The document discusses drug use in the elderly and techniques to avoid polypharmacy. It notes that the elderly population is growing and takes a significant portion of medications while also being more sensitive to drug effects due to physiological changes. Polypharmacy, defined as taking more than 5 medications, is common in the elderly due to multiple comorbidities and providers. This can increase risks of adverse drug reactions, interactions, and non-adherence. The document recommends techniques for optimal prescribing in the elderly like reviewing all medications, simplifying regimens, and eliminating unnecessary drugs to help prevent polypharmacy and its risks.
This document discusses polypharmacy, which is defined as the administration of many drugs simultaneously or an excessive number of drugs. Polypharmacy is common in elderly patients with multiple chronic conditions. It can be appropriate if all drugs achieve therapeutic objectives and minimize adverse effects, but is often inappropriate if drugs are unnecessary or cause harm. Tools like Beers Criteria, STOPP, and START can help identify inappropriate polypharmacy and guide deprescribing. The document outlines factors contributing to polypharmacy and consequences like adverse drug reactions, providing strategies to assess medication benefit-harm and safely discontinue unnecessary drugs.
This document discusses polypharmacy in the elderly, defined as using more than 5 medications. It notes that polypharmacy prevalence increases with age, reaching 50% in those over 65. Consequences can include adverse drug reactions, reduced quality of life, and increased healthcare costs. Pharmacokinetic changes in aging like decreased liver and kidney function must be considered. The Beers Criteria provide guidance on inappropriate medications in elders. Interventions to reduce polypharmacy risk include regular medication reviews, educating patients, and using a personal health record.
The document discusses several issues related to prescribing medications for elderly patients, noting that while the elderly population takes a significant amount of prescription and non-prescription drugs, they are also at higher risk for adverse drug reactions, drug-drug interactions, and under-prescribing of needed medications due to changes in pharmacokinetics and pharmacodynamics that occur with aging. It emphasizes the importance of considering an individual's overall health status and potential for drug interactions when determining the appropriate medication regimen for elderly patients.
Dr. Dalia Hamdy presented on aging and drugs. She discussed that the elderly population is growing significantly and they represent a major group of drug users. Providing safe and effective drug therapy for the elderly is challenging due to lack of clinical trials in this group and changes in physiology. Geriatric pharmacists can play an important role by assessing medication regimens for appropriateness, consulting with physicians on optimizing prescriptions, and providing counseling to improve medication adherence. Live applications of geriatric pharmacists were seen at Qatar University College of Pharmacy.
Polypharmacy, defined as taking multiple medications, is common in the elderly population. Over half of people aged 65 and older take 5-9 medications, while 18% take 10 or more. The prevalence is higher in women due to longer lifespans and more frequent doctor visits. Polypharmacy can lead to adverse drug events, with risk exponentially increasing with more medications. Common signs include dizziness, confusion, and fatigue. Solutions include reducing unnecessary medications, simplifying dosing schedules, and increasing medication management support and provider education to curb this significant health issue in aging populations.
This document discusses polypharmacy and medication errors. It begins by defining polypharmacy as the use of multiple medications where more are being used than clinically indicated. Polypharmacy can increase the risk of drug interactions and adverse events. Common risk factors for polypharmacy include the elderly, multiple comorbidities, recent hospitalization, and multiple physicians or pharmacies. Medication errors are also defined as any error in the medication use process and examples are provided. Reporting systems for medication errors and the most commonly implicated drug classes and individual drugs are outlined. Risk factors for errors and recommendations to reduce polypharmacy and errors are presented.
The document discusses various topics related to geriatric pharmacology and medication use in elderly patients. It covers how aging affects drug absorption, distribution, metabolism, and excretion. It also discusses factors that can lead to polypharmacy in elderly patients and provides strategies to optimize pharmacotherapy and prevent inappropriate prescribing. Key criteria for evaluating potentially inappropriate medications in older adults, known as the Beers Criteria, are also summarized.
This document discusses polypharmacy, which is defined as the administration of many drugs simultaneously or an excessive number of drugs. Polypharmacy is common in elderly patients with multiple chronic conditions. It can be appropriate if all drugs achieve therapeutic objectives and minimize adverse effects, but is often inappropriate if drugs are unnecessary or cause harm. Tools like Beers Criteria, STOPP, and START can help identify inappropriate polypharmacy and guide deprescribing. The document outlines factors contributing to polypharmacy and consequences like adverse drug reactions, providing strategies to assess medication benefit-harm and safely discontinue unnecessary drugs.
This document discusses polypharmacy in the elderly, defined as using more than 5 medications. It notes that polypharmacy prevalence increases with age, reaching 50% in those over 65. Consequences can include adverse drug reactions, reduced quality of life, and increased healthcare costs. Pharmacokinetic changes in aging like decreased liver and kidney function must be considered. The Beers Criteria provide guidance on inappropriate medications in elders. Interventions to reduce polypharmacy risk include regular medication reviews, educating patients, and using a personal health record.
The document discusses several issues related to prescribing medications for elderly patients, noting that while the elderly population takes a significant amount of prescription and non-prescription drugs, they are also at higher risk for adverse drug reactions, drug-drug interactions, and under-prescribing of needed medications due to changes in pharmacokinetics and pharmacodynamics that occur with aging. It emphasizes the importance of considering an individual's overall health status and potential for drug interactions when determining the appropriate medication regimen for elderly patients.
Dr. Dalia Hamdy presented on aging and drugs. She discussed that the elderly population is growing significantly and they represent a major group of drug users. Providing safe and effective drug therapy for the elderly is challenging due to lack of clinical trials in this group and changes in physiology. Geriatric pharmacists can play an important role by assessing medication regimens for appropriateness, consulting with physicians on optimizing prescriptions, and providing counseling to improve medication adherence. Live applications of geriatric pharmacists were seen at Qatar University College of Pharmacy.
Polypharmacy, defined as taking multiple medications, is common in the elderly population. Over half of people aged 65 and older take 5-9 medications, while 18% take 10 or more. The prevalence is higher in women due to longer lifespans and more frequent doctor visits. Polypharmacy can lead to adverse drug events, with risk exponentially increasing with more medications. Common signs include dizziness, confusion, and fatigue. Solutions include reducing unnecessary medications, simplifying dosing schedules, and increasing medication management support and provider education to curb this significant health issue in aging populations.
