PILLS, PILLS, and MORE PILLS! Sound principles of geriatric pharmacology
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1 PILLS, PILLS, and MORE PILLS! Sound principles of geriatric pharmacology Tatyana Gurvich, Pharm.D. USC School of Pharmacy/UCI Sr. Health Center Glendale Adventist FPRP
2 You re Only Old Once! Repeat after me... This small white pill is what I munch at breakfast and right after lunch. I take the pill that s kelly green before each meal and in between... This long flat one is what I take if I should die before I wake. - Dr. Seuss
3 OVERVIEW Age Associated Changes which affect drug therapy Polymedicine/Polypharmacy: What is it? Problem medications What patients can do to improve care? Medications and quality of life
4 Medication Usage by Older patients Older Americans spend $3 billion annually on prescription medications. Most take an average of 3-5 Rx and 3-4 OTC medications 40% of older patients have used some form of dietary supplement within the past year. Adverse Drug Reactions are more common with 5 or more drugs daily
5 Contributing Factors Multiple disease states Multiple health-care providers Time constraints Use of non-prescription medications and herbs Patient driven prescribing New drugs on the market/samples
6 Age Associated Changes which affect drug therapy How is a drug absorbed? How is a drug distributed in the body? How is the drug broken down? How is it cleared?
7 Absorption Stomach acidity changes The gut slows down The rate of absorption changes /Onset of action may be delayed Advil for HA vs. Advil for arthritis
8 Drug Distribution in the body Body fat, water and muscle changes Drugs stay in the body longer; Become more concentrated; Have a prolonged effect Dosage reductions become necessary
9 Medication Breakdown Liver function is highly variable Dependent on many factors: Genetics, Age, Liver disease, Life style Potential for Drug-Drug Interactions
10 Drug Elimination Kidney function declines with age Medication doses must be adjusted Fosamax, Antibiotics, Neurontin Adverse events may be related to kidney function Metformin, Arthritis Medicines Some medications become ineffective Dyazide
11 Drug Sensitivity Changes Older adults become more sensitive to medication side effects: Motrin, Norvasc, Decongestants, breathing treatments Certain medicines are poorly tolerated in older patients Benadryl/ Tylenol PM (Diphenhydramine), Ditropan Blood-brain barrier permeability Timoptic eye drops
12 What is Polymedicine? The use of unnecessary medications which is independent of the number of medications being taken
13 The prescribing cascade Drug induced adverse events which mimic symptoms of other diseases or can precipitate confusion, and or falls. Prozac TO a FALL Prozac for depression. Ativan for Prozac induced anxiety and insomnia. Pt became dizzy, fell and broke a hip Plendil TO a diagnosis of GERD and an ORTHO work up Plendlil for high blood pressure; Prilosec given for Plendil induced heart burn and ORTHO work up ordered for Plendil induced edema Verapamil TO Haldol Verapamil for high blood pressure; Lasix for Verapamil induced Edema; Ditropan for Lasix induced incontinence; Haldol for Ditropan induced confusion and agitation due to Ditropan induced side effects
14 Problem Medications Medicines which work centrally Prozac, Older Anti-depressants Medicines for anxiety and sleep Muscle relaxants
15 Problem Medications Cont: Verapamil when used for blood pressure Clonidine Coumadin (blood thinner)
16 Problem Medications: Cont Cimetidine Anti-cholinergic medications Antihistamines, urinary incontinence medications, stomach anti-spasmodics Sodium containing antacids
17 Problem Medications: Cont Theophylline Inhaler systems Medicines for Osteoporosis Medicines for Arthritis
18 Steps to Reducing Poly-pharmacy Brown Bag all medications at each office visit. Keep accurate records Know all medications by brand/generic name and drug class All drugs prescribed should have a clinical indication Stop any drug without known benefit
19 Steps to Reducing Polypharmacy (CONT) Know the side effects of the drugs prescribed and what to expect from them Be aware for the prescribing cascade: Pay attention to ANY new symptom. It may be a new drug side effect. ONE DISEASE, ONE DRUG, ONCE DAILY START LOW, GO SLOW, BUT GO
20 Steps to Reducing Poly-pharmacy (CONT) Know what you are allergic to: A true allergy vs. a drug intolerance Clean out your medicine cabinet: Get rid of all old prescription vials Go to a single pharmacy: Make sure they have accurate records Check with your doctor before taking anything OTC or herbal Consider what effect drug therapy has on quality of life
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