As a geriatrician: I have cured more diseases by stopping medications than by starting them 10/26/2018
|
|
- Penelope Tate
- 5 years ago
- Views:
Transcription
1 : A 10 Step Approach to Polypharmacy Texas Health Resources Geriatrics Symposium November 3, 2018 Amit Shah, MD, FACP, AGSF Associate Dean for Faculty Affairs, Mayo Clinic School of Medicine Assistant Professor, Division of Community Internal Medicine, Mayo Clinic Shah.Amit@mayo.edu 2015 MFMER slide-1 Disclosure of Financial Relationships Amit Shah, MD Has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients MFMER slide-2 As a geriatrician: I have cured more diseases by stopping medications than by starting them (okay maybe a bit of an overstatement) 2015 MFMER slide-3 1
2 Goals: By the end of this talk you too can: Cure Parkinson s Disease Reverse Dementia Eliminate Gout Gain Your Patient s Trust and Affection Save Your Patient Money 2015 MFMER slide-4 Objectives: Describe the importance of (true) medication reconciliation in the care of the older patient with polypharmacy Identify the roles and responsibilities of each member of the interdisciplinary team in medication reconciliation. Describe a 10 step approach to reducing polypharmacy and discontinuing medications in elderly patients Name at least three medications commonly prescribed to elderly patients which can be discontinued and list some medication sparing treatments List at least three common medications where the risk benefit ratio changes markedly with aging 2015 MFMER slide-5 Disclosures and Caveats I have no conflicts of interest I am not anti-medication Underprescribing can be as much of a problem as overprescribing in the geriatric population (not the focus of this talk) There will be some discussion in this talk about off-label medications (mainly about giving offlabel medication use close scrutiny) 2015 MFMER slide-6 2
3 Wound Debridement Images from MFMER slide-7 Why is it so hard to stop a medication? Prescribing Inertia EMR/EHRs make it easy to continue things Assumption that there must be a thoughtful provider behind the prescription Not wanting to step on toes of the original prescribing provider Patient/provider worries about rocking the boat / if it ain t broke. But I ve always done fine on Valium 2015 MFMER slide-8 10 Steps for Successful Medication Debridement 2015 MFMER slide-9 3
4 1) Do I Know All of the Medications? Image credits: CC BY-SA 2.0 Image By ParentingPatch (Own work) [CC BY-SA 3.0 via Wikimedia Commons MFMER slide-10 1) Do I Know All of the Medications? Medication Reconciliation Obtaining an accurate medication list is challenging! (even if you are in the patient s home ) In one study, 70% of hospital discharge med rec had at least one error, with 30% of these being potentially serious Wong JD, Bajcar JM, Wong GG, Alibhai SM, Huh JH, Cesta A, Pond GR, Fernandes OA. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother Oct;42(10): doi: /aph.1L190. PubMed PMID: Photo: MFMER slide-11 CMS Meaningful Use Stage 2 Objective 7: Medication Reconciliation Must have >50% medication reconciliation for any transition of care (movement of a patient from one setting of care to another) Guidance/Legislation/EHRIncentivePrograms/downloads/7_Medication_Reconciliation.pdf 2015 MFMER slide-12 4
5 Meaningful Med Rec vs. Meaningful Use Med Rec 2015 MFMER slide-13 Meaningful Med Rec vs. Meaningful Use Med Rec 2015 MFMER slide-14 Meaningful Med Rec vs. Meaningful Use Med Rec 2015 MFMER slide-15 5
6 1) Do I Know All of the Medications? Polypharmacy: Typically 4 medications Medication use in the geriatric population (age 65) ~50% on 5 medications (including OTCs) ~37% on 5 prescription medications ~12% on 10 medications Some of our patients don t have enough time in the day to take all of their medications Qato et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA Dec 24;300(24): doi: /jama PubMed PMID: ; PubMed Central PMCID: PMC MFMER slide-16 Transitions of Care Things get messy and mixed up quickly! Great danger of errors during transitions of care 1 in 9 medical patients experienced an ADE during inpatient to outpatient transitions ~1/3 preventable (errors) 1 in 7 of these rated life-threatening >10 medications high risk Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K. and Bates, D. W. (2005), Adverse Drug Events Occurring Following Hospital Discharge. Journal of General Internal Medicine, 20: doi: /j x 2015 MFMER slide-17 Why to care about polypharmacy? Polypharmacy increases the risk for Adverse Drug Reactions, in one study: 4% of individuals potentially at risk of having a major drug-drug interaction 10% in age group ~50% of these involved the use of nonprescription medications >175,000 ED visits annually Anticoagulants (warfarin, NOACs, clopidogrel, etc.) Hypoglycemics (especially insulins, sulfonylureas) Digoxin (careful in doses >0.125mg daily) Qato et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA Dec 24;300(24): doi: /jama PubMed PMID: ; PubMed Central PMCID: PMC Budnitz DS, Shehab N, Kegler SR, Richards CL. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med Dec 4;147(11): PubMed PMID: MFMER slide-18 6
7 1) Do I Know All of the Medications? Only foolproof way: Make a housecall Next best alternatives: Specific orders to home health nurse for medication review (all meds in the home) Create a habit with in your patients so they bring in all of their medications Pre-visit phone calls from pharmacy technician 2015 MFMER slide Do I know all the medications? 2.Is this Medication Harmful? 2015 MFMER slide-20 2) Is this Medication Harmful? (necrotic tissue, has to go!) There are many published lists of medications that are potentially harmful in older patients Drugs for which there are safer alternatives Example: Avoid long-acting sulfonylureas such as chlorpropamide, glyburide, glimepiride (instead use glipizide) In one study, oral hypoglycemics accounted for 10% of hospitalizations for ADEs in older patients Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med Nov 24;365(21): doi: /NEJMsa PubMed PMID: MFMER slide-21 7