This document discusses polypharmacy and medication errors. It begins by defining polypharmacy as the use of multiple medications where more are being used than clinically indicated. Polypharmacy can increase the risk of drug interactions and adverse events. Common risk factors for polypharmacy include the elderly, multiple comorbidities, recent hospitalization, and multiple physicians or pharmacies. Medication errors are also defined as any error in the medication use process and examples are provided. Reporting systems for medication errors and the most commonly implicated drug classes and individual drugs are outlined. Risk factors for errors and recommendations to reduce polypharmacy and errors are presented.
The document discusses various topics related to geriatric pharmacology and medication use in elderly patients. It covers how aging affects drug absorption, distribution, metabolism, and excretion. It also discusses factors that can lead to polypharmacy in elderly patients and provides strategies to optimize pharmacotherapy and prevent inappropriate prescribing. Key criteria for evaluating potentially inappropriate medications in older adults, known as the Beers Criteria, are also summarized.
Polypharmacy, defined as the use of 5 or more medications, is common in elderly patients due to multiple comorbidities. It can lead to negative outcomes like increased adverse drug reactions, costs, and non-adherence. Physicians should regularly review patients' medication profiles and deprescribe unnecessary medications. Pharmacists and patients also play a role in managing polypharmacy through medication reconciliation, education, and adherence support. Guidelines like the Beers Criteria provide guidance on potentially inappropriate medications in older adults. Controlling polypharmacy requires coordination between healthcare providers and patients.
1. The document discusses guidelines for prescribing medication to elderly patients, noting that diseases often present atypically in older adults and multiple conditions usually occur simultaneously.
2. Key considerations include patient compliance, which decreases with more complex regimens, and polypharmacy, as the elderly often receive drugs from multiple sources.
3. Guidelines recommend starting with lower doses than for younger patients, regularly reviewing the need for medication, keeping regimens simple, and enlisting third-party support when needed.
This document discusses pharmacotherapy and rational drug use. It explains that pharmacotherapy aims to safely and effectively manage drug administration based on an understanding of pharmacokinetics and pharmacodynamics to optimize dosing for each patient. Rational drug use requires that patients receive appropriate medications, doses, treatment duration and lowest cost. Irrational drug use can result in treatment failure, increased toxicity and drug resistance. The document outlines various factors that influence drug use and can lead to irrational prescribing, dispensing and non-adherence.
This document discusses the issue of polypharmacy in older adults. Polypharmacy is defined as the concurrent use of multiple medications, which increases the risks of morbidity and mortality in older adults. Specifically, 30% of older adults see two or more physicians, 50% are prescribed five or more medications, and 41% of those aged 65+ are admitted to the hospital due to polypharmacy. Physiological effects in older adults include nonspecific complaints caused by drug interactions and toxicity that lead to increased morbidity and mortality. The Beers Criteria is presented as a clinical tool for nurses to evaluate inappropriate medications, excess dosages, and drug-disease interactions to avoid in older adults in order to reduce the risks of polypharmacy
Pharmacotherapy considerations in elderly adultsSafaa Ali
Pharmacotherapy considerations in elderly adults focuses on how aging affects the body's processing of drugs. Key changes include reduced absorption in the gastrointestinal tract, altered distribution in tissues due to changes in body composition, and decreased metabolism and excretion due to reduced liver and kidney function. These pharmacokinetic changes mean drugs for elderly patients often require dosage adjustments to avoid adverse drug reactions. Common issues include increased risk of drug interactions due to slower drug clearance and greater sensitivity to pharmacodynamic effects like sedation or hypotension.
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
This document outlines psychotropic medications used to treat mental health conditions such as depression, bipolar disorder, and anxiety. It defines psychotropic medications as psychiatric drugs that affect brain chemistry. Common medications are discussed for each condition, along with their dosages, side effects, and nursing considerations. The document emphasizes that pregnant and breastfeeding women should discuss risks and benefits of psychotropic medication with their doctors, as limited research exists on effects during pregnancy and breastfeeding.
This document discusses several key aspects of pharmacology in geriatric patients. It notes that 20% of hospitalizations in those over 65 are due to medications. It then covers common diseases in the elderly and how physiological changes can impact drug absorption, distribution, metabolism and excretion. Specific examples are provided of how classes of drugs like benzodiazepines, opioids, antidepressants and antihypertensives are metabolized differently or have increased risks of adverse effects in elderly patients. The document emphasizes the importance of considering an individual's renal and liver function when dosing medications in geriatric patients.
This document summarizes geriatric pharmacology and aging-related changes. It discusses theories of aging, how aging affects drug absorption, distribution, metabolism, and excretion. It also covers age-related changes in drug sensitivity and interactions, principles of prescribing for older adults, and common diseases in the elderly. Potential anti-aging therapies like calorie restriction, DHEA, and estrogen/progesterone are also mentioned.
This document discusses polypharmacy and aging. It covers several topics related to challenges of geriatric pharmacology including how aging affects pharmacokinetics and pharmacodynamics. Pharmacokinetics like absorption, distribution, metabolism and elimination can all be impacted by aging. Factors like reduced liver and kidney function, lower muscle mass and protein levels can influence how drugs are processed in older patients. Pharmacodynamics may also be altered, with some drugs having increased effects. Careful consideration of age-related changes is important for safe and effective prescribing in geriatric patients.
Alzheimer's disease is a progressive brain disorder that destroys memory and thinking skills. It is the most common cause of dementia among older adults. The main risk factors include older age, family history, and genetic mutations. Symptoms start mildly but worsen over time, progressing from forgetfulness to severe cognitive decline and requiring full time care. Currently, there is no cure and treatment focuses on managing symptoms.
This document discusses psychotropic drug categories and antipsychotic drugs. It summarizes that antipsychotic drugs work by blocking dopamine receptors and are used to treat symptoms of psychosis. It lists common antipsychotic drugs and their dosages and side effects, which include extrapyramidal symptoms like acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia. It provides information on treating side effects and educating clients on antipsychotic medication management.
