Geriatric Pharmacology
|
|
- Meagan Hardy
- 5 years ago
- Views:
Transcription
1 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 changes as one ages that impacts medication use Compare and contrast the Beers criteria and STOPP 1
2 Geriatric Drug Usage Patterns Ambulatory or Community 3-4meds Acute Hospital 3.5-8meds LTCF 7meds But 20% use 10+ Medicare- 41% use 5+meds Consult Pharm 2001;16:54-64 JAMA 2003;289: JGIM 2007;22:6-12 Age 65+ with Chronic Health Conditions Men Women 2
3 Chronic Diseases Medicare Beneficiaries 80% have at least 1 chronic disease 48% have at least 3 chronic diseases 21% have at least 5 chronic diseases =INCREASED DRUG USAGE Health Affairs 2003;W3:37-53 Adverse Drug Events (ADE) 27,000 ambulatory elderly 1523 ADEs/12months 27.6% preventable 42% preventable in LTCF Mostly ordering and monitoring errors JAMA 2003;289: N Engl J Med 2003;348: Am J Med 2005;118: ER Hospitalizations ( ) for ADE yo+ Nearly 100,000 ER hospitalizations 48.1% in 80yo+ 66% unintentional overdoses 4 meds/classes involved in 67% Warfarin Insulins Oral antiplatelet agents Oral hypoglycemic agents N Engl J Med 2011;365:
4 Consequences of ADE in Elderly Increased morbidity and mortality ER visits- 25% linked to ADE Hospitalizations- 49% linked to ADE Older adults are 6.8x more likely to be hospitalized from ADE than younger age JAMA 2006;296: Risk Factors for ADE- Elderly Age 85 years Low body weight or BMI< 22kg/m2 Use of 5 or more medications Use of multiple pharmacies/physicians Dementia 4+ medical problems Non-Compliance JAMA 2003;289: Pharmacokinetic changes Pharmacodynamic changes Using high risk meds Inappropriate self medication Poor education Poor/missing monitoring Hospital stay >14days Addition of 2+ meds from hospital admission Higher ADE Risks in Older Populations 8 drugs=high risk 5-7drugs=medium risk Previous ADE 4 comorbidities Liver disease Am J Med 2012;125: Renal disease High-risk drugs Cognitive impairment Living alone Nonadherence Known psychologic disorder or substance abuse 4
5 Drug Interaction Potential Schwartz JB Principles of Geriatric Medicine and Gerontology.4 th ed 1999 Falls Morbidity & Mortality Every 18 sec=er visit Risk of serious injury 4-5x higher in 85+yo 90% of hip fractures in 65+yo caused by falls Increases admissions to LTCF Medication Related Falls 1 in 3 over 65yo fall each year 6% of hospitalizations in elderly Major medications linked to falls: CNS- antidepressants, benzodiazepines, neuroleptics Anticonvulsants Select cardiovascular N Engl J Med 2003;348:
6 Costs of Potentially Inappropriate Medication(PIM) $7.2 BILLION/YEAR Med Care 2007;45: Pearls Any symptom in a geriatric person should be considered an ADE until proven otherwise Any symptom in a geriatric person should NOT be considered normal aging or worsening of current diseases without ruling out a medication related problem Pharmacokinetics & Aging PK= how the body handles a drug Absorption Distribution Metabolism Excretion 6
7 Absorption Changes- Elderly Decreased gastric emptying plus increased transit time in bowels Changes in ph Decreased active transport mechanisms Iron, Vitamin B12, Calcium Consult Pharm 2008;23: Sem Onc Nurs 2005;21:29-35 Absorption Changes Topical gels/patches- may have altered absorption from skin thinning and/or decreased blood flow to skin Decreased IM/SQ absorption if poor muscle mass and/or poor perfusion Consult Pharm 2008;23: Distribution Changes-Elderly Decreased total body water Decreased albumin (frail, malnourished) Decreased muscle mass Increased adipose tissue Consult Pharm 2008;23: Sem Onc Nurs 2005;21:29-35 Clin Geriatr Med 2002;18:
8 Metabolism Changes- Elderly Multi-pathway, complex system Some, some Cytochrome P450 isoenzymes Some, some Signficant drug interactions Consult Pharm 2008;23: Elimination Changes- Elderly Renal function decreases 1% per year over age 50 Decreased glomerular filtration rate (GFR) Lose 25-50% of GFR between 20-90yo Decreased tubular secretion Decreased renal blood flow Exp Gerontol 2003;38: Consult Pharm 2008;23: Renally Adjusted Medications MANY antimicrobials, opioids, select GI meds, select cardiovascular meds, select diabetic meds Increased accumulation of active metabolites-----toxicity 8
9 Pharmacodynamics & Aging PD= body s response to a drug Not as well understood or studied Involves altered receptors, decreased receptor affinity, altered processing of signals, altered homeostatic control P Dynamic Examples Loss of baroreceptor functionality (=falls) Increased sensitivity to central nervous system medications Increased tardive dyskinesia risk with antipsychotics Increased sensitivity to anticholinergic side effects of medications Exp Gerontol 2003;38: Anticholinergic Side Effects Confusion Memory loss Delirium Sedation Dizziness Hallucinations Cardiac conduction changes Urinary retention Constipation Xerostomia Blurred vision Unsteady gait Tachycardia Thermoregulatory impairment 9