8 The Beers List Formally: The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Original List published in 1991 Updated in 1997, 2003, 2012, and 10/8/ update coming soon! Dr. Mark Beers American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc Oct 8. doi: /jgs PubMed PMID: MFMER slide-22 American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Based on expert review of primary literature: Drugs to Avoid/ Think twice about (not a blacklist!) Drug-Disease/Drug-Syndrome (e.g. CHF and TZDs or dementia and anticholinergics) Drug-Drug interactions (common in older persons) Common drugs to avoid or reduce dose with renal insufficiency (e.g. colchicine) 2015 MFMER slide-23 STOPP / START (Ireland/UK) (more explicit than Beer s Criteria) STOPP: Screening Tool of Older Person s Prescriptions (80 of these) PIMs: potentially inappropriate medications START: Screening Tool to Alert doctors to the Right Treatment (30 of these) PPOs: potential prescribing omissions SENATOR (Software ENgine for the Assessment and optimization of drug and nondrug Therapy in Older persons) O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing Mar;44(2): doi: /ageing/afu145. Epub 2014 Oct 16. PubMed PMID: ; PubMed Central PMCID: PMC MFMER slide-24 8
9 How do you actually stop things (and get patients to do it? Algorithms for stopping: PPI Sulfnoylurea Antipsychotic Benzodiazepene receptor agonist (e.g. Ambien) Cholenesterase/Memantine Pamphelts Infographics Patient guides Tapering guidelines! MFMER slide Do I know all the medications? 2. Is this Medication Harmful? 3.Is This Drug Indicated? 2015 MFMER slide-26 3) Is This Drug Indicated? Beware of off-label prescribing ~20% of all prescribing! Higher in with psychiatric drugs (~40%) An example: gabapentin (Neurontin) If there is a nerve involved, think Neurontin At that time, the largest fine in FDA history: $430 million (Pfizer/Warner-Lambert) >90% off label prescribing Side effects: dizziness, drowsiness, and loss of balance or coordination (especially at effective/therapeutic doses) Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among office-based physicians. Arch Intern Med May 8;166(9): PubMed PMID: MFMER slide-27 9
10 1. Do I know all the medications? 2. Is this Medication Harmful? 3. Is This Drug Indicated? 4.Has This Drug Outlived its Utility? 2015 MFMER slide-28 4) Has This Drug Outlived its Utility? Jumping Cactus (Jumping Cholla) 2015 MFMER slide-29 4) Has This Drug Outlived its Utility? Proton Pump Inhibitors continued posthospitalization Antidepressant medications continued indefinitely without a trial of discontinuation 2015 MFMER slide-30 10
11 1. Do I know all the medications? 2. Is this Medication Harmful? 3. Is This Drug Indicated? 4. Has This Drug Outlived its Utility? 5.Do the side effects outweigh the potential benefits of this drug? 2015 MFMER slide-31 5) Do the side effects outweigh the potential benefits of this drug? Avoid prescribing drugs with highly statistically significant, but clinically meaningless results 2015 MFMER slide-32 5) Do the side effects outweigh the potential benefits of this drug? e.g. Anticholinergics for urge urinary incontinence From the package insert for VESIcare (solifenacin): 1.3 fewer micturitions per 24 hours (2.4 vs. 1.7 less) 0.7 fewer incontinent episodes per 24 hours (1.8 vs. 1.1) (mean incontinent episodes on treatment=~1/day) ~20-30 ml more urine voided p <0.001 for all of these 23% more dry mouth; ~11% more constipation 3% blurry vision, 2% more UTIs COST: >$300/month!!! 2015 MFMER slide-33 11
12 5) Do the side effects outweigh the potential benefits of this drug? Cholinesterase Inhibitors such as Aricept (donepezil) Improve on the ADAS-cog by ~3 points But the scale is 0-70 points 0.8 points on the MMSE (30 points) The drug does not affect the underlying course of disease ; no decline in institutionalization or progression of disability at 3 years GI side effects in 20% Bradycardia with increased in rate of syncope hospitalization by 3.2/100 patient-years New onset urinary incontinence and increased risk of anticholinergic bladder medication (1.55 times higher) Gill SS, Mamdani M, Naglie G, Streiner DL, Bronskill SE, Kopp A, Shulman KI, Lee PE, Rochon PA. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med Apr 11;165(7): PubMed PMID: MFMER slide-34 Aricept 23mg vs 10mg Severe Impairment Battery (0-100) Cost: >$300/month (vs. as low as $8/month generic 10mg tablets) 2015 MFMER slide Do I know all the medications? 2. Is this Medication Harmful? 3. Is This Drug Indicated? 4. Has This Drug Outlived its Utility? 5. Do the side effects outweigh the potential benefits of this drug? 6.Are there any drug-drug or drug-disease interactions? 2015 MFMER slide-36 12
13 6) Are there any drug-drug or drug-disease interactions? Impossible to remember all of the drug-drug reactions Beware of click-through and alert fatigue Utilize Epocrates Multicheck or Medscape interaction checker or similar apps 2015 MFMER slide-37 6) Are there any drug-drug or drug-disease interactions? Drug-Disease interactions Anticholinergic medications in a patient with BPH (benign prostatic hyperplasia) Thiazolidinediones (TZDs) in patients with comorbid congestive heart failure 2015 MFMER slide Are there any drug-drug or drug-disease interactions? 7.What about the over-thecounter and supplements/herbal medications? 2015 MFMER slide-39 13