This document discusses mood stabilizers used to treat bipolar disorder. It describes the symptoms of mania and depression in bipolar disorder. Lithium, valproic acid, carbamazepine, lamotrigine and various antipsychotics are described as first-line mood stabilizing agents. The mechanisms of action of these drugs involve inhibition of inositol monophosphatase and other enzymes, decreasing intracellular inositol levels. Novel targets for treating bipolar disorder discussed include inhibition of glycogen synthase kinase-3, protein kinase C, modulation of brain-derived neurotrophic factor, enhanced Bcl2 expression, effects on oxidative stress, and modulation of glutamatergic transmission.
This document discusses medication non-compliance in chronic mental illnesses. It notes that non-compliance is the number one cause of increasing disability in these illnesses. It outlines reasons for non-compliance including disease factors like poor insight and treatment factors like side effects. Consequences of non-compliance include relapse and worsening of symptoms over time. The document recommends strategies like psychoeducation, family support, and long-acting injectable medications to improve medication adherence.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
This document discusses opioid dependence and addiction. It begins with an overview of opioids and their mechanism of action in the body. It then defines addiction, dependence, and tolerance. The mechanisms of dependence and addiction involve both negative reinforcement from withdrawal and positive reinforcement from rewarding effects. Physical dependence theory and positive incentive theory are described as models of addiction. The document outlines treatment options including drug substitution therapy with methadone or buprenorphine, abstinence-based treatment, and psychosocial treatments. It discusses opioid withdrawal and post-acute withdrawal syndrome. The six stages of recovery are defined. Special considerations for treating opioid addicts are noted.
Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.
The document discusses physiological changes with aging and their implications for pharmacotherapy in elderly patients. It notes that aging results in changes to absorption, distribution, metabolism and excretion of drugs. This can increase the risk of adverse drug reactions and interactions due to altered pharmacokinetics and pharmacodynamics. The role of clinical pharmacists is highlighted in optimizing drug therapy for elderly patients by identifying inappropriate prescribing, ensuring proper dosing and monitoring for safety issues like non-compliance and polypharmacy. Guidelines for prescribing in elderly emphasize starting with low doses and simplifying drug regimens.
General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...Koppala RVS Chaitanya
1. The document discusses physiological differences between pediatric and adult patients that are important to consider when selecting and dosing medications.
2. It outlines age classifications for pediatric patients from preterm neonates to adolescents and describes how drug absorption, distribution, metabolism, and excretion can vary significantly across age groups.
3. Selecting appropriate doses and accounting for changing pharmacokinetics is essential for safe and effective pharmacotherapy in pediatric patients.
Polypharmacy, defined as the use of 5 or more medications, is common in elderly patients due to multiple comorbidities. It can lead to negative outcomes like increased adverse drug reactions, costs, and non-adherence. Physicians should regularly review patients' medication profiles and deprescribe unnecessary medications. Pharmacists and patients also play a role in managing polypharmacy through medication reconciliation, education, and adherence support. Guidelines like the Beers Criteria provide guidance on potentially inappropriate medications in older adults. Controlling polypharmacy requires coordination between healthcare providers and patients.
1. The document discusses guidelines for prescribing medication to elderly patients, noting that diseases often present atypically in older adults and multiple conditions usually occur simultaneously.
2. Key considerations include patient compliance, which decreases with more complex regimens, and polypharmacy, as the elderly often receive drugs from multiple sources.
3. Guidelines recommend starting with lower doses than for younger patients, regularly reviewing the need for medication, keeping regimens simple, and enlisting third-party support when needed.
This document discusses pharmacotherapy and rational drug use. It explains that pharmacotherapy aims to safely and effectively manage drug administration based on an understanding of pharmacokinetics and pharmacodynamics to optimize dosing for each patient. Rational drug use requires that patients receive appropriate medications, doses, treatment duration and lowest cost. Irrational drug use can result in treatment failure, increased toxicity and drug resistance. The document outlines various factors that influence drug use and can lead to irrational prescribing, dispensing and non-adherence.
This document discusses the issue of polypharmacy in older adults. Polypharmacy is defined as the concurrent use of multiple medications, which increases the risks of morbidity and mortality in older adults. Specifically, 30% of older adults see two or more physicians, 50% are prescribed five or more medications, and 41% of those aged 65+ are admitted to the hospital due to polypharmacy. Physiological effects in older adults include nonspecific complaints caused by drug interactions and toxicity that lead to increased morbidity and mortality. The Beers Criteria is presented as a clinical tool for nurses to evaluate inappropriate medications, excess dosages, and drug-disease interactions to avoid in older adults in order to reduce the risks of polypharmacy
Pharmacotherapy considerations in elderly adultsSafaa Ali
Pharmacotherapy considerations in elderly adults focuses on how aging affects the body's processing of drugs. Key changes include reduced absorption in the gastrointestinal tract, altered distribution in tissues due to changes in body composition, and decreased metabolism and excretion due to reduced liver and kidney function. These pharmacokinetic changes mean drugs for elderly patients often require dosage adjustments to avoid adverse drug reactions. Common issues include increased risk of drug interactions due to slower drug clearance and greater sensitivity to pharmacodynamic effects like sedation or hypotension.
Medication Error are the most preventable events and Clinical Pharmacists can play a vital role in preventing them. in this presentation i have tried to provide maximum information regarding medication error in minimum slides.
This document outlines psychotropic medications used to treat mental health conditions such as depression, bipolar disorder, and anxiety. It defines psychotropic medications as psychiatric drugs that affect brain chemistry. Common medications are discussed for each condition, along with their dosages, side effects, and nursing considerations. The document emphasizes that pregnant and breastfeeding women should discuss risks and benefits of psychotropic medication with their doctors, as limited research exists on effects during pregnancy and breastfeeding.
This document discusses several key aspects of pharmacology in geriatric patients. It notes that 20% of hospitalizations in those over 65 are due to medications. It then covers common diseases in the elderly and how physiological changes can impact drug absorption, distribution, metabolism and excretion. Specific examples are provided of how classes of drugs like benzodiazepines, opioids, antidepressants and antihypertensives are metabolized differently or have increased risks of adverse effects in elderly patients. The document emphasizes the importance of considering an individual's renal and liver function when dosing medications in geriatric patients.
This document summarizes geriatric pharmacology and aging-related changes. It discusses theories of aging, how aging affects drug absorption, distribution, metabolism, and excretion. It also covers age-related changes in drug sensitivity and interactions, principles of prescribing for older adults, and common diseases in the elderly. Potential anti-aging therapies like calorie restriction, DHEA, and estrogen/progesterone are also mentioned.
