Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher Do you know the common Beer’s Criteria Medications, these are medications to watch out for and avoid in geriatric populations? You would be surprised at all the changes we experience with the aging process. What we may consider a safe medication when we are younger can become quite dangerous to our body as we age. What vitamin deficiency in the geriatric population can lead to memory impairment, fatigue, irritability, mood changes? Let’s find out! Begin your journey and become a very informed consumer. This short slide deck is your passageway to obtaining medication and supplement safety super geriatric knowledge. Special focus on geriatric populations. Learn it-Live it-Love it-Take control of your health! Michelle Peck | Legal Nurse | Nurse Practitioner | Health Care | Geriatric | Consultant | Speaker | Educator | Researcher

1. SOME GOOD…
SOME BAD…
SOME WONDERFUL…
MEDICATIONS &
SUPPLEMENTS
MICHELLE PECK & COMPANY
Michelle Peck, MSN, MPH, ANP-BC, GNP-BC, CLNC
Nurse Practitioner | Nursing Faculty | Legal Nurse
WEB nursepeck.com

2. PRESCRIBING CHALLENGES
AGE OVER 60
Adverse drug reactions
increase as the number of
prescribed medications
increases
Adherence to complex,
multiple drugs is difficult:
poor vision, poor memory,
limited funds, etc.

3. ADVERSE DRUG EVENTS
Multiple medications is
the primary risk factor
Multiple medical
conditions increases
risk
Many reactions
preventable

4. PRESCRIBING STRATEGIES
Prescribing ALL indicated
medications, may NOT be
the best approach
Triage medications - start
with most needed first,
assess impact and then
add second most
important…
Some conditions assumed
to be “aging” can be drug
effects - confusion, falls,
incontinence
Try Using One Drug to
Treat Multiple Problems

5. RISK FACTORS FOR ADVERSE
DRUG EVENTS INCREASE
> 6 DIAGNOSES
> 12 MED DOSES/DAY
> 9 MEDICATIONS
MULTIPLE PRESCRIBERS
A PREVIOUS REACTION
LOW BODY WEIGHT
AGE > 85 YEARS
KIDNEY, LIVER FUNCTION

6. BENEFIT VS.
Appropriate medication use requires that
benefits of therapy clearly outweigh the
associated risks.
Benefit-to-risk ratio is unique to an
individual; the very medication and dosage
that helps one patient may harm another.

7. BEER’S CRITERIA
Expert Panel from around the world
Developed this wonderful list of Medications to Avoid
if you are over 65
Recently Updated in 2012
Severity ratings of medications on High to Low Scale
Problems grouped based on Disease
Concerns listed independent of Disease

10. > 65 YEARS AVOID MEDS HIGH
ANTI-CHOLINERGIC PROPERTIES
Benadryl
Tricyclic antidepressants
Anti-spasmotics
Anti-psychotics
Anti-parkinsonian and muscle
relaxants
Urinary incontinence medications

11. AVOID DRUG-DISEASE
INTERACTIONS
Avoid NSAIDs (Aleve, Ibuprofen, Advil):
With Stomach, Colon Bleeding & Kidney Disease
Avoid Anticholinergic Medications:
With Prostate/Bladder Outlet Obstruction,
Alzheimer’s Disease & Chronic Constipation
Avoid Benzodiazepines/Tricyclic Antidepressants:
With Falling & Balance Disturbances

12. How YOU take
YOUR medication
matters!

13. Read the Rx label.
Know your
pharmacist.
Ask questions.
Often taking medications or vitamins with food or drinks
other than water can decrease the effectiveness.
Grapefruit juice should be avoided with medications and
supplements, it severely decreases effectiveness.

14. WHAT YOU TAKE WITH
MEDICATION MATTERS.
Levothyroxine Example:
Only 60-80% is absorbed.
Absorption occurs 3 hours of ingestion.
Maximal absorption when stomach is empty:
Calcium binds and will reduce absorption;
Coffee decreases absorption by 27-36%.

15. RISKS, ESPECIALLY TO
OLDER CONSUMERS
Many supplements contain active ingredients
that have strong biological effects in the body
This could make them unsafe in some situations
St. John’s Wort Example: May reduce the effectiveness
of prescription drugs used for heart disease,
depression, seizures, and certain cancers.

