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The Effects of Medications
Posted: July 12, 2012


Direct Effects
  • Concentration
    AMA Guides, Table 13-2, page 309
    Criteria for Rating Impairment of Consciousness and Awareness
    For Class 1 impairment, or 0%-14% WPI, the individual is expected to perform activities of daily living (ADL) independently but may need assistance with activities that require fine motor dexterity.
  • Dizzyness
    AMA Guides, Table 17-5, page 529
    Lower Limb Impairment Due to Gait Derangement
    or Table 13-2, page 309
    Table 17-5 can be used if the symptoms include difficulty walking for more than 5 blocks; continued pain; needs a cane when walking outside their home; can no longer play sports or run.
  • Sleep
    AMA Guides, Table 13-4, page 317
    Criteria for Rating Impairment Due to Sleep and Arousal Disorders
    Use if the medication interrupts the sleep of the applicant. The symptoms can include the ability to complete most necessary work, but works less efficiently and cannot take on any new special projects.
Indirect Effects
  • Upper GI
    AMA Guides, Table 6-3, page 121
    Criteria for Rating Permanent Impairment Due to Upper Digestive Tract Disease
    Gastric pain and painful episodes lasting up to 2 weeks, wake the applicant at night, and require antacids, food, and over-the-counter blockers for relief.
  • Lower GI
    AMA Guides, Table 6-4, page 128
    Criteria for Rating Permanent Impairment Due to Colonic Rectal Disorders
    Use for colonic and rectal disorders if there is cramping with bowel movements or alternating diarrhea and constipation.
  • Respiratory
    AMA Guides, Table 5-12, page 107
    Impairment Classification for Respiratory Disorders, Using Pulmonary Function and Exercise Test Results
    Use if pulmonary distress awakens the patient from their sleep or pulmonary distress while walking on level ground (the latter condition can be rated from 10%-25% WPI).
  • Liver
    AMA Guides, Table 6-7, page 133
    Criteria for Rating Permanent Impairment Due to Liver Disease
    Use when GGT is elevated. This suggests a Class 1 impairment of 0%-14%. Many medications (including analgesics, anti-psychotics, anti-diabetics, and others) and many illnesses (diabetes, obesity, and alcoholism) lead to hepatic inflammation. Pay close attention to the liver enzymes. The most sensitive indicator of hepatic damage is GGT (gamma glutamyl transpeptidase). The evaluation should include a test for GGT.
  • Kidney
    AMA Guides, Table 7-1, page 146
    Criteria for Rating Permanent Impairment Due to Upper Urinary Tract Disease
    Use if creatinine levels are elevated. If the creatinine level is known before the injury and it doubles, the kidney has lost half of its function. In addition, an injured worker with only one kidney should be considered to already have a 10% WPI in addition to what is going on with the existing kidney and the impairments should be combined using the CVC.
  • Psyche
    AMA Guides, Chapter 14, page 359
    Has the doctor evaluated the medications necessary to control such symptoms as hallucinations? The medications may result in decreased motivation and level of activity. These side effects should be considered in evaluating the overall severity of the individual's impairment and ability to function.

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