14 7) What about the over-the-counter and supplements/herbal medications? Any interactions? Calcium supplements decrease absorption of: Levothyroxine Fluoroquinolone antibiotics Tetracycline antibiotics 2015 MFMER slide Are there any drug-drug or drug-disease interactions? 7. What about the over-the-counter and supplements/herbal medications? 8.Is this drug being used to treat the side effects of another drug? 2015 MFMER slide-41 8) Is this drug being used to treat the side effects of another drug? Prescribing Cascade Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ : British Medical Journal. 1997;315(7115): Figure adapted from: MFMER slide-42 14
15 8) Is this drug being used to treat the side effects of another drug? Thiazide Diuretics Allopurinol for Gout ~2 times the risk for HCTZ dose 25mg When I cured Parkinson s Disease Patient with nausea/vomiting and Diabetes Metoclopramide 10mg QID scheduled started Parkinsonian features neurologist levodopa treatment with Sinemet ~3-5 times more likely to be started on levodopa in a study of NJ Medicaid patients Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ : British Medical Journal. 1997;315(7115): MFMER slide Are there any drug-drug or drug-disease interactions? 7. What about the over-the-counter and supplements/herbal medications? 8. Is this drug being used to treat the side effects of another drug? 9.Is there a non-pharmacologic approach I can try instead of a drug? 2015 MFMER slide-44 9) Is there a non-pharmacologic approach I can try instead of a drug? Urinary Incontinence Kegel/pelvic floor strengthening Exercises Scheduled Voiding Sleep problems Counseling about the normal changes in sleep with aging Sleep Hygiene Relaxation techniques Addressing the underlying issue (e.g. pain) 2015 MFMER slide-45 15
16 6. Are there any drug-drug or drug-disease interactions? 7. What about the over-the-counter and supplements/herbal medications? 8. Is this drug being used to treat the side effects of another drug? 9. Is there a non-pharmacologic approach I can try instead of a drug? 10.Will my patient live long enough to gain potential benefit from the drug? 2015 MFMER slide-46 10) Will my patient live long enough to gain potential benefit from the drug? 102 year old put on statin for primary prevention Risk/Benefit in the old-old? Bisphosphonates in patients >85 years old Prognostication is difficult: 2015 MFMER slide Do I know all the medications? 2. Is this medication harmful? 3. Is this drug indicated? 4. Has this drug outlived its utility? 5. Do the side effects outweigh the potential benefits? 6. Any drug-drug or drug-disease interactions? 2015 MFMER slide-48 16
17 7. What about the over-the-counter and supplements/herbal medications? 8. Is this drug being used to treat the side effects of another drug? 9. Is there a non-pharmacologic approach I can try instead of a drug? 10.Will my patient live long enough to gain potential benefit from the drug? 2015 MFMER slide-49 Let s Do Meaningful Medication Reconciliation, which means debriding that medication list! 2015 MFMER slide-50 Thank You! Questions/Discussion 2015 MFMER slide-51 17
Medication Debridement: A 10 Step Approach to Polypharmacy
Medication Debridement: A 10 Step Approach to Polypharmacy Texas Health Resources Geriatrics Symposium November 3, 2018 Amit Shah, MD, FACP, AGSF Associate Dean for Faculty Affairs, Mayo Clinic School
More informationKatee Kindler, PharmD, BCACP
Speaker Introduction Katee Kindler, PharmD, BCACP Current Practice: Clinical Pharmacy Specialist Ambulatory Care, St. Vincent Indianapolis Assistant Professor of Pharmacy Practice, Manchester University,
More informationMedication Use in Older Adults
Medication Use in Older Adults F. Michael Gloth, III, MD, AGSF, FACP, CMD Clinical Professor Department of Geriatrics, Florida State University College of Medicine Associate Professor of Medicine Division
More informationDeconstructing Polypharmacy. Alan B. Douglass, M.D. Director
Deconstructing Polypharmacy Alan B. Douglass, M.D. Director Recognize this patient? Mrs. Brown- 82 years young Active Medical Problems Hypertension Hyperlipidemia Type 2 Diabetes Peripheral edema Osteoarthritis
More informationDeprescribing Unnecessary Medications: A Four-Part Process
Deprescribing Unnecessary Medications: A Four-Part Process Scott Endsley, MD Fam Pract Manag. 2018;25(3):28-32. Abstract and Introduction Introduction www.medscape.com Ms. Horatio is a 76-year-old patient
More informationGeri-PARDY! (2015 Beers Criteria) Pharmacology Edition
Geri-PARDY! Pharmacology Edition (2015 Beers Criteria) Aurelio Muyot, MD, AGSF, FACP Assistant Professor College of Osteopathic Medicine Touro University Nevada Objectives Review the 2015 Beers Criteria
More informationPrescribing in the Elderly: Ins and Outs of PIMs. April 8, 2016 Ronan Factora, MD Center for Geriatric Medicine
Prescribing in the Elderly: Ins and Outs of PIMs April 8, 2016 Ronan Factora, MD Center for Geriatric Medicine Learning Objectives Recognize effects on aging on pharmacokinetic/pharmacodynamics of medications
More informationStrategies to Decrease Medication Errors in Elderly. Abeer Zeitoun, Pharm. D Certified in Medication Safety, MCPHS
Strategies to Decrease Medication Errors in Elderly Abeer Zeitoun, Pharm. D Certified in Medication Safety, MCPHS Road Map..Outline 1. Introduction A. Definitions B. Geriatrics: High risk population C.