This document discusses polypharmacy and aging. It covers several topics related to challenges of geriatric pharmacology including how aging affects pharmacokinetics and pharmacodynamics. Pharmacokinetics like absorption, distribution, metabolism and elimination can all be impacted by aging. Factors like reduced liver and kidney function, lower muscle mass and protein levels can influence how drugs are processed in older patients. Pharmacodynamics may also be altered, with some drugs having increased effects. Careful consideration of age-related changes is important for safe and effective prescribing in geriatric patients.
Alzheimer's disease is a progressive brain disorder that destroys memory and thinking skills. It is the most common cause of dementia among older adults. The main risk factors include older age, family history, and genetic mutations. Symptoms start mildly but worsen over time, progressing from forgetfulness to severe cognitive decline and requiring full time care. Currently, there is no cure and treatment focuses on managing symptoms.
This document discusses psychotropic drug categories and antipsychotic drugs. It summarizes that antipsychotic drugs work by blocking dopamine receptors and are used to treat symptoms of psychosis. It lists common antipsychotic drugs and their dosages and side effects, which include extrapyramidal symptoms like acute dystonia, pseudoparkinsonism, akathisia, and tardive dyskinesia. It provides information on treating side effects and educating clients on antipsychotic medication management.
This document discusses mood stabilizers used to treat bipolar disorder. It describes the symptoms of mania and depression in bipolar disorder. Lithium, valproic acid, carbamazepine, lamotrigine and various antipsychotics are described as first-line mood stabilizing agents. The mechanisms of action of these drugs involve inhibition of inositol monophosphatase and other enzymes, decreasing intracellular inositol levels. Novel targets for treating bipolar disorder discussed include inhibition of glycogen synthase kinase-3, protein kinase C, modulation of brain-derived neurotrophic factor, enhanced Bcl2 expression, effects on oxidative stress, and modulation of glutamatergic transmission.
This document discusses medication non-compliance in chronic mental illnesses. It notes that non-compliance is the number one cause of increasing disability in these illnesses. It outlines reasons for non-compliance including disease factors like poor insight and treatment factors like side effects. Consequences of non-compliance include relapse and worsening of symptoms over time. The document recommends strategies like psychoeducation, family support, and long-acting injectable medications to improve medication adherence.
This document provides an overview of depression, including its definition, types, epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, investigations, and treatment. Depression is defined as a common mental disorder characterized by depressed mood, loss of interest, feelings of guilt, sleep disturbances, low energy, and poor concentration. Major types include major depressive disorder, bipolar disorder, dysthymic disorder, and situational depression. Depression affects over 350 million people globally and is a leading cause of disability. Causes may include genetic, environmental, biochemical and neurological factors. Treatment involves antidepressant medications like SSRIs, TCAs, and MAOIs as well as psychotherapy and other non-pharmacological approaches.
This document discusses opioid dependence and addiction. It begins with an overview of opioids and their mechanism of action in the body. It then defines addiction, dependence, and tolerance. The mechanisms of dependence and addiction involve both negative reinforcement from withdrawal and positive reinforcement from rewarding effects. Physical dependence theory and positive incentive theory are described as models of addiction. The document outlines treatment options including drug substitution therapy with methadone or buprenorphine, abstinence-based treatment, and psychosocial treatments. It discusses opioid withdrawal and post-acute withdrawal syndrome. The six stages of recovery are defined. Special considerations for treating opioid addicts are noted.
Health promotion is the process of enabling people to increase control over & improve their health by developing their resources to maintain or enhance well being.
The document discusses physiological changes with aging and their implications for pharmacotherapy in elderly patients. It notes that aging results in changes to absorption, distribution, metabolism and excretion of drugs. This can increase the risk of adverse drug reactions and interactions due to altered pharmacokinetics and pharmacodynamics. The role of clinical pharmacists is highlighted in optimizing drug therapy for elderly patients by identifying inappropriate prescribing, ensuring proper dosing and monitoring for safety issues like non-compliance and polypharmacy. Guidelines for prescribing in elderly emphasize starting with low doses and simplifying drug regimens.
General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...Koppala RVS Chaitanya
1. The document discusses physiological differences between pediatric and adult patients that are important to consider when selecting and dosing medications.
2. It outlines age classifications for pediatric patients from preterm neonates to adolescents and describes how drug absorption, distribution, metabolism, and excretion can vary significantly across age groups.
3. Selecting appropriate doses and accounting for changing pharmacokinetics is essential for safe and effective pharmacotherapy in pediatric patients.
This document discusses drug-induced diseases and adverse drug reactions. It begins by defining a drug-induced disease as an unintended effect of a drug that results in symptoms requiring medical attention or hospitalization. It then discusses various terms used to describe adverse drug effects such as adverse drug reactions, adverse events, unexpected adverse reactions, and serious adverse events. The document notes that drug reactions can be categorized as either type A reactions, which are exaggerated pharmacological effects, or type B reactions, which are unpredictable and idiosyncratic. It also discusses factors that can influence individual responses to drugs such as genetics, organ dysfunction, and fluid and electrolyte imbalances.
Priciples of therapeutics, Dosage Indiviualization, Herbal SupplimentsFarazaJaved
This presentation briefly covers the general aspect of therapeutics and drug development then its dose adjustment according to the pt. need and checking either patient comply to that therapy or not. last portion based on herbal supplements and its use.
The document discusses the issues of polypharmacy and adverse drug reactions (ADRs) in elderly patients. It notes that polypharmacy is associated with reduced quality of life, increased healthcare costs, and preventable hospitalizations and deaths in seniors. The elderly have unique pharmacokinetics that increase their risk of ADRs. The document proposes a CARE approach to reduce polypharmacy and ADRs through caution, compliance, adjusting doses, regular review of medication regimens, and educating patients. It also recommends the use of a personal health record.
This document discusses key issues in geriatric pharmacotherapy. It covers how aging affects drug absorption, distribution, metabolism and elimination in the body. It also discusses challenges like polypharmacy and increased risk of adverse drug events. The principles of optimal prescribing for older patients focus on starting with lower doses, avoiding unnecessary medications, and carefully monitoring for drug interactions and side effects.
