START, STOPP, Beers Oh My! Navigating the World of Geriatric Pharmacy
|
|
- Cody Lee
- 5 years ago
- Views:
Transcription
1 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 options among geriatric patients Identify and review common references for optimizing medication use in the elderly Conduct a patient chart review and identify factors which may influence and/or contribute to potentially inappropriate treatment options among geriatrics Review pertinent counseling points for common Beers List, STOPP, and START criteria medications as it applies to geriatric patients BACKGROUND 1
2 What is Geriatrics? Geriatrics refers to the medical care of the elderly Who is elderly? Difficult to define and resource dependent Typically defined as those aged 60 to 65 years and older Why is Geriatrics important? Physiologic changes among older adults Polypharmacy Potentially inappropriate medications (PIMs) Misuse vs. Under use Medications to avoid Adverse Drug Reactions (ADRs) 25% of ER visits related to ADRs are for elderly patients Drug-Drug Interactions (DDIs) Physiologic Changes in the Elderly PROCESS PHYSIOLOGIC CHANGE CLINICAL SIGNIFICANCE Absorption Decreased gastric acid production (increased gastric ph) Decreased gastric emptying Decreased GI motility Decreased GI blood flow Decreased absorptive surface area Possible reduction of tablet dissolution Possible reduction in solubility Increase exposure time in stomach Distribution Decreased total body mass (lean) Increased body fat Decreased total body water Decreased plasma albumin Altered protein binding Influence dosing weight Alter the onset and duration of water-soluable and highly-tissue bound drugs May delay onset of action among lipophilic drugs 2
3 Physiologic Changes in the Elderly PROCESS PHYSIOLOGIC CHANGE CLINICAL SIGNIFICANCE Metabolism Excretion Tissue Sensitivity Reduced liver mass Reduced blood flow to liver Reduced Phase I metabolism Reduced enzyme activity Reduced renal blood flow Reduced glomerular filtration Reduced function of tubular secretion Alterations in receptor numbers and affinity Alterations in second messanger function s Alterations in cellular and nuclear responses Decreased first passmetabolism Decreased renal elimination Variable sensitivity to drugs Could result in ADE, therapy failure, or insignificant responses Physiologic Changes in the Elderly PHYSIOLOGIC CHANGE Cognitive function may decrease over time Bone loss CLINICAL SIGNIFICANCE May impair understanding and adherence to medication regimen Increase fall risk Increased fracture Gait may slow and balance may worsen May increase fall and fracture risk Polypharmacy What is polypharmacy? Various defined Refers to the use of multiple medications Why is it a concern? Multiple provides Prescribing cascades Increase risk for DDIs and ADRs Inappropriate dosing and prescribing 3
4 QUESTION #1 Which of the following factors can influence medication dosing among the elderly? a) delayed gastric emptying b) declining kidney and liver function c) co-morbidities d) reduced and/or increased sensitivity to certain medications e) all of the above Introduction to Geriatric References Beers Criteria START Criteria STOPP Criteria Canadian Criteria Consider these tools, not rules 2012 AGS BEERS Criteria for Potentially Inappropriate Medication Use in Older Adults List of potentially inappropriate medications (PIMs) for elderly Advantages Quick and easy reference for problem drugs Recent data (2012 update) Disadvantages Limited scope Limited evidence, inconclusive 4
5 START/STOPP Criteria Screening Tool to Alert Doctors to the Right Treatment (START) Screening Tool of Older People s potentially inappropriate Prescriptions (STOPP) Advantages Recommendations for medications that are often omitted with therapeutic alternatives Recent data More patient-centric Disadvantages Limited evidence that outcomes are affected by its use QUESTION #2 Which of the following references can be used to identify potentially inappropriate medication use in the elderly? a) Beers list b) START/STOPP Criteria c) JNC-8 d) A and B e) all of the above What is the concern? Fall Risk Hypoglycemia Hypotension Dizziness Sedation Constipation Urinary Retention Cognitive Impairment Toxicity 5
6 Anticholinergics Constipation/Urinary Retention Oral Corticosteroids complications Limit treatment to exacerbations (<3 months) Beta Blockers Consider cardio-selective beta blockers if necessary Tricyclic Antidepressants Cognitive impairment Alpha blockers Avoid for treatment of HTN Consider 5-alpha reductase inhibitors as alternatives for treatment of BPH Tamsulosin has less ADEs Alpha agonists Avoid (exception with hypertensive emergencies) 6
7 Benzodiazepines Cognitive impairment Re-evaluate need for therapy frequently Consider shorter acting benzodiazepines Antihistamines Constipation Urinary retention If treatment for allergies needed: Reserve for PRN use Consider second generation over first generation Consider nasal corticosteroids instead CASE PRESENTATION AB is a 69 year-old female PMH: COPD, Type 2 Diabetes, dyslipidemia, HTN, and HF C/O recent episodes of falling within past 30 days. Dizziness bothers her the most when she gets out of bed in the morning and middle of the night Medication List: Atorvastatin 10mg qam Carvedilol 6.25mg BID Diazepam 10mg BID PRN (typically takes qhs) Lisinopril 40mg qam Metformin 500mg BID Spiriva qday Symbicort 160/4.5mcg, 2 inhalations BID 7
8 QUESTION #3 Which of the medications on AB s chart may increase her fall risk? a) lisinopril b) diazepam c) atorvastatin d) A and B e) all of the above QUESTION #4 Which of the following counseling points would be appropriate to help AB minimize her fall risk? a) Recommend patient take offending medication(s) at bedtime b) Discuss with patient and provider need for continued use of diazepam c) Recommend patient move slowly and have a grasp on a steady object when changing positions (i.e. sitting to standing) d) B and C e) all of the above 8