More informationSTOPP START Toolkit Supporting Medication Review in the Older Person
STOPP START Toolkit Supporting Medication Review in the Older Person STOPP: Screening Tool of Older People s potentially inappropriate Prescriptions START: Screening Tool to Alert doctors to Right (appropriate,
More informationSTOPP and START criteria October 2011
# START and STOPP are newer criteria to identify potentially inappropriate medications in elderly, including drug drug and drug disease interactions, drugs which increase risk of falls and drugs which
More informationIf a bad thing is happening to a patient, a drug did it until proven otherwise
Dr Vicki s First Rule of Geriatrics Deprescribing in the Elderly Victoria Braund MD, FACP, CMD Director, Division of Geriatrics NorthShore University HealthSystem Medical Director, Brandel Health & Rehab
More informationPresented by: Ontario s Geriatric Steering Committee
Polypharmacy: A Medication Management Opportunity Chris Fan-Lun, BScPhm, ACPR, CGP Clinical Practice Leader, Dept. of Pharmacy Services Mount Sinai Hospital, Sinai Health system Learning Objectives Provide
More informationPitfalls in Pharmacotherapy of Geriatrics
Pitfalls in Pharmacotherapy of Geriatrics DR Ali M. Alyami (M Pharm., PhD) Case Study An 85 year old female with a history of atrial fibrillation, stroke, dementia, and hypertension, who is receiving chronic
More informationIMPROVING MEDICATION SAFETY AMONG ELDERLY PATIENTS IN AN AMBULATORY SETTING. Alyssa Berry, Rebecca Burgett, Erin Day, Aron Hrubetz
IMPROVING MEDICATION SAFETY AMONG ELDERLY PATIENTS IN AN AMBULATORY SETTING Alyssa Berry, Rebecca Burgett, Erin Day, Aron Hrubetz Improving Medication Safety Among Elderly Patients in an Ambulatory Setting
More informationPatient Safety in Older Adults
Patient Safety in Older Adults Scott Martin Vouri, PharmD, MSCI, BCPS, BCGP, FASCP St. Louis College of Pharmacy Faculty Disclosure Dr. Vouri is funded by the Washington University Institute of Clinical
More informationMedication Management. Medications: The Right Balance. Who are we talking about? Geriatric Syndromes 9/19/2016. Older adults are a heterogenous group!
Medication Management Who are we talking about? Older adults are a heterogenous group! Patricia W. Slattum, PharmD, PhD Professor of Pharmacotherapy and Outcomes Science Director, Geriatric Pharmacotherapy
More informationPatient Safety in Older Adults
Patient Safety in Older Adults Scott Martin Vouri, PharmD, MSCI, BCPS, BCGP, FASCP St. Louis College of Pharmacy Faculty Disclosure Dr. Vouri is funded by the Washington University Institute of Clinical
More informationPolypharmacy. Polypharmacy. Suboptimal Prescribing in Older Adults. Kenneth Schmader, MD Professor of Medicine-Geriatrics
Polypharmacy Kenneth Schmader, MD Professor of Medicine-Geriatrics Polypharmacy Definition Causes Consequences Prevention/management Suboptimal Prescribing in Older Adults Overuse Polypharmacy Underuse
More informationTransforming Care for the Elderly
Transforming Care for the Elderly Session 2: Engaging Pharmacists & Interdisciplinary Care Teams to Improve Prescribing of Antipsychotics & to Reduce Polypharmacy January 11, 2017 3 @cfhi_fcass Welcome
More informationPolypharmacy and Polymorbid Patients: Practical Tips and Tricks
Polypharmacy and Polymorbid Patients: Practical Tips and Tricks November 2, 2013 Faculty/Presenter Disclosure Faculty: Chris Fan-Lun, BScPhm, ACPR, CGP Pharmacist - Geriatric Medicine Clinical Practice
More informationPharmaceutical Care for Geriatrics
Continuing Professional Pharmacy Development Program Pharmaceutical Care for Geriatrics Presented by: Alla El-Awaisi; MPharm, MRPharmS, MSc Event Organizer: Dr. Nadir Kheir; PhD Disclaimer: PRESENTING
More informationMaximizing Medication Safety UNIVERSITY OF HAWAII AUGUST 31, 2016
Maximizing Medication Safety UNIVERSITY OF HAWAII AUGUST 31, 2016 Adverse Drug Events (ADE s) RISK FACTORS FOR Adverse Drug Events (ADEs) 6 or more concurrent chronic conditions 12 or more doses of drugs/day
More informationPatient Safety in an Aging World. Patient Safety in Aging Society Tokyo, 13 April 2018 Albert W. Wu, MD, MPH Professor, Johns Hopkins University
Patient Safety in an Aging World Patient Safety in Aging Society Tokyo, 13 April 2018 Albert W. Wu, MD, MPH Professor, Johns Hopkins University The World is Aging Population structure of Japan Go Seigen
More informationDisclosures. Use caution in the elderly: review of safe and effective medication use in older patients. Institute of Medicine. Learning Objectives