10 Anticholinergic Burden 180/201 patients 65+yo had serum antichol activity with cognitive impairment Can exacerbate underlying dementia and/or antagonize effects of dementia meds AC Risk Scale, AC Drug Scale, AC Burden Scale Arch Gen Psychiatry 2003;60: , Arch Intern Med 2008;168: , J Clin Pharmacol 2006;46: , Aging Health 2008;4: Meds w/anticholinergic Activity Antispasmodics- dicyclomine, oxybutynin Antihistamines- diphenhydramine Antidepressants- tricyclics, paroxetine, trazodone, duloxetine Antipsychotics- olanzapine, risperidone Antiemetics- prochlorperazine, promethazine Muscle relaxants- cyclobenzaprine Urinary incontinence meds- oxybutynin Beers List or Beers Criteria List of potentially inappropriate meds (PIM) to use in geriatric patients LTCF residents elderly older adults older adults J Am Geriatr Soc 2012;60:
11 Outcomes with Beers List Meds Studies show 14-40% inappropriate prescribing Increased hospitalizations Increased ER visits Increased healthcare costs Death Ann Pharmacother 2007;41: J Am Geriatr Soc 2011;59: Ann Pharmacother 2011;45: Arch Intern Med 2011;171: Beers Categories I. PIM/classes to avoid Diphenhydramine, sliding-scale insulin, benzodiazepines, digoxin>125mcg, antipsychotics (in behaviors with dementia) II. PIM/classes to avoid with certain diseases/syndromes Tramadol/Seizure history, NSAID/Heart failure, Anticholinergics/Dementia PIM= Potentially Inappropriate Medication Beers Categories III. Meds to be used with caution Aspirin for cardiac primary prevention in 80yo+ ***Hospice/palliative care acknowledgement for patient-specific circumstances (specific, short-term use) 11
12 STOPP- Screening Tool of Older Person s Prescriptions UK alternative to Beers List 65 criteria for potentially inappropriate prescribing Incorporates concurrent diagnoses Ibuprofen in hypertension or heart failure Furosemide as 1 st monotherapy for BP Int J Clin Pharmacol Ther 2008;46:72-83 STOPP versus Beers 600 consecutive 65+ yo over 4 months 158 (26.3%) patients had 329 ADEs 219 (66.6%) of ADEs related to admission 151 (68.9%) of admission ADEs were avoidable/potentially avoidable Likelihood of serious, avoidable ADE STOPP----OR 1.847, p<0.001 Beers----OR 1.276, p=0.11 Arch Intern Med 2011;171: Good Palliative-Geriatric Practice Algorithm 70 patients (mean 82.8yo), 19 months 61%--3 comorbids, 26%--5 comorbids 311 meds (58% of meds) discontinued in 64 patients Successful discontinuation in 81% No significant adverse effects 88% reported global improvements Arch Intern Med 2010;170:
13 10 Step Framework- Med Reduction in Older Patients 1. Ascertain all drugs 2. Identify patients at high risk of or experiencing ADEs 3. Estimate life expectancy 4. Define care goals in reference to life expectancy, level of functional incapacity, quality of life, and patient/ caregiver priorities Am J Med 2012;125: Step Continued 5. Define and confirm existent indications for ongoing treatment with reference to defined care goals 6. Determine time until benefit for preventative disease-specific medications 7. Determine disease-specific benefit-harm thresholds that may support treatment discontinuation 10 Step Continued 8. Review the relative utility of individual drugs 9. Identify drugs that may be discontinued or have their dosing modified 10. Implement and monitor revised therapeutic plan with ongoing reappraisal of drug utility and patient adherence 13
14 Geriatric Med Considerations Older adults *** ***Points of change Inc. Use of Medications *** Inc. Negative Outcomes Pearls of Geriatric Pharmacology M A S T E R minimize number of meds alternatives to be considered start low and go slow titrate therapy educate patient review and monitor regularly Consult Pharm 2008;23: Questions & Answers Thank you for your attendance! 14
START, 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 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 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 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 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 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 informationPrescribing and Pharmacokinetic Considerations in the Elderly
Prescribing and Pharmacokinetic Considerations in the Elderly Melanie A. Dodd, Pharm.D., Ph.C., BCPS Associate Professor of Pharmacy in Geriatrics College of Pharmacy The University of New Mexico OBJECTIVES
More informationBiology of Aging. Faculty Disclosure. Learning Objectives. I have no relevant financial disclosures relative to the content of this presentation.