Consumers should learn about the warnings for their medications and talk with their health care professionals about how to lower the risk of interactions. Many common foods, dietary supplements, and other drugs can negatively interact with prescription and over-the-counter medications, increasing risks. The rate of adverse drug reactions increases dramatically when patients take four or more medications. It is important for consumers to keep all health care providers informed about all drugs and supplements they take to reduce risks of dangerous interactions.
Aspects of Pharmacotherapy, Clinical Pharmacology and Drug DevelopementAnshuNautiyal1
This slide contains all the necessary detalis regarding the aspects of pharmacotherapy along with Clinical Pharmacology and explains the important steps undertaken during Drug Development.
This slide is a work of Dr Ankit Bairwa, 2nd Year at All India Institute of Medical Sciences, Bathinda
This document discusses polypharmacy in the elderly population. It defines polypharmacy as taking more medications than are clinically necessary. The elderly are at high risk for polypharmacy due to increased prevalence of illnesses and use of multiple providers. Polypharmacy can lead to adverse drug reactions, decreased adherence, poor outcomes and quality of life. Primary care physicians play an important role in managing polypharmacy through annual medication reviews called "brown bag reviews" where patients bring all medications. This helps optimize treatment by discontinuing unnecessary medications and simplifying dosing regimens.
Polypharmacy and Rational Prescribing in Elderly Patients.pptxAhmed Mshari
Polypharmacy is typically defined as the prescription of five or more medications.
It also refers to the prescription of medications that do not have a specific current indication, that duplicate other medications, or that are known to be ineffective for the condition being treated.
In other words, polypharmacy is the use of multiple medications that are unnecessary and have the potential to do more harm than good.
PK and Drug Therapy in pediatrics, geriatrics and pregnancy & LactationSreeja Saladi
This document summarizes key points about pharmacokinetics and drug therapy in geriatrics, pediatrics, pregnancy, and lactation. It discusses how age-related physiological changes can impact absorption, distribution, metabolism, and excretion of drugs in geriatric and pediatric patients. It also describes factors that influence placental transfer and breastmilk exposure of drugs in pregnancy and lactation. Providing safe and effective drug therapy to these special populations requires consideration of altered pharmacokinetics and potential risks to the fetus or breastfeeding infant.
Synthetic Drugs/Hormones - Boon or Bane- Concept of Dooshivisha and Gara VishaIJARIIT
21st century is the world full of synthetics and everyone are living in the influence of synthetic substances. Altered life
styles, food habits and irregular sleep pattern had resulted not only Non communicable disease but also resulting in reduced
immunity and is risking the person more for infections. Pharma Industry has grown as big as hierarchy in recent centauries
and introduces new chemical molecules quoting as capable for treating diabetes, hypertension etc. But bitter truth is prolonged
usage these medications itself has adverse effect on liver and kidneys causes hepatotoxicity and nephrotoxicity or organs
specific toxicity.
Drug interaction - Potential antimicrobial drug interaction in a hospital set...Dr. Jibin Mathew
A drug interaction is a situation in which a substance affects the activity of a drug when both are administered together. This action can be synergistic or antagonistic or a new effect can be produced that neither produces on its own
Drug interactions can occur when one drug alters the effects of another drug. They can be either harmful or beneficial. Common causes of interactions include one drug inhibiting or inducing the metabolic pathways of another drug. This can increase or decrease drug levels in the body, potentially causing toxic effects or reducing therapeutic effectiveness. It is important for pharmacists and clinicians to be aware of potential drug interactions and monitor patients taking multiple medications.
This document discusses drug interactions in psychiatry. It begins by defining drug interactions and explaining why they are important, noting the increased risk for psychiatric patients on multiple medications. It then describes how interactions can present and lists various risk factors. The document outlines the main types of interactions - pharmacokinetic involving absorption, distribution, metabolism and excretion, and pharmacodynamic involving receptor-level effects. Finally, it analyzes specific drug interaction case examples and consequences like serotonin syndrome or increased sedation.
This document discusses drug therapy in geriatrics. It begins by listing common drug classes used to treat various conditions in elderly patients, including antibiotics, antiallergics, antiasthmatics, and antihypertensives. It then discusses several age-related changes to pharmacokinetic and pharmacodynamic processes in geriatric patients. These changes can impact drug absorption, distribution, metabolism, and excretion. It also notes an increased risk of drug interactions and adverse reactions in elderly patients due to polypharmacy and physiological changes. Finally, it discusses the role of pharmacists in optimizing drug therapy for geriatric patients.
Similar to Drug use in elderly and techniques to avoid polypharmacy (20)
1) Aminoglycosides are polybasic amino groups linked glycosidically to aminosugar compounds. They are highly water soluble and excreted unchanged in urine.
2) They are bactericidal, inhibiting protein synthesis by binding to the 30S/50S interface of bacterial ribosomes. This causes misreading of mRNA and nonfunctional protein formation.
3) Common adverse effects include ototoxicity (hearing loss) and nephrotoxicity. Individual drugs vary in their specific toxicities.
This document discusses two broad spectrum antibiotics - chloramphenicol and tetracyclines. It provides details on their mechanisms of action, resistance mechanisms, pharmacokinetics, therapeutic uses, and adverse effects. Chloramphenicol and tetracyclines are bacteriostatic and inhibit bacterial protein synthesis. Their widespread use led to many resistant bacterial strains. Recent interest in their clinical use has increased due to fewer resistant bacteria. The document reviews specifics on the properties and use of each antibiotic.
Macrolides, Lincosamides and VancomycinDrSahilKumar
1) Macrolides, lincosamides, and glycopeptides are classes of antimicrobials. Macrolides like erythromycin and azithromycin are bacteriostatic and act by inhibiting bacterial protein synthesis. Lincosamides like clindamycin have similar properties. Glycopeptides like vancomycin and teicoplanin are bactericidal against gram-positive cocci including MRSA.
2) These drugs are used to treat respiratory, skin and soft tissue infections caused by susceptible bacteria. However, they can cause adverse effects like diarrhea, liver toxicity, and ototoxicity. Resistance occurs through modifications of the bacterial ribosome or cell membrane.
3) Proper
This document discusses fluoroquinolone antibiotics, including their parent drug nalidixic acid, mechanisms of action, classifications, and individual drug profiles. It notes that fluoroquinolones act by inhibiting DNA gyrase and topoisomerase enzymes in bacteria. Common adverse effects include gastrointestinal upset and neurological toxicity. Resistance can develop through chromosomal mutations in bacterial targets or reduced drug permeability. First-generation fluoroquinolones like ciprofloxacin are often used to treat urinary tract infections and respiratory infections.