Use caution in the elderly: review of safe and effective medication use in older patients Disclosures I have no disclosures or conflicts of interest related to this presentation John T. Holmes, PharmD,
More informationPOLYPHARMACY IN OLDER ADULTS AND BEERS CRITERIA UPDATE
POLYPHARMACY IN OLDER ADULTS AND BEERS CRITERIA UPDATE Jeannie Kim Lee, PharmD, BCPS, CGP Clinical Pharmacy Director College of Pharmacy The University of Arizona Learning Objectives: State the risks of
More informationCOMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK
COMMON DRUG RELATED PROBLEMS SEEN IN PACE AND MECHANISMS TO MITIGATE RISK Robert L Alesiani, PharmD, CGP Chief Pharmacotherapy Officer CareKinesis, Inc. (a Tabula Rasa Healthcare Company) 2 3 4 5 Pharmacogenomics
More informationThank You to Our Sponsors: Evaluations & CE Credits. Featured Speakers. Conflict of Interest & Disclosure Statements 10/18/2016
Thank You to Our Sponsors: University at Albany School of Public Health NYS Department of Health Conflict of Interest & Disclosure Statements The planners and presenters do not have any financial arrangements
More informationTOP 5 DRUGS.. TO AVOID IN THE ELDERLY
TOP 5 DRUGS.. TO AVOID IN THE ELDERLY Debbie Kwan, BScPhm., MSc., FCSHP Canadian Geriatrics Society, April 20, 2013 Disclosure of Potential for Conflict of Interest: Financial Disclosure: None Mar 26,
More informationPolypharmacy and the Older Adult. Leslie Baker, PharmD, BCGP Umanga Sharma, MD
Polypharmacy and the Older Adult Leslie Baker, PharmD, BCGP Umanga Sharma, MD Objectives Identify what polypharmacy is Identify factors leading to polypharmacy Discuss consequences of polypharmacy Identify
More informationquoted South Park in a talk
So Many Drugs: Using the Updated Beers' List to Address Polypharmacy MONA Annual Meeting April 22, 2016 Just so I can tell my Teenage Boy I quoted South Park in a talk 1 Objectives: To discuss the potential
More informationGeriatric Pharmacology
Geriatric Pharmacology Janice Scheufler R.Ph.,PharmD, FASCP Clinical Pharmacist Hospice of the Western Reserve Objectives List three risk factors for adverse drug events in the elderly Discuss two physiological
More informationDiabetes and the Elderly: Medication Considerations When Determining Benefits and Risks
Diabetes and the Elderly: Medication Considerations When Determining Benefits and Risks Gretchen M. Ray, PharmD, PhC, BCACP, CDE Associate Professor UNM College of Pharmacy September 7 th, 2018 DISCLOSURES
More informationPharmacology in the Elderly
Pharmacology in the Elderly James Hardy Geriatrician, Royal North Shore Hospital A recent consultation Aspirin Clopidogrel Warfarin Coloxyl with senna Clearlax Methotrexate Paracetamol Pantoprazole Cholecalciferol
More informationThere s A Pill For That (But should my patient be on it?) A Review of Tools for the Evaluation of Optimal Prescribing in Geriatric Patients
There s A Pill For That (But should my patient be on it?) A Review of Tools for the Evaluation of Optimal Prescribing in Geriatric Patients Marilyn N. Bulloch, PharmD, BCPS Assistant Clinical Professor
More informationGeriatric Pharmacology. Kwi Bulow, M.D. Clinical Professor of Medicine Director, Academic Geriatric Resource Center
Geriatric Pharmacology Kwi Bulow, M.D. Clinical Professor of Medicine Director, Academic Geriatric Resource Center Silver Tsunami 2010: 40 million (13%) 2030: 72 million (20%) Baby Boomers (1946-1964)
More informationHA CONVENTION Effectiveness of Pharmacist-led Frail Elderly Medication Service in Acute Geriatric Ward
Effectiveness of Pharmacist-led Frail Elderly Medication Service in Acute Geriatric Ward HA CONVENTION 2017 Candis Chang Pharmacist Department of Pharmacy Ruttonjee and Tang Shiu Kin Hospitals Background
More informationScreening tools for elderly patients in primary care
Screening tools for elderly patients in primary care Cristín Ryan 1 Prof. Julia Kennedy 1 Dr. Denis O Mahony 2 Dr. Stephen Byrne 1 Co-Investigator: Dr. Paul Gallagher 2 1 Pharmaceutical Care Research Group,
More informationUpdate in Geriatrics: Choosing Wisely Primum Non Nocere
Joseph G. Ouslander, M.D. Professor of Clinical Biomedical Science Senior Associate Dean for Geriatric Programs Chair, Department of Integrated Medical Science Charles E. Schmidt College of Medicine Professor
More informationRational Medication Use in Dementia
Rational Medication Use in Dementia Stephen Thielke sthielke@u.washington.edu (206) 764 2815 I have no conflicts of interest to report. I am an employee of the federal government. The opinions in this
More informationRebecca Rottman-Sagebiel, Pharm.D., BCPS Sharon Jung Tschirhart, Pharm.D., BCPS Geriatric Clinical Pharmacy Specialists STVHCS, Audie L.