9 Rules of Thumb Consider physiologic changes in geriatric patients Evaluate and treat every patient individually Many elderly patients may take these medications, not all require intervention or recommendations to avoid Screen for adverse events at each interaction Counsel patients thoroughly REFERENCES Beers M, Ouslander J, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med 1991; 151: Beyth R, Shorr R. Principles of drugt therapy in older patients: rational drug prescribing. Clin Geriatr Med 2002; 18: Fick D, Cooper J, Wade W, et al. Updating the Beers Criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003; 163: Fick D, Waller J, Maclean J, et al. Potentially inappropriate medication use in a Medicare managed care population: association with higher costs and utilization. J Managed Care Pharm 2001; 7: Goulding M. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 2004; 164: Gu Q, Dillon C, Burt V. Prescription Drug Use Continues to Increase: US Prescription Drug Data for NCHS Data Brief; 42. Available at Accessed on January 27, 2015 Potentially Harmful Drugs in the Elderly: Beers List. Available at 1&dd=280610&pb=PL&searchid= #CHART4413. Accessed on January 6, Reuben D, Herr K, Pacala J, et al. Geriatrics at Your Fingertips. 16 th ed. American Geriatrics Society; STARTing and STOPPing Medications in the Elderly. Available at Accessed on January 6,
Geriatric 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 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 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 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 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 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 informationSafe Medication Use. Holly Divine, PharmD, CGP, CDE. University of Kentucky College of Pharmacy Department of Pharmacy Practice & Science
Safe Medication Use in the Older Adult Holly Divine, PharmD, CGP, CDE Associate Professor University of Kentucky College of Pharmacy Department of Pharmacy Practice & Science Objectives Know the principles
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 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 informationARIC Manuscript Proposal #2493. PC Reviewed: 2/10/15 Status: A Priority: 2 SC Reviewed: Status: Priority:
ARIC Manuscript Proposal #2493 PC Reviewed: 2/10/15 Status: A Priority: 2 SC Reviewed: Status: Priority: 1. a. Full Title: Potentially inappropriate medication use in older people: Prevalence and outcomes.
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 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 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 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 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 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 informationPhysical and Sensory Changes in the Older Adult: Considerations for Medication Management
Physical and Sensory Changes in the Older Adult: Considerations for Medication Management Amber M. Hutchison, PharmD, BCPS Assistant Clinical Professor Auburn University Harrison School of Pharmacy Disclosure/Conflict
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 informationPolypharmacy and Elders. Leslie Baker, Pharm. D., RPh, CGP Sanford Center for Aging
Polypharmacy and Elders Leslie Baker, Pharm. D., RPh, CGP Sanford Center for Aging Prescription Medication Use In Elders 1 13% of the US population is age 65+ Age 65 years 13% Age 65+ account for 34% of
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 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 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 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 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 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 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 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 informationVariation in drug responses & Drug-Drug Interactions
Variation in drug responses & Drug-Drug Interactions 1 Properties of an Ideal Drug Effective Safety Selective Reversible Action Predictable Freedom from drug interactions Low cost Chemically stable Sources
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 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 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 informationDeprescribing with Confidence Dr Sanjay Suman MD FRCP
Deprescribing with Confidence Dr Sanjay Suman MD FRCP Clinical Director Elderly Care and Stroke Medway NHS Foundation Trust Kent 45% of all medications prescribed for 65 years 1 1. Wynne et al Maturitas
More informationJanice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND THE OLDER ADULT
Janice Lazear, DNP, FNP-C, CDE DIAGNOSIS AND THE OLDER ADULT Objectives u At conclusion of the presentation the participant will: 1. Discuss challenges to glycemic control unique in the older population
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 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 informationRational Pharmacotherapy for LUTS in Older People. Dr William Gibson MBChB MRCP
Rational Pharmacotherapy for LUTS in Older People Dr William Gibson MBChB MRCP Frailty Frailty = state of increased vulnerability resulting from agingassociated decline in reserve and function NOT synonymous
More informationLearning Objectives 2/4/2016. Patrick Leung, Pharm.D., BCPS, PhC. Patrick Leung, Pharm.D., BCPS, PhC Davena Norris, Pharm.D., BCPS, PhC 2/20/2016
Patrick Leung, Pharm.D., BCPS, PhC Davena Norris, Pharm.D., BCPS, PhC 2/20/2016 Learning Objectives Identify age-related pharmacokinetic and pharmacodynamic changes in older adults. Utilization the START/STOPP
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 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 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 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 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 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 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 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 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 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 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 informationIntelligent Polypharmacy. Professor Colin P Bradley Department of General Practice University College Cork
