Geriatric Pharmacology

2004 ◽  
Vol 94 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Rollin M. Wright ◽  
Rick W. Warpula
Keyword(s):  
Elderly Patients ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Drug Effects ◽  
Drug Dose ◽  
Adverse Drug Effects ◽  
Prescribing Practices ◽  
Older Patient ◽  
Dose Frequency ◽  
Age Related

Adverse drug effects are common in elderly patients but can often be avoided. Judicious prescribing practices require the clinician to be aware of age-related changes in drug absorption, distribution, metabolism, and elimination. Clinicians may need to adjust drug dose, frequency, or the choice of drug altogether as they consider the physiologic changes of aging. This article reviews prescribing situations with elderly patients commonly encountered by the podiatric physician. Strategies for medication management are provided to minimize the risk of adverse drug events in the older patient. (J Am Podiatr Med Assoc 94(2): 90-97, 2004)

scholarly journals Drug Prescribing to the Elderly Patients

2018 ◽  
Vol 1 (2) ◽  
pp. 65
Author(s):  
Misha’l Aly A
Keyword(s):  
Elderly Patients ◽  
Drug Interactions ◽  
Adverse Drug Event ◽  
Older Patients ◽  
Adverse Drug Events ◽  
The Elderly ◽  
Health Sciences ◽  
Drug Event ◽  
Drug Prescribing ◽  
Age Related

Age-related physiologic and anatomic changes in various body systems are accompanied by significant pharmacokinetic and pharmacodynamic alterations that make it mandatory for treating physicians to adjust types and dosages of medications for their older patients. Moreover, physicians should be always alert for adverse drug events, and consider any new symptoms as drug-related until proven otherwise. Other issues addressed include prescribing cascades, polypharmacy, drug-drug interactions, and the need to review all medications used by the elderly patients, with special attention to non-prescription and herbetic drugs. This review aims at maximizing safe medicine prescribing, and minimizing adverse drug event in caring for older subjects.International Journal of Human and Health Sciences Vol. 01 No. 02 July’17. Page : 65-69

scholarly journals Effects of a pilot multidisciplinary clinic for frequent attending elderly patients on deprescribing

2016 ◽  
Vol 40 (1) ◽  
pp. 86 ◽  
Author(s):  
Alison Mudge ◽  
Katherine Radnedge ◽  
Karen Kasper ◽  
Robert Mullins ◽  
Julie Adsett ◽  
...  
Keyword(s):  
Pilot Study ◽  
Elderly Patients ◽  
Adverse Drug Events ◽  
Hospital Admissions ◽  
Medication Management ◽  
Management Plan ◽  
Transitions Of Care ◽  
Potentially Inappropriate Medications ◽  
Medical Patients ◽  
Medication History

Objective Multimorbidity and associated polypharmacy are risk factors for hospital re-admission. The Targeting Hospitalization Risks in Vulnerable Elders (THRIVE) clinic is a novel multidisciplinary out-patient clinic to improve transitions of care and decrease re-admission risk for older medical patients with frequent hospital admissions. This pilot study examined the effect of the THRIVE model on medication count, tablet load and potentially inappropriate medicines (PIMs). Methods Participants with frequent medical admissions were referred within 2 weeks of discharge from hospital and assessed at baseline and then at 4 and 12 weeks by the THRIVE team. A thorough reconciliation of all medications was performed collaboratively by a clinical pharmacist and a physician. Optimising medications, including deprescribing, was in collaboration with the participants’ general practitioner. The complete medication history of each patient was compared retrospectively by an independent assessor at baseline and after the 12-week clinic, comparing total number of regular medications, tablet load and PIMs (measured using the Screening Tool of Older Persons Prescriptions (STOPP) tool). Results All 17 participants attending the pilot THRIVE clinic were included in the study. At 12 weeks, there was a significant reduction in mean medication count (from 14.3 to 11.2 medications; P < 0.001) and mean tablet load (from 20.5 to 16.9 tablets; P < 0.01). There was an absolute reduction in the total number of PIMs from 38 to 14. Common medications deprescribed included opioids, tricyclic antidepressants, benzodiazepines and diuretics. Conclusions Patients who attended the THRIVE clinic had a significant reduction in medication count and tablet load. The pilot study demonstrates the potential benefits of a multidisciplinary out-patient clinic to improve prescribing and reduce unwarranted medications in an elderly population. An adequately powered comparative study would allow assessment of clinical outcomes and costs. What is known about the topic? Elderly patients are prone to polypharmacy. The identification and deprescribing of potentially inappropriate medications is effective in reducing adverse drug events in this population. However, acute hospitalisation is not always the ideal setting to initiate deprescribing. What does the paper add? Intensive multidisciplinary out-patient care for frequently re-admitted patients optimises their medication management plan and helps reduce the use of unwarranted medications. What are the implications for practitioners? Effective deprescribing in elderly patients can be achieved after hospital discharge using a multidisciplinary collaborative model, but costs and clinical benefits require further investigation.