Rebecca Rottman-Sagebiel, Pharm.D., BCPS Sharon Jung Tschirhart, Pharm.D., BCPS Geriatric Clinical Pharmacy Specialists STVHCS, Audie L. Murphy Division Clinical Assistant Professors, University of Texas/UTHSCSA
More informationMeds and Falls: Keep in Step with your Meds
Meds and Falls: Keep in Step with your Meds Donna Bartlett PharmD, CGP, RPh Associate Professor-Pharmacy Practice MCPHS University Clinical Pharmacist-MCPHS University- Pharmacy Outreach Program donna.bartlett@mcphs.edu
More informationSAFETY CONCERNS WITH MULTIPLE MEDICATIONS AND BEYOND. Sandra Brownstein, PharmD, CGP
SAFETY CONCERNS WITH MULTIPLE MEDICATIONS AND BEYOND Sandra Brownstein, PharmD, CGP Objectives: List potential medication related problems that increase in the frail elderly with acute illness Differentiate
More informationAssociation between Potentially Inappropriate Prescription (PIP) and Health Outcome Among Geriatric Home Residents
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (6), Page 4660-4665 Association between Potentially Inappropriate Prescription (PIP) and Health Outcome Among Geriatric Home Residents Moatassem
More informationDrug use in long term care. Graziano Onder Centro Medicina Invecchiamento Università Cattolica Sacro Cuore, Rome
Drug use in long term care Graziano Onder Centro Medicina Invecchiamento Università Cattolica Sacro Cuore, Rome Polypharmacy in nursing home (USA) Concurrent use of 9 medications was reported for 39.7%
More informationReduction of High Risk Medications Using A Quality Initiative Perspective
Reduction of High Risk Medications Using A Quality Initiative Perspective Richard Mueller PharmD, MBA, MS, Director of Pharmacy Dianne Hempel BSN, RN Quality Improvement Coordinator Objectives Learn what
More informationDeprescribing in CKD patients: Is less more? Speaker: Dr. Judith G. Marin, PharmD
2016 Deprescribing in CKD patients: Is less more? Speaker: Dr. Judith G. Marin, PharmD Case Mr. Kid Ney is a 75 y/o patient who has been on dialysis for the last 4 years (PD, then HD). PMHx: HTN, DM,
More informationHospital Transition Management. Barbara Wood, BSN, MBA
Hospital Transition Management Barbara Wood, BSN, MBA Director, Embedded Care Management Programs OBJECTIVES Improve health care quality for our patients by streamlining care transitions Reduce avoidable
More informationPolypharmacy. A CPPE distance learning programme
A CPPE distance learning programme DLP 177 January 2016 Contents About CPPE distance learning programmes About this learning programme Glossary of key terms v vii ix Contents Section 1 The problem with
More informationSTART, STOPP, Beers Oh My! Navigating the World of Geriatric Pharmacy
START, STOPP, Beers Oh My! Navigating the World of Geriatric Pharmacy Jessica DiLeo, PharmD Kate Murphy, PharmD OBJECTIVES Identify pharmacodynamic and pharmacokinetic parameters that may influence treatment
More informationStronger together - optimizing pharmacotherapy on geriatric wards?
Stronger together - optimizing pharmacotherapy on geriatric wards? Clinicamp FOD 27/4/2018 Dr. Jean-Claude Lemper ( Geriater UZ Brussel) Apr. Julie Hias (ziekenhuisapotheker UZ Leuven) Project College
More information1/21/2016 UPDATE ON THE AMERICAN GERIATRICS SOCIETY 2015 BEERS CRITERIA DISCLOSURE OBJECTIVES AGING GOALS BEERS CRITERIA
UPDATE ON THE AMERICAN GERIATRICS SOCIETY 2015 BEERS CRITERIA DISCLOSURE I have no financial conflict of interest to disclose. Lacey Charbonneau, Pharm.D. PGY-1 Community Practice Resident Baptist Medical
More informationUniversity of Hawaii Center on Aging
University of Hawaii Center on Aging. Supported in part by a cooperative agreement No. 90AL0011-01-00 from the Administration on Aging, Administration for Community Living, U.S. Department of Health and
More informationGeneral Principles of Geriatric Drug Therapy Timothy W. Cutler, PharmD, BCGP; Thomas R. Clark, RPh, MHS, BCGP
journal of contemporary pharmacy practice General Principles of Geriatric Drug Therapy Timothy W. Cutler, PharmD, BCGP; Thomas R. Clark, RPh, MHS, BCGP review Published online: March, 2018 Ms. Gutierrez
More informationCompleted audit cycle to explore the use of the STOPP/START toolkit to optimise medication in psychiatric in-patients with dementia
Completed audit cycle to explore the use of the STOPP/START toolkit to optimise medication in psychiatric in-patients with dementia Victor M. Aziz, Natalie Hill, Sugandha Kumar BJPsych Bulletin (08) 4,
More informationHave you already tried different drugs for your schizophrenia? Here s another option you and your doctor may want to consider.
Have you already tried different drugs for your schizophrenia? Here s another option you and your doctor may want to consider. 1 Benefits of Clozapine Clozapine may work when other medications don t. Doctors
More informationADVANCED PRACTICE PROVIDER ROUNDS:
ADVANCED PRACTICE PROVIDER ROUNDS: UTILIZING CMS CHRONIC CARE MANAGEMENT FOR DIFFICULT CASES APARNA GUPTA, MSN, MBA, RN Senior CRNP, Benedum Geriatric Center, UPMC Chair, UPMC APP Preceptor Academy Director,
More informationFrom medicines reconciliation to medicines review. Dr. Fatma Karapinar Hospital pharmacistepidemiologist
From medicines reconciliation to medicines review Dr. Fatma Karapinar Hospital pharmacistepidemiologist Conflict of interest Nothing to disclose Questions Medication review is more important than medicines