16. COMPLEMENTARY
AND
ALTERNATIVE
MEDICINE
CAM

17. What are examples
of CAM?

18. DIETARY
SUPPLEMENTS

20. A DIETARY SUPPLEMENT
A product (other than tobacco) intended to
supplement the diet that bears or contains one or
more of the following dietary ingredients
VITAMINS
MINERALS
HERBS OR OTHER BOTANICALS
AMINO ACIDS
CONCENTRATE, METABOLITE,
CONSTITUENT, EXTRACT OR
COMBINATION OF INGREDIENTS

21. Are dangerous
supplements
marketed and sold
to consumers?

22. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm236774.htm

23. THE DIRTY DOZEN
ACONITE
BITTER ORANGE
CHAPARRAL
COLLOIDAL SILVER
COLTSFOOT
COMFREY
COUNTRY MALLOW
GERMANIUM
GREATER CELANDINE
KAVA
LOBELIA
YOHIMBE
Why are they still for sale?
Two national retailers we
contacted about specific
supplements said they
carried them because the
FDA has not banned them…
The FDA does not regulate
supplements so they cannot
ban them!

24. You have to be careful about
what supplements you take!
Most health care consumers DO NOT inform their
health care providers of their supplement use.
They think that either their provider does not care
or does not need to know.
This bad logic can lead to BIG FAILURE.

25. DIETARY SUPPLEMENTS
Example: St.
John’s Wort can
increase the
metabolism of
other drugs
making them
less effective…

26. Example: Kava Kava is
associated with liver
toxicity…

27. Example: Echinacea
decreases immune
response with long-term
use…

28. The “G-Team” Ginkgo
Biloba, Garlic & Ginger
all have antiplatelet
effects and can lead to
uncontrolled bleeding…

29. TO CHOOSE GOOD
SUPPLEMENTS LOOK FOR
U.S.P. notation
GMP or cGMP notation
Consumer Lab seal
Consider manufacturer
distributor
Look at brand used in
studies reporting positive
outcome
Look for third party testing

30. The USP Verified Mark and What It Means
Contains the ingredients and amounts listed on the label
Does not contain harmful levels of specified contaminants
Will break down and release into the body
Made according to FDA current Good Manufacturing
Practices using sanitary and well-controlled procedures

32. TO CHOOSE A SUPPLEMENT
Look for available quality clinical research
Check for long tradition of use (safety)
Check that active ingredient(s) are identified
Review mechanism of action determined
Verify available from a reliable source
 Ingredients and potency documented
Quality assurance documented, seal of approval

33. What common vitamin
deficiency in older adults can
cause symptoms of fatigue,
memory impairment,
irritability, depression and
personality changes?
B12

34. OLDER ADULTS
1.6 to 2.3 times more
likely to have
vitamin B12 deficiency
3.7 to 4 times more
likely to have
vitamin D deficiency

35. How much daily
Vitamin D
should you take if
you are
over 70 years old?

36. HOW MUCH DAILY VITAMIN D?
Older skin cannot synthesize vitamin D as well
Likely to spend more time indoors
Inadequate dietary intakes of vitamin D
51–70 years
600 IU
(15 mcg)
600 IU
(15 mcg)
>70 years
800 IU
(20 mcg)
800 IU
(20 mcg)
Age Male Female

37. SAVVY CONSUMERS SHARE
INFORMATION WITH THEIR
HEALTH CARE TEAM
1. Please list which supplements you take, how often,
and why you take them.
2. Are you currently taking or have you recently taken
any over-the-counter medications (e.g., aspirin, cold
medicine, stool softener, pain reliever, etc.)?
3. What prescription medication(s) are you currently
taking, if any?

38. SPECIAL THANKS FOR
CONTENT & IDEAS
UC IRVINE, REYNOLDS GRANT
UNIVERSITY CINCINNATI/HEALTH ALLIANCE,
REYNOLDS GRANT
THE AMERICAN GERIATRICS SOCIETY, BEER’S CRITERIA
US FOOD AND DRUG ADMINISTRATION