This document discusses potassium channels and their modulators. It outlines the types of potassium channels classified based on their structure into 3 families: 6 TM voltage gated channels, 2 TM ATP sensitive channels, and 4 TM leak channels in neurons. It then discusses various potassium channel openers like diazoxide, minoxidil, nicorandil, and pinacidil; their doses; and pharmacological actions in treating conditions like hypertension, angina, hypoglycemia, and alopecia. The document concludes with a discussion of additional potassium channel openers like flupirtine, retigabine, and iptakalim and their potential uses.
Vasopressin receptor antagonists, also known as vaptans, are aquaretic drugs that promote loss of water while retaining electrolytes. They work by blocking vasopressin receptors, mainly the V2 receptor, reducing urine concentration and increasing free water clearance. Some approved vaptans include conivaptan, tolvaptan, and lixivaptan, which are used to treat hyponatremia associated with conditions like SIADH, congestive heart failure, and cirrhosis. Ongoing clinical trials are investigating additional vaptans for these indications.
This document discusses the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), which is a statutory body formed under the Prevention of Cruelty to Animals Act in India. It oversees animal experimentation through Institutional Animal Ethics Committees (IAEC). The CPCSEA introduces guidelines for animal housing, care, experimental facilities, and promotes the 3R principles of replacement, reduction and refinement of animal use in research. It is composed of scientists, regulators and animal activists who monitor compliance through IAECs at the institutional level.
The document discusses animal models commonly used in biomedical research. It notes that mice and rats are the most widely used species, making up 74% and 7% of animals in pharmacological research, respectively. These rodents are preferred due to their low cost, short lifespans, and similarities to human biology like reproductive and nervous systems. The document also describes how transgenic mice engineered to express human genes are valuable for modeling human diseases. Overall, the selection of animal models aims to use phylogenetically close and relevant species to best study biological processes and safely test new drugs.
This document discusses medical emergencies that can occur in a dental chair and how dentists should prepare for them. It notes that emergencies are more common in elderly patients, those undergoing painful procedures, or those with concomitant medical conditions or drug use. Taking a thorough patient history is important for prevention. Common conditions that can precipitate emergencies include syncope, angina, hypertension, and allergic reactions. Dental clinics should have an emergency kit containing drugs like oxygen, epinephrine, nitroglycerin, and glucose, as well as training in CPR, since drugs alone are not always sufficient. Proper preparation is key to treating emergencies without serious issues.
This document discusses the different types of receptors:
1) Ligand-gated ion channels directly open ion channels in response to neurotransmitters.
2) G-protein coupled receptors activate intracellular second messenger systems through G-proteins.
3) Kinase-linked receptors activate intracellular protein kinases.
4) Nuclear receptors regulate gene transcription by binding to DNA response elements as dimers.
GABA, glutamate receptors and their modulationDrSahilKumar
This document provides an overview of glutamate and GABA, their receptors and therapeutic applications. It discusses the synthesis, storage, release and termination of glutamate and GABA in the central nervous system. It describes the ionotropic and metabotropic glutamate receptors and GABAA and GABAB receptors. It also discusses conditions associated with glutamate like seizures, neurodegenerative diseases and stroke. Finally, it outlines current and upcoming therapeutic agents that target glutamate and GABA receptors and their uses, mechanisms and adverse effects.
This document outlines the process for vaccine trials from pre-clinical evaluation through post-licensure safety monitoring. It discusses the various phases of vaccine trials including phase I safety/immunogenicity trials, phase II dose-ranging trials, phase III large-scale efficacy/safety trials, and phase IV post-marketing surveillance. It also covers topics like emergency approval, notable past safety issues, and efforts to improve global vaccine safety monitoring. The overall goal is to demonstrate a vaccine's safety, immunogenicity and efficacy through rigorous clinical testing before and after product approval and implementation.
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This document provides an overview of the renin angiotensin system (RAS) and its applications. It discusses the history and components of the RAS, including renin, angiotensinogen, angiotensin peptides, and angiotensin receptors. It also summarizes the effects of the RAS and drugs that act on it, such as ACE inhibitors, ARBs, direct renin inhibitors, and aldosterone antagonists. The document provides details on the mechanisms, pharmacokinetics, uses, and side effects of these drug classes for conditions like hypertension, heart failure, and diabetic nephropathy.
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- Prescriptions were traditionally addressed to apothecaries in Latin for accuracy, but now address patients directly.
- Only certain medical professionals like physicians and dentists can prescribe, and they must be registered and have recognized qualifications.
- There are different types of prescriptions like compounded and pre-compounded.
- Guidelines are provided on prescription format, abbreviations to avoid, dosage writing, and ensuring legibility to prevent errors and legal issues.
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2. The IEC's main responsibilities are to protect participants, ensure universal ethical values are followed, and help develop research that meets local health needs.
3. The IEC reviews documents like protocols, consent forms, recruitment materials, safety information, and investigators' qualifications before research begins and conducts continuing annual reviews. It documents its approval, required modifications, or disapproval of proposed studies in writing.
This document defines drug interactions and outlines their outcomes, contributing factors, commonly involved drugs, types, mechanisms, and approaches to checking for interactions. It discusses how drug interactions can be beneficial or harmful and result from multiple drug therapy, diseases, prescribers, or noncompliance. The main types are drug-drug, drug-food, and drug-disease interactions, which can occur via pharmaceutical, pharmacokinetic, or pharmacodynamic mechanisms. Factors like absorption, distribution, metabolism, and excretion can be affected. The role of pharmacists in monitoring interactions and educating patients is also covered, as are newer online and mobile tools for checking drug interactions.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Drug use in elderly and techniques to avoid polypharmacy
1. DRUG USE IN ELDERLY &
TECHNIQUES TO AVOID
POLYPHARMACY
Dr Sahil Kumar
Department of Pharmacology
Maulana Azad Medical College
New Delhi
2. 2
The Aging Imperative
Challenges of pharmacotherapy in elderly
Elderly and Medications: Physiological
changes in PK, PD, behavior & lifestyle
Drug groups requiring monitoring in elderly
Polypharmacy: Causes & Consequences
Principles of Optimal prescribing in elderly
Preventing Polypharmacy
Conclusion
Topics Covered
4. The Aging Imperative
“Elderly” - 65 years old or older, those from
65 through 74 years old -“early elderly” and
those over 75 years old - “late elderly.”