Biology of Aging Aging Changes That Impact Medication Management Emily P. Peron, PharmD, MS, BCPS, FASCP Assistant Professor of Geriatrics Virginia Commonwealth University School of Pharmacy Richmond,
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 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 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 informationAging Changes That Impact Medication Management
Biology of Aging Aging Changes That Impact Medication Management Emily P. Peron, PharmD, MS, BCPS, FASCP Assistant Professor of Geriatrics Virginia Commonwealth University School of Pharmacy Richmond,
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 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 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 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 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 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 informationPrescribing Drugs to the Elderly
Answers to your questions from University of Toronto experts Prescribing Drugs to the Elderly Can drugs do more harm than good? M.A. is a 90-year-old man living at home. He has dementia and due to wandering
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 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 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 informationPolypharmacy & De-prescribing In Older Adults
Polypharmacy & De-prescribing In Older Adults Maryland Association of Osteopathic Physicians Annual Meeting September 15, 2018 Elizabeth Phung, DO Lead Clinical Associate Physician Beacham Center for Geriatric
More informationThe role of medication in falls risk
The role of medication in falls risk Patrick A. Ball, Foundation Professor of Rural Pharmacy, Charles Sturt University, Wagga Wagga Lecture outline The aged are not created equal Insidious nature of onset
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 informationAging and Geriatric Assessment March 31, 2008 Sharon Leigh, Pharm D. BCPS Providence ElderPlace
Aging and Geriatric Assessment Page 1 Aging and Geriatric Assessment March 31, 2008 Sharon Leigh, Pharm D. BCPS Providence ElderPlace I. Aging A. Demographics Age 65+ population 3.1 million 1900 31.2 million
More informationPrevention of Medication-Related Falls Through Appropriate Medication Use. Clay Sprouse, MEd., CPhT Piedmont Technical College
Prevention of Medication-Related Falls Through Appropriate Medication Use Clay Sprouse, MEd., CPhT Piedmont Technical College Disclosure I have no relevant financial or nonfinancial relationships to disclose
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 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 informationPreventing Falls in Older Adults A Matter of Safety
Preventing Falls in Older Adults A Matter of Safety Roger Tam, BSc. Pharm. Wal-Mart Clinical Designated Pharmacist Falls Prevention Pharmacist Specialist NCCHC-Pre/Post Test Educator Q.U.I.T Educator Overview
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 informationSafe and Effective Use of. Psychotropic Drugs. Introduction. Psychotropic Drugs. Jun NAKAMURA
Psychotropic Drugs Safe and Effective Use of Psychotropic Drugs JMAJ 47(6): 259 264, 2004 Jun NAKAMURA Professor, Department of Psychiatry, School of Medicine, University of Occupational and Environmental
More informationPennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016
Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016 Disclosures: Drugs in Older Adults: Beers Criteria Heather Sakely,
More informationCHAPTER 2. GERIATRICS, SELF-ASSESSMENT QUESTIONS
CHAPTER 2. GERIATRICS, SELF-ASSESSMENT QUESTIONS 1. The following is an accurate description of the aging population: A. The number of older adults will reach 17 million in 2030 B. The ratio of women to
More informationMedications are Additive (Anticholinergic) Diane W. Healey, M.D. Center for Healthy Aging March 10, 2017
Medications are Additive (Anticholinergic) Diane W. Healey, M.D. Center for Healthy Aging March 10, 2017 Disclosures This speaker has indicated there are no relevant financial relationships to be disclosed.