Intelligent Polypharmacy Professor Colin P Bradley Department of General Practice University College Cork Polypharmacy No standard definition 2005 review the use of medications that are not clinically
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 informationUSING MTM TO IMPROVE STAR RATINGS : CASE STUDIES
USING MTM TO IMPROVE STAR RATINGS : CASE STUDIES Sept 13, 2015 Amanda Applegate, PharmD, BCACP Disclosures Nothing to disclose Learning Objectives Describe how MTM can improve star ratings Discuss strategies
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 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 informationIntroducing Pharmacokinetics and Pharmacodynamics. Janice Davies Pharmacist Room 23 Maudland Building
Introducing Pharmacokinetics and Pharmacodynamics Janice Davies Pharmacist Room 23 Maudland Building JADavies5@uclan.ac.uk 1 elearn 2 DVD Any problems / questions? 3 Learning outcomes Define and discuss
More informationOpen Access. A Prospective Study on Medication Prescribing Pattern for Geriatric Patients in a Tertiary Care Teaching Hospital
A Prospective Study on Medication Prescribing Pattern for Geriatric Patients in a Tertiary Care Teaching Hospital Research Article Article Info: Received on: 02/05/2016 Published on:31/05/2016 QR Code
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 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 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 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 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 informationConflict of interest declaration and sources of funding
Potentially Inappropriate Prescribing immediately prior to Long-Term Care admission (PIP in LTC): Validation of tools for their future use across Ontario Bruyère CLRI Webinar March 24 th, 2016 and Bruyère
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 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 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 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 informationNational Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL or FAX
National Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie PRESCRIBING IN THE ELDERLY INTRODUCTION According to the most recent census
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 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 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 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 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 informationNavigating the Road to Efficient Medication Use
Navigating the Road to Efficient Medication Use Molly R. Sinert, RPh, PharmD Clinical Pharmacist HospiScript Services LLC a Catamaran Rx Company October 28, 2013 Objectives Describe the components of the
More informationPharmacotherapy In Geriatrics: Cause For Concern
http://www.dcmsonline.org/jax-medicine/1998journals/august98/geriatrics.htm Pharmacotherapy In Geriatrics: Cause For Concern Sherry A. King, M.D. Sherry A. King, M.D. is Clinical Assistant Professor of
More informationChitra Fernando, MD March 18, 2008
Chitra Fernando, MD March 18, 2008 Definition Statistics Risk factors Why older adults are more prone to ADE Manifestations Inappropriate medications for older adults What can be done to minimize adverse
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 informationROAD TO UNDERSTANDING POLYPHARMACY. Lt Col PHIL L. SAMPLES BS Phr, Pharm. D., BCNSP
ROAD TO UNDERSTANDING POLYPHARMACY Lt Col PHIL L. SAMPLES BS Phr, Pharm. D., BCNSP Definition occurs when: 1. a medical regimen includes at least one unnecessary medication 2. Medications have not been
More informationAspirin and Sta,ns and Benzos! Oh My! Polypharmacy in the Older Adult
Aspirin and Sta,ns and Benzos! Oh My! Polypharmacy in the Older Adult Valerie Zamudio, MD Advanced Fellow, Geriatric Medicine UCLA Bureau of Health Professions Faculty Training Program February 25, 2015
More informationPrescribing in the Elderly. Dr Alison Macrae and Dr Debbie Vest GPST2 Drs in Psychiatry
Prescribing in the Elderly Dr Alison Macrae and Dr Debbie Vest GPST2 Drs in Psychiatry 24 th September 2014 Objectives Understand the significance of polypharmacy in the elderly Become familiar with the
More informationMedication Management When Caring for Seniors at Home
Medication Management When Caring for Seniors at Home White Paper May 24, 2013 2013 Physician s Choice Private Duty http://private-duty.pchhc.com 1 Proper medication management for seniors who live at
More informationTaking the harm out of Polypharmacy Step by step. Karen Reid and Claire Stein Lead Integrated Care Pharmacist NHS Lothian
Taking the harm out of Polypharmacy Step by step Karen Reid and Claire Stein Lead Integrated Care Pharmacist NHS Lothian Presentation: Polypharmacy Overview of the 2015 guidelines The Seven Steps Application
More informationDisclosure and Acknowledgements
Greetings from Penn Nursing SOHN 37 TH ANNUAL CONGRESS AND NURSING SYMPOSIUM POLYPHARMACY AND OLDER ADULTS: HIGH RISK MEDS, TOO MANY MEDS, AND TOO FEW MEDS Sarah H. Kagan PhD, RN University of Pennsylvania,
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 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 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 informationManagement of DM in Older Adults: It s not all about sugar! Who needs treatment for DM? Peggy Odegard, Pharm.D., BCPS, CDE
Management of DM in Older Adults: It s not all about sugar! Peggy Odegard, Pharm.D., BCPS, CDE Who needs treatment for DM? 87 year old, frail male with moderately severe dementia living in NH with persistent
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 informationSlide 1. Slide 2. Slide 3. Drug Action and Handling. Lesson 2.1. Lesson 2.1. Drug Action and Handling. Drug Action and Handling.