Constitute 13% of the population & purchase
33% of all prescription medications.
20% of hospitalizations for those >65 are
due to medications they’re taking.
4
5. The Aging Imperative
India in a phase of demographic transition.
Sharp increase in the number of elderly
persons between 1991 and 2001 and it has
been projected that by 2050, it would rise to
about 324 million.
India has thus acquired the label of “an
ageing nation”.
5
6. Challenges of Pharmacotherapy
in Elderly
Multiple co-morbid states
Effects of aging physiology
Polypharmacy
Medication compliance
Medication cost
New drugs available each year
FDA approved, off-label indications expanding
Increasing popularity of “nutraceuticals”
6
7. ELDERLY AND MEDICATIONS
The physiologic changes that occur
with aging make the body more
sensitive to the effects of medications.
Pharmacokinetic, Pharmacodynamic ,
Behavioral changes, lifestyle changes
occur in elderly.
7
9. Physiologic Changes of Aging
Affecting Absorption
Physiologic change
↓ gastric acidity
↓ gastrointestinal blood flow
Delayed gastric emptying
Slowed intestinal transit time
General clinical effect
Decreased transport: Decreased bioavailability for
some drugs like aspirin.
9
10. Physiologic Changes of Aging
Affecting Distribution
Decreased Total body water
Increased Plasma Conc. of water soluble drugs
Lower doses are required: Lithium, digoxin, ethanol, etc
Decreased Lean body mass
Accumulation into fat of lipid soluble drugs: BZDs.
Decreased Serum Albumin
Increased unbound fraction of highly protein bound drugs
Binds acidic drugs: warfarin, phenytoin, digitalis, etc
Decreased Alpha1 Acid glycoprotein
Increased unbound fraction of highly protein bound drugs
Binds basic drugs: lidocaine and propranolol, etc
10
11. Physiologic Changes of Aging
Affecting Metabolism11
Aging ↓ liver mass/ hepatic
blood flow
Delayed/reduced metabolism of drugs
Higher plasma levels
Examples: diazepam, barbiturates,
lidocaine.
Decline in liver ability to recover from
injury
Lower serum protein levels
Loss of protein binding
12. Physiologic Changes of Aging
Affecting Elimination
Physiologic change
Decreased GFR
Decreased renal blood flow
Decreased renal mass
General clinical effect
Decreased clearance, Increased (t½) of
drugs eliminated from the kidney.
Eg. atenolol, gabapentin, ranitidine,
digoxin, allopurinol, quinolones
12
13. Aging and Pharmacodynamics
PD- What the drug does to the body.
⇑ sensitivity to sedation and psychomotor
impairment with benzodiazepines
⇑ level and duration of pain relief with
narcotic agents
⇑ drowsiness with alcohol
⇑ sensitivity to anti-cholinergic agents
⇑ cardiac sensitivity to digoxin
13
14. Aging and Behavioral changes
Cognitive changes associated with vascular
and other pathologies.
Age related dementia leads to problems in
compliance.
Death of a closed one can be a trigger for
depression.
14
15. Aging and Lifestyle Changes
Economic stresses associated with reduced
income or increased expenses due to illness.
May have to choose
OTCs instead of expensive doctor visits
Use of outdated medications
Use of home remedies
Share medications
Nutritional status may affect how body
metabolizes medications
15
20. Polypharmacy
Taking >5 medications at the
same time.
At any given time, an elderly
patient takes, on average, four
or five prescription drugs and
two over-the-counter (OTC)
medications.
20
21. Causes of Polypharmacy in Elderly
Presence of several chronic disorders.
Receiving health care from several physicians.
Purchasing medications from more than one
pharmacy.
“The prescribing cascade”.
The discovery of a broad range of pharmaceuticals
for a wide variety of conditions.
In addition, complementary and alternative
medicines, such as herbal therapies, are becoming
increasingly popular among all patients, including
the elderly.
21
22. Consequences of Polypharmacy
Adverse drug Reactions (ADRs)
Medication Errors
Drug interactions
Duplication of drug therapy
Decreased quality of life
Unnecessary cost
Medication non-adherence
22
23. Adverse Drug Reactions
(ADRs)
Responsible for 5-28% of acute geriatric
hospital admissions.
Greater than 95% of ADEs in the elderly are
considered predictable and approximately
50% are considered preventable.
New or sudden-onset GI distress is often
caused by medication.
Most common ADEs among elderly patients -
nausea, vomiting, diarrhea, constipation, and
abdominal pain.
23
26. Drug Interaction is defined as the
pharmacological activity of one
drug being altered by the
concomitant use of another drug
or by the presence of some other
substance.
DEFINITION
26
27. Watch for Drug-Drug, Drug-Disease,Watch for Drug-Drug, Drug-Disease,
and Drug-Food Interactionsand Drug-Food Interactions
27
28. Drug-Drug Interactions
Absorption may be ⇑ or ⇓.
Drugs with similar effects can result in
additive effects.
Drugs with opposite effects can
antagonize each other.
Drug metabolism may be inhibited or
induced.
28
30. Drug Disease Interaction
Drug – Condition interaction occurs when a drug
worsens or exacerbates an existing medical
condition.
Nasal decongestants + Hypertension … BP↑
NSAIDs + Asthmatic Patients … Airway obstr.
Nicotine + Hypertension … Heart Rate↑
Metformin + Heart failure … Lactate level↑
30
31. Drug Food Interactions
GARLIC when combined with diabetes medication
could cause dangerous decrease in blood sugar.
ORANGE JUICE increases the absorption of
aluminum and leads to severe constipation.
MILK contains elements like Mg and Ca which
chelate antibiotics like tetracycline and hence
decrease its absorption and effect.
GRAPEFRUIT JUICE inhibits CYP3A4;
increasing levels of antidepressants (sertraline),
benzodiazepines, verapamil.
31
32. Role of Pharmacist
Be vigilant in monitoring for potential drug
interactions.
Advising patients regarding proper use.
Educate the patient on foods and beverages
to avoid when taking certain medications.