More informationWorkshop 4: Preventing Falls through Medication Vigilance
Workshop 4: Preventing Falls through Medication Vigilance Nancy L. Losben, R.Ph., CCP, FASCP, CG Chief Quality Officer Omnicare, Inc. & Diane C. Vaughn, RN, C-DONA/LTC, LNHA VP, Clinical Services Benedictine
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 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 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 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 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 informationPolymedication in nursing home. Graziano Onder Centro Medicina dell Invecchiamento Università Cattolica del Sacro Cuore Rome - Italy
Polymedication in nursing home Graziano Onder Centro Medicina dell Invecchiamento Università Cattolica del Sacro Cuore Rome - Italy Services and Health for Elderly in Long TERm care (SHELTER) 4156 residents
More informationInterdisciplinary detection of potential drug related problems in older people
Interdisciplinary detection of potential drug related problems in older people Prof. dr. Mirko Petrovic Department of Internal Medicine, Ghent University Department of Geriatrics, Ghent University Hospital,
More informationAnthony J. Caprio, MD, CMD, AGSF 1
Objectives 1) Discuss the dangers of polypharmacy 2) Review potentially inappropriate medications for older adults Doc, I think I am taking too many medications! 3) Develop strategies for prioritizing
More informationAppropriate prescribing and deprescribing for older people getting it right. Alan Davis Northland District Health Board
Appropriate prescribing and deprescribing for older people getting it right Alan Davis Northland District Health Board Unused returns Potentially inappropriate medication use in the elderly 15% of older
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationFamily Medicine for English language students of Medical University of Lodz. Seminar 12. Elderly care. Przemysław Kardas MD PhD
Family Medicine for English language students of Medical University of Lodz Seminar 12 Elderly care Przemysław Kardas MD PhD Europe is facing demographic challenge 2014 2080 2 3 Old vs young: major differences
More informationUpdated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Dr. Janice Hoffman, PharmD, CGP, FASCP Dr. Sam Shimomura, PharmD, CGP, FASHP Western University of Health Sciences College
More informationDEPRESCRIBING IN THE ELDERLY
DEPRESCRIBING IN THE ELDERLY G E R I A T R I C S R E F R E S H E R D A Y W E D N E S D A Y, A P R I L 5 TH, 2 0 1 7 V É R O N I Q U E F R E N C H M E R K L E Y, M D, C C F P ( C O E ) B R U Y È R E C O
More information2/25/2015 PHARMACODYNAMICS OF AGING: NARROWING OF THE THERAPEUTIC INDEX IN THE FACE OF THERAPEUTIC OPPORTUNITY OVERALL PRESCRIBING
Mean # Drugs/Resident 2/25/2015 PHARMACODYNAMICS OF AGING: NARROWING OF THE THERAPEUTIC INDEX IN THE FACE OF THERAPEUTIC OPPORTUNITY Darrell R. Abernethy, M.D., Ph.D. Associate Director for Drug Safety
More informationDisclosures. Outline. Epidemiology. Medication Management in the Elderly. In 2008 pts age 65 and older represented 40% of all hospitalized adults
Medication Management in the Elderly Disclosures Melissa Stevens MD Atlanta VA Medical Center Assistant Professor Emory University Department of Medicine I have no significant financial interest or other
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 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 information2/26/2015 PHARMACODYNAMICS OF AGING: NARROWING OF THE THERAPEUTIC INDEX IN THE FACE OF THERAPEUTIC OPPORTUNITY
PHARMACODYNAMICS OF AGING: NARROWING OF THE THERAPEUTIC INDEX IN THE FACE OF THERAPEUTIC OPPORTUNITY Darrell R. Abernethy, M.D., Ph.D. Associate Director for Drug Safety Office of Clinical Pharmacology
More informationIatrogenic Delirium. Heather Carey, PharmD, BCPP Clinical Psychiatric Pharmacist University Hospitals Richmond Medical Center
Iatrogenic Delirium Heather Carey, PharmD, BCPP Clinical Psychiatric Pharmacist University Hospitals Richmond Medical Center Objectives Discuss proposed mechanisms of medication induced delirium Identify
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 informationOpioid Use and Misuse in Older Adults. Alison Moore, MD, MPH Division of Geriatrics and Gerontology
Opioid Use and Misuse in Older Adults Alison Moore, MD, MPH Division of Geriatrics and Gerontology 1 Why do older adults use opioids? Persistent pain is experienced by approximately half of people aged
More informationHow to Teach About Drugs and Aging
How to Teach About Drugs and Aging Brandon Koretz MD Assistant Clinical Professor Division of Geriatrics Challenges Prescription pad:internist::scalpel: Surgeon Artificial split between theory and practice
More informationFalls most commonly seen in RACFs are due to tripping, slipping and stumbling (21.6%). Falling down stairs is relatively uncommon in
This Presentation Medications and Falls Dr Peter Tenni M Pharm (Curtin), PhD (UTAS) AACPA Director, CPS A fall is an event which results in a person coming to rest inadvertently on the ground or floor
More informationPHARMACOTHERAPY IN THE OLDER PERSON NAMIRAH JAMSHED M.B;B.S ASSOCIATE PROFESSOR UTSW MEDICAL CENTER DALLAS
1 PHARMACOTHERAPY IN THE OLDER PERSON NAMIRAH JAMSHED M.B;B.S ASSOCIATE PROFESSOR UTSW MEDICAL CENTER DALLAS OBJECTIVES 2 Know and understand: Key issues in geriatric pharmacology Effects of age on pharmacokinetics
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 informationBehavioral Issues in Dementia. March 27, 2014 Dylan Wint, M.D.