More informationAdjusting and Withdrawing Medications in the Elderly
Adjusting and Withdrawing Medications in the Elderly Louise Mallet, B.Sc.Pharm., Pharm.D., CGP Professor in Clinical Pharmacy, Faculty of Pharmacy, University of Montreal Clinical Pharmacist in Geriatrics,
More informationUse caution in the elderly: review of safe and effective medication use in older patients
Use caution in the elderly: review of safe and effective medication use in older patients John T. Holmes, PharmD, BCPS Assistant Professor of Family Medicine and Pharmacy Practice In support of improving
More informationGeriatrics and Cancer Care
Geriatrics and Cancer Care Roger Wong, BMSc, MD, FRCPC, FACP Postgraduate Dean of Medical Education Clinical Professor, Division of Geriatric Medicine UBC Faculty of Medicine Disclosure No competing interests
More informationWestern University of Health Sciences, College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of
Western University of Health Sciences, College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Topic UAN# Target Audience A
More informationFall Prevention in Hospice (A pharmacologic and nonpharmacologic approach)
Fall Prevention in Hospice (A pharmacologic and nonpharmacologic approach) Chinenye Emereole, Pharm.D. Clinical Pharmacist Hospice Pharmacy Solutions Objectives Assess and identify hospice patients who
More informationDementia of the Alzheimer Type: the Drug Treatment Debate
Dementia of the Alzheimer Type: the Drug Treatment Debate I have no financial conflict of interest. Many years ago I was given a trip to San Fran and taught to use a slide set from the drug company. I
More informationDe-prescribing in Older Adults. Wael Hamade, MD, FAAFP 04/08/2016
De-prescribing in Older Adults Wael Hamade, MD, FAAFP 04/08/2016 DISCLOSURES None of the faculty, planners, speakers, providers nor CME committee has any relevant financial relationships with commercial
More informationPRESCRIBING IN THE ELDERLY. CARE HOME PHARMACY TEAM Bhavini Shah, Eleesha Pentiah & Puja Vyas
PRESCRIBING IN THE ELDERLY CARE HOME PHARMACY TEAM Bhavini Shah, Eleesha Pentiah & Puja Vyas LEARNING OUTCOMES Medicines Optimisation The effects of aging on health and medicines. Polypharmacy Acute Kidney
More informationDementia and Fall Geriatric Interprofessional Training. Wael Hamade, MD, FAAFP
Dementia and Fall Geriatric Interprofessional Training Wael Hamade, MD, FAAFP Prevalence of Dementia Age range 65-74 5% % affected 75-84 15-25% 85 and older 36-50% 5.4 Million American have AD Dementia
More informationManaging medicines in older people. Jane Noble and Caroline Ralph
Managing medicines in older people Jane Noble and Caroline Ralph Where? Community Hospital Care Home What? Prescribing Dispensing Administering Case 1 84 year old lady Admitted with reduced mobility Recurrent
More informationMedication safety in vulnerable patient groups - Elderly patients -
Woodennature/CC-BY-SA-3.0 http://theintelligence.de Medication safety in vulnerable patient groups - Elderly patients - 20th Congress of EAHP 25-27 March, 2015, Hamburg, Germany Dr. rer. nat. Beate Wickop
More informationPolypharmacy and Anticholinergic Burden in Hospitalised Older Patients - A Cross Sectional Audit
INTERNATIONAL JOURNAL of BIOMEDICAL SCIENCE ORIGINAL ARTICLE Polypharmacy and Anticholinergic Burden in Hospitalised Older Patients - A Cross Sectional Audit Joanna Ulley 1, Sakila Sickander 2, Ahmed H.
More informationDRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future
DRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future Daniel S. Sitar Professor Emeritus University of Manitoba Email: Daniel.Sitar@umanitoba.ca March 6, 2018 INTRODUCTION EPIDEMIOLOGY
More informationAbout ISMP Canada. Analysis Outputs: Safety Bulletins. Less is More: An Introduction to Deprescribing. canada.org
Less is More: An Introduction to Deprescribing Lindsay Yoo, BSc, BScPhm, RPh, CDE, CGP, PharmD Medication Safety Analyst, ISMP Canada About ISMP Canada The Institute for Safe Medication Practices Canada
More informationPolypharmacy in the Elderly
Polypharmacy in the Elderly Physiotherapy Alberta Conference September 24 th 2016 Lesley Charles Associate Professor and Program Director Division of Care of the Elderly Department of Family Medicine,
More information< = > less is more. De-diagnosing De-prescribing Non-testing
< = > less is more De-diagnosing De-prescribing Non-testing Who says? Overdiagnosis Polypharmacy False positives Too much medicine Risk aversion $$$ Sources Prof David Le Couteur, Clin Pharm and Aged Care
More informationPolypharmacy. in the Elderly. Lesley Charles, MBChB, CCFP
Polypharmacy in the Elderly Lesley Charles, MBChB, CCFP Associate Professor and Program Director Division of Care of the Elderly Department of Family Medicine, University of Alberta March 06, 2016 1 Faculty/Presenter
More informationSignificance A Busy Clinician's Guide to Seniors with Memory Loss
Significance A Busy Clinician's Guide to Seniors with Memory Loss Victoria Braund MD FACP CMD Division of Geriatrics. NorthShore University HealthSystem Alzheimer's disease is the sixth leading cause of
More informationThe Role of Pharmacists achieving international best practice standards and realising key opportunities.