Advising patients in disease conditions.
Keep up-to-date on potential drug-drug and
drug-food interactions of medications to
counsel the patients.
(ASHP Guidelines American Society of Health-System Pharmacists)
32
33. Newer Approaches to check
interactions
Free Online Drug Interaction Checking
Software:
https://www.drugs.com/drug_interactions.p
hp (Drugs.com)
http://reference.medscape.com/drug-
interactionchecker (Medscape)
http://desktopindia.com/Drug-inter.aspx
(Doctor’s Desktop: Medical Practice
Software - Indian)
33
38. Principles of optimal
prescribing in elderly
Knowing which drugs frequently cause problems.
Ask about drug allergies, adverse reactions, alcohol.
Investigate and document all medications the patient
is taking, including OTC and herbal products.
“Brown bag" method.
Choose a drug that can be given once or twice, rather
than three times a day.
Simplify the patient's regimen as much as possible
by, for example, prescribing a single agent rather
than multiple drugs to treat a condition.
38
39. Avoiding Polypharmacy
Avoid “a pill for every ill”. Always consider
non-pharmacologic therapy.
Start low and go slow but treat adequately.
Maximize dose before switching to another drug.
Avoid starting two drugs at the same time.
Review medications regularly and each time a new
medication started or dose is changed.
Eliminate duplicate medications—those prescribed
by different healthcare providers for the same
problem—and drugs with no therapeutic benefit or
clinical indication.
39
40. Encourage client to use one pharmacy.
Find out how often and in what doses the patient
has been taking all medications, and compare
that with what the prescription calls for. About
40% of elderly patients fail to take their drugs as
instructed.
Be aware of conditions that might increase the
risk of certain drug-drug interactions.
40
Avoiding Polypharmacy
41. Substitute safer medications whenever possible.
Avoid treating an adverse reaction caused by
one drug with a second drug; if possible,
discontinue the drug that's causing the problem
or reduce the dosage.
Maintain accurate medication records (include
vitamins, OTCs, and herbals).
Suggest using innovative pill box reminders for
correct adherence and avoid confusion when
taking many pills.
41
Avoiding Polypharmacy
42. Innovative pill box reminders
Medminder® : $40-65. Looks like traditional
pill boxes, 7 day (qid) boxes that lock. Flashing
light/audible/text message/phone calls for
reminders. Also, caregivers can get reports via
text/emails/internet.
Locked medication systems (eg e-pill): $200-500.
Dispensers that lock/alarm.
iPhone apps: Free-$3.99. Virtual pillbox. Can
set medications, dosages and times a dose is
needed. Alarms, reminders, etc.
42
44. Conclusion
Successful pharmacotherapy means using the
correct drug at the correct dose for the correct
indication in an individual patient.
Age alters PK and PD.
Polypharmacy is prescribing more than 5 drugs at
the same time.
ADRs and Drug Interactions are common among
the elderly because of polypharmacy.
These can be minimized by appropriate
prescribing and avoiding polypharmacy.
44
India is in a phase of demographic transition.
There has been a sharp increase in the number of elderly persons between 1991 and 2001 and it has been projected that by the year 2050, the number of elderly people would rise to about 324 million. India has thus acquired the label of “an ageing nation”.
Co-morbidities:
1) Decreased Visual Acuity Due To Cataract and Refractive Errors In 57% of the Elderly
2) Pain in the Joints And Joint Stiffness In 43.4%
3) Dental and Chewing Complaints In 42%
4) Hearing Impairment In 15.4%
5) Hypertension (14%)
6) Diarrhea (12%)
7) Chronic Cough (12%)
8) Skin Diseases (12%)
9) Heart Disease (9%)
10) Diabetes (8.1%)
11) Asthma (6%)
12) Urinary Complaints (5.6%)
13) Type 2 Diabetes
14) Stroke
15) Alzheimer’s Disease
16) Osteoarthritis, Osteoporosis
17) Prostatic hypertrophy, Urinary Incontinence
18) Anorexia/Malnutrition/Weight Loss Decubitus Ulcers,
19) Sleep Disorders, Delirium, Cognition Impairment (Dementia)
MORTALITY
According to the Government of India statistics
Cardiovascular disorders account for one third of elderly mortality.
Respiratory disorders account for 10% mortality while infections including TB account for another 10%.
Neoplasm accounts for 6%
accidents, poisoning and violence constitute less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal (GI) and genitourinary infections.
Compared to the general population, a patient over 65 is more likely to have several chronic disorders, each requiring at least one medication.
Elderly patients with more than one health condition are likely to receive care from several healthcare providers, each of whom may prescribe a different medication to treat the same symptoms.
Additionally, patients may purchase medications from more than one pharmacy, and each pharmacy checks for potential problems only on those medications that its pharmacist knows the patient is, or is supposed to be, taking. Drug-related problems are less likely to occur when one physician oversees the patient's medication regimen.
The prescribing cascade: An elderly patient develops side effects from a medication he's taking; however, his healthcare provider interprets the symptoms not as side effects of the drug but as symptoms of a disease. The healthcare provider then prescribes yet another drug, creating the potential for even more side effects.
An elderly patient is also more likely to be taking a medication that has been prescribed inappropriately—one that's unnecessary, ineffective, or potentially dangerous—and to suffer an adverse drug event (ADE). In a study of more than 150,000 elderly patients, 29% had received at least one of 33 potentially inappropriate drugs.
Most ADEs are the result of drug interactions; the more drugs a patient takes, the higher the risk of interactions.
The estimated incidence of drug interactions rises from 6% in patients taking two medications a day to as high as 50% in patients taking five a day.
Medication errors : Wrong drug, time, route
One effective way to take a drug history is with what's called the "brown bag" method. Rather than relying solely on the patient's medical record, ask the patient to bring all of his medications with him to the hospital or office visit. A recent study found that this method produces a more accurate list of the drugs an elderly patient takes. Be sure to tell your patient to bring in all the medications he takes, including prescription and OTC drugs, topical preparations, herbal products, vitamins, and other supplements. Also ask if he is using any medications he gets from family or friends.
To reduce your elderly patients' risk of an ADR, heed the adage to "start low and go slow." Although requirements vary considerably from patient to patient, doses often must be reduced for elderly patients by one-third to one-half of the recommended adult dose.