Behavioral Issues in Dementia March 27, 2014 Dylan Wint, M.D. OVERVIEW Key points Depression Definitions and detection Treatment Psychosis Definitions and detection Treatment Agitation SOME KEY POINTS
More informationSUMMARY OF PRODUCT CHARACTERISTICS FOR BENZODIAZEPINES AS ANXIOLYTICS OR HYPNOTICS
SUMMARY OF PRODUCT CHARACTERISTICS FOR BENZODIAZEPINES AS ANXIOLYTICS OR HYPNOTICS Guideline Title Summary of Product Characteristics for Benzodiazepines as Anxiolytics or Hypnotics Legislative basis Directive
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 informationUsing the ASCP-NCOA Falls Risk Reduction Toolkit Part 1: A Companion to CDC's STEADI Toolkit
Using the ASCP-NCOA Falls Risk Reduction Toolkit Part 1: A Companion to CDC's STEADI Toolkit Target Audience: Pharmacists ACPE#: 0202-9999-18-056-L01-P Activity Type: Application-based Disclosures Kathleen
More informationMedications Contributing to Falls. Kate Niemann, PharmD BCGP AuBurn Pharmacy
Medications Contributing to Falls Kate Niemann, PharmD BCGP AuBurn Pharmacy Why Are Falls Important? Leading cause of injury in elders Costs to the system (CDC, 2008) ER Visits: 2.2 million $28.2 billion
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 informationFrom the Front Lines AlixaRx Clinical Pharmacists Address Everyday Challenges in Long-Term Care
May 2015 Issue From the Front Lines AlixaRx Clinical Pharmacists Address Everyday Challenges in Long-Term Care Behavior Monitoring When is behavior monitoring required? In Long-term care, medications are
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 informationDEMENTIA AND MEDICATION
DEMENTIA AND MEDICATION Dr. Siobhan Ni Bhriain, MRCP, MRCPsych. Clinical Director, Tallaght and SJH MHS, Consultant Old Age Psychiatrist, Chair, DSIDC Steering Committee. SUMMARY OF TODAY S TALK Dementia-definition,
More informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationJefferson In the News!
Evaluation of a Pharmacist-led Medication Assessment to Identify the Prevalence of Polypharmacy and Potentially Inappropriate Medication (PIM) Use Among Ambulatory Seniors with Cancer Ginah Nightingale,
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 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 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 informationDRUGS THAT ACT IN THE CNS
DRUGS THAT ACT IN THE CNS Anxiolytic and Hypnotic Drugs Dr Karamallah S. Mahmood PhD Clinical Pharmacology 1 OTHER ANXIOLYTIC AGENTS/ A. Antidepressants Many antidepressants are effective in the treatment
More informationPrescribing for older people
Search Student BMJ Search Student BMJ Education Prescribing for older people What do you need to be aware of when prescribing for elderly people? Louise E Cotter and Una Martin discuss By: Louise E Cotter,
More informationFriend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines
Friend or Foe? Review of the Regulations & Benefits: Risk Profiles of the Benzodiazepines Program Learning Objectives At the conclusion of the activity, participants should be able to: Have a basic understanding
More informationA Geriatrician s Perspective on Successful Aging. Ariel Green, MD, MPH Assistant Professor of Medicine
A Geriatrician s Perspective on Successful Aging Ariel Green, MD, MPH Assistant Professor of Medicine 1 Disclosures Johns Hopkins Clinical Research Scholars Program American College of Cardiology Foundation
More informationPolypharmacy in the Elderly
Polypharmacy in the Elderly Or How Scotland invented the Modern World Sir William Ferguson Anderson 1914-2001 Became the first Professor of Geriatrics in the world when he was appointed to the David Cargill
More informationPolypharmacy: What the Nurse Practitioner Should Know Audrey M. Stevenson PhD, MPH, MSN, FNP-BC Las Vegas 2017
Polypharmacy: What the Nurse Practitioner Should Know Audrey M. Stevenson PhD, MPH, MSN, FNP-BC Las Vegas 2017 Disclosure I have no current affiliation or financial arrangement with any grantor or commercial
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 informationNEW ZEALAND DATA SHEET ACUPAN TM. 3. PHARMACEUTICAL FORM White, round, biconvex, film-coated tablets (7 mm diameter) engraved APN on one face.