The Role of Pharmacists achieving international best practice standards and realising key opportunities. Dr. Stephen Byrne Senior Lecturer in Clinical Pharmacy & Director of the MSc in Clinical Pharmacy
More informationRational prescribing in the older adult. Assoc Prof Craig Whitehead
Rational prescribing in the older adult Assoc Prof Craig Whitehead Introduction Physioloical ageing and frailty Medication risks in older adults Drug Burden Anticholinergic and sedative drug burden Cascade
More informationPolypharmacy: Making it all Work Kathy Wilson, RPh, RWSIR Director of Pharmacy
Polypharmacy: Making it all Work Kathy Wilson, RPh, RWSIR Director of Pharmacy Polypharmacy can be defined as the use of multiple medications for the treatment of a patient s medical conditions. The term
More informationA Step Forward: Promoting Independence through Falls Prevention
A Step Forward: Promoting Independence through Falls Prevention 2014 Geriatric Update Meharry Consortium Geriatric Education Center A Step Forward: Promoting Independence through Falls Prevention Moderator:
More informationTransitions of Care & Medication Reconciliation Ashley King, PharmD, BCGP Clinical Pharmacist LECOM Health March 2018
Transitions of Care & Medication Reconciliation Ashley King, PharmD, BCGP Clinical Pharmacist LECOM Health March 2018 Objectives Identify when to complete medication reconciliation Understand the importance
More informationCase Study #1 GUIDING PRINCIPLES FOR THE CARE OF OLDER ADULTS WITH MULTIMORBIDITY
Case Study #1 GUIDING PRINCIPLES FOR THE CARE OF OLDER ADULTS WITH MULTIMORBIDITY Panel Moderator & Panelists: Edward Perrin, MD Banner icare Scott Bolhack, MD, MBA Sandra Brownstein, PharmD Paige Hector,
More informationPresentation Goals 4/14/2015. Pharmacology for Urinary Incontinence in Women. Medications Review anti muscarinic medications Focus on newer meds
Presentation Goals Pharmacology for Urinary Incontinence in Women Medications Review anti muscarinic medications Focus on newer meds Introduce beta adrenergic medications Current Concepts in Drug Therapy
More informationOptimising Safe & Appropriate Medicines Use and Deprescribing. Katie Smith, Director, East Anglia Medicines Information Service February 2014
Optimising Safe & Appropriate Medicines Use and Deprescribing Katie Smith, Director, East Anglia Medicines Information Service February 2014 Background Objectives How & why the OSAMU document was developed
More informationINDEX OF HEALTH AND WELLNESS NEWS ITEMS January 2013-December 2014
INDEX OF HEALTH AND WELLNESS NEWS ITEMS January 2013-December 2014 Topic (followed by title, month and page number) (Many issues can be found on the KORA website . Complete file is in
More informationAmal AL-Anazi, BSc.(Pharm) Medication Safety Officer In Eastern Region
Risks Of Polypharmacy Amal AL-Anazi, BSc.(Pharm) Medication Safety Officer In Eastern Region What is Polypharmacy? Polypharmacy means many drugs. In practice, polypharmacy refers to the use of more medication
More informationDoreen Wan-Chow-Wah, MD, FRCPC Assistant Professor, Division of Geriatric Medicine, Department of Medicine McGill University Health Center Associate
Doreen Wan-Chow-Wah, MD, FRCPC Assistant Professor, Division of Geriatric Medicine, Department of Medicine McGill University Health Center Associate member, Department of Oncology McGill University Medical
More informationCONTINENCE BEHAVIORAL REHABILITATION PROGRAM
CONTINENCE BEHAVIORAL REHABILITATION PROGRAM PHYLLIS A. HEINTZ, PHD, RN, CTN-B NURSING, CALIFORNIA STATE UNIVERSITY, BAKERSFIELD AUDREY COCHRAN, MSN, RN, GCNS-BC HEALTH CARE PLANNING AND EDUCATION FOR
More informationBriefing Document on Medication use and Falls
Briefing Document on Medication use and Falls This document is intended as a briefing document and is not to be regarded as a document offering definitive legal advice in relation to the subject matter.
More informationPolypharmacy: Guidance for Prescribing in Frail Adults
Polypharmacy: Guidance for Prescribing in Frail Adults Why is reviewing polypharmacy important? Medication is by far the most common form of medical intervention. Four out of five people aged over 75 years
More informationDementia and Primary Care. A Structured Team Approach UNE/MGEC Conference June 2014
Dementia and Primary Care A Structured Team Approach UNE/MGEC Conference June 2014 First Proviso I have no actual or potential conflict of interest in relation to this program or presentation. Second Proviso
More informationRationalizing Medications. Tan Jianming Senior Pharmacist KTPH
Rationalizing Medications Tan Jianming Senior Pharmacist KTPH + Older patients are more likely to: 2 Have multiple co-morbid diseases Have age-related physiological changes that result in a reduced tolerance
More informationRight drug. Right dose. Right now. Delivering on the promise and value of personalized prescribing
Right drug. Right dose. Right now. Delivering on the promise and value of personalized prescribing 2 Table of Contents Part One: Pharmacogenetics 101...Slides 4-16 Time Requirement: 20 minutes Part Two:
More informationIf you wake up to urinate 2 or more times a night, ask your doctor about NOCTIVA
If you wake up to urinate 2 or more times a night, ask your doctor about NOCTIVA IMPORTANT SAFETY INFORMATION WARNING: HYPONATREMIA See full prescribing information for complete boxed warning. NOCTIVA
More informationBeers Criteria: Practical Considerations. A Clinician Education Tool. Curt Wood, RPh, CGP, FASCP
Beers Criteria: Practical Considerations A Clinician Education Tool Curt Wood, RPh, CGP, FASCP Objectives: u Explain the purpose of the Beers Criteria u Discuss the key concepts in applying the Beers Criteria
More informationOBJECTIVES. Key issues in geriatric pharmacology. Effects of age on pharmacokinetics and pharmacodynamics
PHARMACOTHERAPY 1 OBJECTIVES 2 Know and understand: Key issues in geriatric pharmacology Effects of age on pharmacokinetics and pharmacodynamics Risk factors for adverse drug events for older patients
More informationKetorolac injection. Supportive care
Supportive care Ketorolac injection Supportive care: specialist medicines This leaflet provides information on a medicine called ketorolac which is used to treat pain that is difficult to control. It is
More informationObjectives. Case Ruby. 1- Warfarin. 1- Warfarin. Warfarin discontinuation 8/13/ DRUGS TO STOP GIVING HOSPICE PATIENTS
Objectives 10 DRUGS TO STOP GIVING HOSPICE PATIENTS Richard E. Allen MD, MPH Hospice Medical Director Family Medicine Residency Director Salt Lake City, Utah 2 Recognize 10 commonly prescribed medications
More information*Drug-drug Interactions and Polypharmacy in HIV and Aging
*Drug-drug Interactions and Polypharmacy in HIV and Aging The primary care provider is highly encouraged to perform annual medication reconciliation and a medication review at every visit so that a complete
More informationFinding the sweet spot: Individualized targets for older adults with Type 2 DM
Finding the sweet spot: Individualized targets for older adults with Type 2 DM Samuel C. Durso, M.D., M.B.A. Mason F. Lord Professor of Medicine Director, Division of Geriatric Medicine and Gerontology
More information