Slide 1 Drug Action and Handling Chapter 2 1 Slide 2 Lesson 2.1 Drug Action and Handling 1. Differentiate dose, potency, and efficacy in the context of the actions of drugs. 2. Explain the pharmacologic
More informationNOCDURNA (desmopressin acetate) sublingual tablets Initial U.S. Approval: 1978
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use safely and effectively. See full prescribing information for. (desmopressin acetate) sublingual tablets
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 informationLet it go! Rationalising medicines for patients with life limiting illness
Let it go! Rationalising medicines for patients with life limiting illness Inga Andrew Senior Clinical Pharmacist Northumbria Healthcare Trust E-mail: inga_andrew@northumbria-healthcare.nhs.uk Welcome
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 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 informationThe Use, Misuse and Abuse of Alcohol, and Psychoactive Drugs among Older Persons
The Use, Misuse and Abuse of Alcohol, and Psychoactive Drugs among Older Persons Alison A. Moore, MD, MPH Division of Geriatric Medicine David Geffen School of Medicine at UCLA Drinking in Older Adults:
More informationDIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 37 TOP: NURSING PROCESS: General MSC: NCLEX: Health Promotion and Maintenance
Instant download and all chapters Test Bank Pharmacology and the Nursing Process 8th Edition Linda Lane Lilley https://testbanklab.com/download/test-bank-pharmacology-nursing-process-8th-editionlinda-lane-lilley/
More informationSummary of Lothian Joint Formulary Amendments
Summary of Lothian Joint Formulary Amendments The purpose of this summary is to detail the main changes to the LJF sections and provide additional information on the reasons for some of the changes. The
More information2/11/2016. Managing Polypharmacy: Evidence-based Dissection of Pharmaceuticals. Disclosure. Objectives
Managing Polypharmacy: Evidence-based Dissection of Pharmaceuticals Heather Veeder MD Medical Director VITAS Healthcare San Antonio, TX Adjunct Professor of Medicine University of Texas Health Science
More informationAgonists: morphine, fentanyl Agonists-Antagonists: nalbuphine Antagonists: naloxone
Opioid Definition All drugs, natural or synthetic, that bind to opiate receptors Agonists: morphine, fentanyl Agonists-Antagonists: nalbuphine Antagonists: naloxone Opioid agonists increase pain threshold
More informationApplication for Endorsement of CQI (Clinical Audit) Activities for MOPS Credits Allocation
Application for Endorsement of CQI (Clinical Audit) Activities for MOPS Credits Allocation Below is the form you need to fill out. NAME Dianne Vicary Health Hawke s Bay DATE JUNE 2012 TITLE OF ACTIVITY
More informationSymptom Management Challenges at End-of-Life
Symptom Management Challenges at End-of-Life Amanda Lovell, PharmD, BCGP Clinical Pharmacist- Inpatient Units Optum Hospice Pharmacy Services February 15, 2018 Hospice Pharmacy Services Objectives Identify
More informationINSOMNIA IN THE GERIATRIC POPULATION. Shannon Bush, MS4
INSOMNIA IN THE GERIATRIC POPULATION Shannon Bush, MS4 CHANGES IN SLEEP ARCHITECTURE 2 Reduction in slow wave sleep (stage 3 and 4) Increase in lighter stages of sleep (stage 1 and 2) Decrease in REM sleep
More information