1. PRODUCT NAME ACUPAN 30 mg tablets 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains nefopam hydrochloride 30 mg. For a full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM
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 informationPolypharmacy: What the Nurse Practitioner Should Know Audrey M. Stevenson PhD, MPH, MSN, FNP-BC Nashville, TN 2017
What is Polypharmacy Polypharmacy: What the Nurse Practitioner Should Know Audrey M. Stevenson PhD, MPH, MSN, FNP-BC Nashville, TN 2017 The use of multiple medications simultaneously Rx OTC Herbal Disclosure
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 informationPRESCRIBING PRACTICE IN DELIRIUM. John Warburton Critical Care Pharmacist
PRESCRIBING PRACTICE IN DELIRIUM John Warburton Critical Care Pharmacist Learning outcomes Modifiable medication risk factors for delirium An appreciation of contributing factors modifiable with medicines
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 informationCan PK and Modelling Help?
Safeguarding public health Can PK and Modelling Help? Terry Shepard Pharmacokinetics Assessor, Statistics Unit MHRA, London EMA Workshop: Ensuring safe and effective medicines for an ageing population
More informationPAIN MANAGEMENT DISCHARGE COMMUNICATION (PM-DC) AUDIT TOOL
PAIN MANAGEMENT DISCHARGE COMMUNICATION (PM-DC) AUDIT TOOL Facility: Date: Data Collector s name: Email/Phone: Purpose: To evaluate your facility practices regarding communication of requisite pain management-related
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 informationManagement of Delirium in Hospice Patients
Presentation Objectives Management of Delirium in Hospice Patients Lynn Williams, BSPharm Clinical Pharmacist Hospice Pharmacy Solutions Identify the clinical features of delirium Understand the underlying
More informationPresenter. Dr. Ronald Lucchino
Adverse Drug Reactions in Adults with Down Syndrome Presenter Dr. Ronald Lucchino rvluc@comcast.net PURPOSE To increase staff awareness that older adults with DD may have higher levels of medication in
More informationM0BCore Safety Profile. Active substance: Bromazepam Pharmaceutical form(s)/strength: Tablets 6 mg FR/H/PSUR/0066/001 Date of FAR:
M0BCore Safety Profile Active substance: Bromazepam Pharmaceutical form(s)/strength: Tablets 6 mg P-RMS: FR/H/PSUR/0066/001 Date of FAR: 26.11.2013 4.3 Contraindications Bromazepam must not be administered
More informationFrom MCI to Dementia DR YU- MIN LIN GERIATRICIAN AUG 2018
From MCI to Dementia DR YU- MIN LIN GERIATRICIAN AUG 2018 Overview What is dementia? Common causes Normal cognitive decline Abnormal decline and mild cognitive impairment How do we manage dementia Can
More informationA Primer on Safe Prescribing to the Elderly. Dr. John Puxty
A Primer on Safe Prescribing to the Elderly Dr. John Puxty Learning Objectives Describe an approach to safe prescribing for older patients. Appreciate the significance and causes of Polypharmacy. Identify
More informationENSURING EXCELLENCE IN PRESCRIBING FOR OLDER ADULTS
ENSURING EXCELLENCE IN PRESCRIBING FOR OLDER ADULTS Philip J. Schneider, MS, FASHP The University of Arizona College of Pharmacy Learning Objectives: Describe the medication-use system and all interdependent
More information