxic/ hazardous

The following medication has been deemed to be hazardous therefore requires special handling and disposal: Azathloprine, Chlorambucil, Chlorampheniol, Colchicine, Cyclosporine, Dienestrol, Diethylstilbestrol, Dutasteride, Estradiol, Estrogen, Exemestane, Finasteride, Fluorouracil, Megestrol, Methrotrexate, Podofilox, Progesterone, Tacrolimus, Tamoxifen, Testosterone, Tretinoin.

The above medication SHOULD NOT be handled directly. Pots used to administer cytotoxic/ hazardous medication should be labeled and kept separate from the other medication pots.

Anti-epileptic drugs (AEDs)

You cannot omit anti-epileptic medication because it increases the risk of further seizures, increases the length of stay, the patient can come serious harm, even death. Ensure patient with epilepsy are taking their medication on time every day. Maintain seizure diary with the clear description. If fit last for more than 5 minutes call emergency service 999. If more than 1 fit occurs subsequently call 999.

Example of AEDs: Acetazolamide, Carbamazepine, Clobazam, Clonazepam, Eslicarbazepine acetate, Ethosuximide, Gabapentin, Lacosamide, Lamotrigine, Levetiracetam, Nitrazepam, Oxcarbazepine, Perampanel, Piracetam, Phenytoin, Phenobarbital, Pregabalin, Primidone, Retigabine, Rufinamide, Sodium Valproate, Stiripentol, Tiagabine, Topiramate, Vigabatrin, Zonisamide.

After seizure:

• Put the person into the recovery position.
• Check their mouth to see that nothing is blocking their airway
• Stay with the patient until they are fully recovered.

Parkinson medication

Ensure patient with Parkinson are taking their medication on time every day. If medication is being omitted or not given in time has very big impact on the patient by becoming slower in the activity of daily living, increase the risk of immobility, pressure sores, falls and fracture.

Most common Parkinson medication: Madopar, Caramet CR, Duodopa, Sinemet, Half Sinemet, Lecado, Stalevo.

Antipsychotic medication

Antipsychotic drugs are a group of medications that are usually used to treat people with mental health conditions such as schizophrenia. Only one antipsychotic – risperidone – is licensed for use in people with dementia. Other commonly used antipsychotics include aripiprazole, olanzapine, quetiapine and haloperidol.

Antipsychotic drugs help around half of the people with dementia who take them and can be an important part of their treatment. However, they can also cause side-effects, especially when used for longer than 12 weeks. Side effects include sedation, shakiness, and unsteadiness, falls, blood clots, stroke and worsening of dementia symptoms. Side-effects can usually be managed through careful monitoring during short-term use (up to 12 weeks). Over longer periods of time, the risk to the person becomes higher. This is why all prescriptions should be reviewed and stopped after 12 weeks except in extreme circumstances.