Adverse Drug Effects in Ambulatory Elderly Patients--Reply

JAMA ◽  
2003 ◽  
Vol 289 (24) ◽  
pp. 3238-b-3239
Author(s):  
J. H. Gurwitz
Keyword(s):  
Elderly Patients ◽  
Drug Effects ◽  
Adverse Drug Effects

Adverse Drug Effects in Ambulatory Elderly Patients--Reply

JAMA ◽  
2003 ◽  
Vol 289 (24) ◽  
pp. 3238-a-3238
Author(s):  
G. K. Graham
Keyword(s):  
Elderly Patients ◽  
Drug Effects ◽  
Adverse Drug Effects

scholarly journals Cross-sectional study on the drug utilization and evaluation indicator of antibiotics used in pediatric population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xu Hu ◽  
Xueting Zhang ◽  
Yao Wang ◽  
Xuefeng Xie
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Pediatric Population ◽  
Effective Means ◽  
Drug Dose ◽  
Defined Daily Dose ◽  
Dose Frequency ◽  
Cross Sectional ◽  
Age Related ◽  
Antibiotic Drug ◽  
Daily Dose

Abstract Background The lack of medication standards is a serious problem in paediatrics mainly because of age-related differences in organ development and physiological functions in children. Consequently, dosage measurement becomes inaccurate. For this reason, methods for evaluating and monitoring rational paediatric medications should be developed. Drug use indicators, such as those similar to the drug utilisation index (DUI) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) and widely used for the assessment of appropriate dosage in adults, should be explored in terms of their applicability to children. Methods A total of 5,538 prescriptions of antibiotics selected from a general teaching hospital were included. Drug, dose, frequency and treatment duration were obtained from each prescription. The prescription daily dose (PDD) of each antibiotic drug was calculated as the average of the daily doses. Underdose and overdose were determined in terms of the PDD/DDD ratio for each prescription. Children’s DUI (cDUI) was explored in terms of the appropriate dosage for children as follows: the meaning of children’s DDD (cDDD) and the evaluation of paediatric drug dosage. Results The top five antibiotics and their utilisation rates were as follows: cefmetazole sodium injection (18.47 %), erythromycin lactobionate injection (15.07 %), amoxicillin/clavulanate potassium injection (10.72 %), ceftriaxone sodium injection (9.50 %) and azithromycin dry suspension (8.02 %). The ratio of cDUI and PDD/cDDD was mostly not close to 1. Conclusions The establishment of a cDUI system is an effective means of paediatric dosage evaluation. In addition to DDDs, cDUI and PDD/cDDD should be used to analyse the utilisation of antibiotics in children.

scholarly journals OPTIMAL MEDICATION MANAGEMENT IN ALZHEIMER’S DISEASE AND DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S13-S13
Author(s):  
Ariel Green
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Adverse Drug Events ◽  
Medication Management ◽  
Drug Effects ◽  
Multiple Chronic Conditions ◽  
Older Individuals ◽  
Cognitive Changes ◽  
Medication Side ◽  
Caucasian Patients

Abstract For older individuals with Alzheimer’s disease and related dementias (ADRD) and multiple chronic conditions (MCC), taking more medications is associated with greater risk of adverse drug events, drug interactions, treatment burden, and cognitive changes from medication side effects. Optimizing medication through deprescribing (the process of reducing or stopping the use of inappropriate medications or medications unlikely to be beneficial) can help avoid adverse drug effects and improve outcomes for MCC patients, particularly for those with ADRD. Findings to date are limited to primarily Caucasian patients. This talk will focus on work geared to elicit perspectives on medication use, communication about medication, and deprescribing among African American and Hispanic older adults with ADRD and MCC, their family members, and clinicians caring for these populations.

Pain Management in Elderly Patients

2007 ◽  
Vol 20 (1) ◽  
pp. 49-63 ◽  
Author(s):  
Meri D. Hix
Keyword(s):  
Pain Management ◽  
Adverse Effects ◽  
Elderly Patients ◽  
Pain Perception ◽  
Drug Effects ◽  
Interdisciplinary Approach ◽  
Underlying Mechanism ◽  
Pharmacologic Therapy ◽  
Geriatric Population ◽  
Age Related

In elderly patients, persistent pain negatively impacts quality of life. An interdisciplinary approach to pain management and emphasis on quality improvement will help to achieve better therapeutic outcomes. Managing pain in the geriatric population is challenging because of age-related changes in pain perception, cognition, pharmacokinetics, and drug effects. Improvement and maintenance of physical and emotional function is the goal. Pharmacotherapy should be initiated conservatively and titrated to effective doses with minimal adverse effects. Milder pain should be treated with non-opioid analgesics with a progression toward opioids and/or adjuvant medications as the pain intensifies. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant medications represent most of the analgesic agents used in pain management. Knowing the underlying mechanism of pain will help guide pharmacologic therapy. The patient should be monitored initially, with every dose change, and periodically to assess efficacy and severity of adverse effects.

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