Meds and Falls: Keep in Step with your Meds

Transcription

1 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 March 2017

2 Objectives Learn about medications that may increase your of falling Learn about programs and techniques you can use to find out more Discuss best choice options for the older patient including new guidelines Evaluate a patient medication list to recognize red flags of medications that may increase risk of falls risk

3 Beers List

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6 Syncope Gait Vision Cognition Polypharmacy Vitamin D deficiency Orthostatic hypotension

7 Polypharmacy

8 Gait Vision Cognition Polypharmacy Vitamin D deficiency Orthostatic hypotension Syncope

9 Syncope Diuretics or water pills Nitroglycerin Blood pressure medications Erectile dysfunction medications Eye drops

10 Syncope Vision Cognition Polypharmacy Vitamin D deficiency Orthostatic hypotension Gait

11 Gait/Mobility Impairment First generation antihistamines or allergy medications Benzodiazepines of medications for anxiety Muscle relaxants Alcohol

12 Syncope Gait Cognition Polypharmacy Vitamin D deficiency Orthostatic hypotension Vision

13 Vision/Sensory Impairment Seizure medications Medications to strengthen bones Allergy and sleep medications Erectile dysfunction medications Pain reliever: Celecoxib (Celebrex ) Incontinence medications

14 Syncope Gait Vision Polypharmacy Vitamin D deficiency Orthostatic hypotension Cognition

15 Cognitive Impairment Benzodiazepines or anti-anxiety medications Pain relievers Alcohol Diabetic medications Blood pressure/cardiac medications Anticholinergics/antihistamines Antiparkinsonian Seizure medications Antidepressants/antipsychotics

16 Syncope Gait Vision Cognition Polypharmacy Vitamin D deficiency Orthostatic hypotension

17 Orthostatic Hypotension Blood pressure medications Antipsychotics Antidepressants Antiparkinsonian Nitrates Narcotics/Pain relievers Anticholinergics/urinary incontinence/allergy medications

18 Syncope Gait Vision Cognition Polypharmacy Orthostatic hypotension Vitamin D deficiency

19 Condition Avoid/Use with caution Better Option Pain Anxiety Depression Insomnia Oxycodone, hydrocodone, ibuprofen, naproxen Diazepam, clonazepam, alprazolam, lorazepam Fluoxetine, paroxetine, citalopram > 20mg Diazepam, clonazepam, lorazepam acetaminophen Sertraline Sertraline Melatonin Diabetes Glyburide Glipizide or glimepiride Reflux/Stomach Acid Omeprazole, pantoprazole, and other PPIs (long term) PPIs for 1-2 weeks, or use ranitidine Nerve Pain Gabapentin Lowest dose; Have Magnesium levels checked

20 Good Reliable Information

21 Get Your Meds Checked

22 Medication Appropriateness Index Indication for medication? Medication effective for condition? Correct dosage? Correct directions are they practical? Drug/drug interactions? Drug/disease interactions? Duplication of therapy? Duration of therapy appropriate? Least expensive alternative for similar outcomes?

23 Ask Me 3 1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this? Empowers patient

24 Teach Back Method

25 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid Omeprazole 20mg daily Simvastatin 20mg qd Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals

26 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid Omeprazole 20mg daily Simvastatin 20mg daily Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals

27 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid Omeprazole 20mg daily Simvastatin 20mg daily Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals

28 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid Omeprazole 20mg daily Simvastatin 20mg daily Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals

29 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid Omeprazole 20mg daily Simvastatin 20mg daily Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals

30 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid Omeprazole 20mg daily Simvastatin 20mg daily Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals

31 Case A 76 yo woman is discharged from the hospital. The medications she is taking includes the following. What medications may increase her risk of falling? Medications: Amlodipine 5mg daily Aspirin 81mg daily Clonazepam 0.5mg tid prn Furosemide 40mg daily Levemir 10 units daily Lisinopril 10mg daily Metformin 1000mg bid? Calcium 500mg daily or bid Omeprazole 20mg daily Simvastatin 20mg daily Bupropion SR 150mg bid Naproxen 500mg bid Gabapentin 300mg tid Nicotine patch 14mg/24hr qd NovoLog 6 units before meals? Vitamin D IU daily

32 Remember Falls can be prevented Check your Meds Thank you

33 References American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. JAGS 2015;63: Gallagher PF, O Connor MN, O Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clinical Pharmacology & Therapeutics. 2011;89(6): Hutchinson LC, Sleeper RB. Polypharmacy and other forms of suboptimal drug use in older patients. In: Fundamentals of Geriatric Pharmacotherapy. ASHP. Bethesda, MD. 2010:p STEADI (Stopping Elderly Accidents, Deaths & Injuries) Tool Kit for Health Care Providers. Last reviewed: September 30, 2015; Last updated: September 30, 2015; Accessed April 26, Moylan KC, Binder EF. Falls in Older Adults: Risk assessment, management and prevention. The American Journal of Medicine. 2007;120: