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.
This power point is my attempt to address the common yet serious issue of Polypharmacy.
Polypharmacy in elderly is a necessary evil. Although it is not always inappropriate, but the “inappropriateness” should be judged on a case to case basis.
Necessary tools should be used to avoid it.
And deprescribing is recommended to correct it as soon as it is labeled as a case of “inappropriate polypharmacy”.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
This power point is my attempt to address the common yet serious issue of Polypharmacy.
Polypharmacy in elderly is a necessary evil. Although it is not always inappropriate, but the “inappropriateness” should be judged on a case to case basis.
Necessary tools should be used to avoid it.
And deprescribing is recommended to correct it as soon as it is labeled as a case of “inappropriate polypharmacy”.
Polypharmacy appropriate and inappropriate based on risk and benefit assessment case study, negative consequences of polypharmacy, deprescribing tools,
This slide contains in-dept knowledge about prescribing in geriatric patients. Steps how to overcome polypharmacy and how to increase medication adherence in geriatrics. It also tells about geriatrics care. Examples of case studies are also included.
Understanding drugs and addiction By Mzwandile Mashinini mzwandile mashinini
the presentation is based on drugs and addiction, we first start of by defining the terms drug and addiction, then discus the different kinds of drugs available to humans and finally we highlight some of the consequences of addiction together with a treatment plan . all the sources consulted that have been consulted are sited on the reference section
Medication Adherence , setting up directions .. Ahmed Nouri
presenting the terminology of adherence, statistics of non-adherence and its impact, why do patients have difficulty with treatment, how to measure and how to improve the adherence, in addition to the role of the pharmacist in improving adherence.
Parkinson's Disease, SYMPTOMS OF PARKINSONISM, STAGES OF PARKINSONISM, ETIOLOGY OF PARKINSONISM, PATHOPHYSIOLOGY OF PARKINSONISM, TREATMENT OF PARKINSONISM.
This slide contains in-dept knowledge about prescribing in geriatric patients. Steps how to overcome polypharmacy and how to increase medication adherence in geriatrics. It also tells about geriatrics care. Examples of case studies are also included.
Understanding drugs and addiction By Mzwandile Mashinini mzwandile mashinini
the presentation is based on drugs and addiction, we first start of by defining the terms drug and addiction, then discus the different kinds of drugs available to humans and finally we highlight some of the consequences of addiction together with a treatment plan . all the sources consulted that have been consulted are sited on the reference section
Medication Adherence , setting up directions .. Ahmed Nouri
presenting the terminology of adherence, statistics of non-adherence and its impact, why do patients have difficulty with treatment, how to measure and how to improve the adherence, in addition to the role of the pharmacist in improving adherence.
Parkinson's Disease, SYMPTOMS OF PARKINSONISM, STAGES OF PARKINSONISM, ETIOLOGY OF PARKINSONISM, PATHOPHYSIOLOGY OF PARKINSONISM, TREATMENT OF PARKINSONISM.
POINTS TO BE INCLUDED
Definition, scope,
Technical definitions, common terminologies used in clinical
settings
Daily activities of clinical pharmacists
Ward round participation
Treatment Chart Review
Adverse drug reaction monitoring
Interprofessional collaboration
Introduction to adverse drug reactions
Definitions and classification of ADRs
Detection and reporting
Methods in Causality assessment
Severity and seriousness assessment
Predictability and preventability assessment
Management of adverse drug reactions
Unnecesary Medication Use in Long Term Care FacilitesDebbie Ohl
Meds are a key component in the clinical process.
The guidelines are intended to insure medication use is of value and necessary. T
Significant emphasis is placed on preventing and recognizing adverse drug reactions ASAP.
Consequently, surveyors will expect to see:
Rationale for use, Parameters for monitoring
Prompt recognition and evaluation of new onset problems and conditions worsening
Consideration for dose reduction and discontinuance as appropriate.
The Comprehensive Geriatric Assessment.pptxAhmed Mshari
Comprehensive Geriatric Assessment (CGA) is a process of care comprising a number of steps. Initially, a multidimensional holistic assessment of an older person considers health and wellbeing and leads to the formulation of a plan to address issues which are of concern to the older person (and their family and carers when relevant). Interventions are then arranged in support of the plan. Progress is reviewed and the original plan reassessed at appropriate intervals with the interventions reconsidered accordingly.
Helicobacter pylori (H. pylori) has so far infected more than half the global population. It is the most important and controllable risk factor for gastric cancer. The elderly, who are at a higher incidence of the infection, are also commonly found to develop antibiotic resistance. The symptoms, diagnosis, clinical features (of gastric or extra-digestive diseases), and treatment of H. pylori infection in the elderly, are different from that in the non-elderly. Health conditions, including comorbidities and combined medication have limited the use of regular therapies in elderly patients. However, they can still benefit from eradication therapy, thus preventing gastric mucosal lesions and gastric cancer. In addition, new approaches, such as dual therapy and complementary therapy, have the potential to treat older patients with H. pylori infection.
DYSLIPIDAEMIA Management the European approach.pptxAhmed Mshari
Atherosclerotic cardiovascular diseases are responsible for millions of deaths worldwide each year.
More patients are surviving their first CVD event and are at high-risk of recurrences.
The prevalence of some risk factors, notably diabetes and obesity, is increasing.
In recent years, a number of international and regional guidelines were developed to deal with this problem.
Frailty is a common clinical syndrome in older adults.
It is a risk factor for many health problems that older adults face.
Frailty is a major focus of geriatrics medicine.
This lecture will review the definition, epidemiology, etiologies, and consequences of frailty.
It will also discuss how to identify and manage frail older adults.
PHC represents a philosophical approach to health and health care.
This approach is characterized by a holistic understanding of health as well-being, rather than the absence of disease.
It integrates knowledge of the medical, biological, physical, social, psychological, and behavioral sciences.
PHC provides a comprehensive care including health promotion, illness prevention, treatment and care of the sick, and rehabilitation.
Injurious falls is a true geriatric syndrome and serious clinical problems facing older adults.
Falls result in significant morbidity and mortality and an increased rate of nursing home placement.
هو نهج جديد يتم تطبيقه في بعض مراكز الرعاية الصحية الأولية، يهدف الى دعم وتحسين نظام الرعاية الصحية الأولية والمساهمة بتوفير حزمة الخدمات الصحية الأساسية بجودة عالية، وبتكلفة يسيرة، ومستندة الى الأدلة العلمية المحدثة.
Depression in elderly people, also known as late-life depression, is a clinical syndrome characterized by persistent feelings of sadness, loss of interest or pleasure in activities, and a range of emotional, cognitive, and physical symptoms that significantly impact the individual's functioning and quality of life.
Insulin has three characteristics:
Onset: is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.
Peak time: is the time during which insulin is at maximum strength in terms of lowering blood glucose.
Duration: is how long insulin continues to lower blood glucose.
Constipation is one of the most frequent GIT disorders encountered among older adults in clinical practice.
Up to 50% of elderly experiencing constipation at some point in their lives.
Elderly women are having 2–3 times more constipation than men.
Approximately, 30% of older adults are regular nonprescription laxative users, such as stimulant and bulking laxatives.
Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mass, microarchitecture deterioration of bone tissue, bone fragility, and a consequent increase in fracture risk.
In this overview, we draw inspiration from the article titled "Managing Hypertension in Primary Care“, published in the Canadian Family Physician journal (Vol 65: October 2019).
The article, edited by Khrystine Waked PharmD, Jeff Nagge PharmD, and Kelly Grindrod PharmD MSc,.
It provides valuable insights and evidence-based approaches to tackle Hypertension Management In Primary Care.
By incorporating the recommendations discussed in this article, we can enhance our ability to manage hypertension and ultimately improving patient outcomes and quality of life.
المداخلات المبسطة للتحرر من التبغ.pptxAhmed Mshari
التدخين هو عملية يتم فيها حرق مادة التبغ وإستنشاقه.
يعتبر التدخين واحداً من أسوأ الأختراعات التي عرفها التاريخ ومن أهم المشاكل التي تواجه مجتمعات العالم وخاصة النامية منها.
لوحظ تسارع إنتشار هذه الظاهرة بين الفئات العمرية كافة وخاصة فئة الشباب والمراهقين وبين أوساط النساء أيضاً.
إن ضرره يتعدى الجانب الصحي, فهو يساهم بحدوث أضرار بيئية وأجتماعية وأقتصادية كبيرة.
To the consultation, the patient brings ideas, concerns, expectations, feelings and emotions related to his health problem. These areas are often grouped together and called the “Patent’s Agenda”.
Some of these emotional concerns may be explicit “Open Agenda”, but a large part may never be expressed openly if doctors do not proactively elicit them.
In 1981, Barsky, an American psychiatrist, gave a name to this assortment of hidden concerns; he called it the “Hidden Agenda”.
An important objective of a medical consultation is to understand as much as possible these hidden emotions.
Unless the doctor is able to fathom these, the patient may only be left with therapy that will treat his most obvious symptoms but not resolve the underlying problems.
Referral Process in Family Practice.pptxAhmed Mshari
It the process that involve seeking the assistance of another specialist with a resource to guide in managing a specific problem and sharing responsibility in patient care.
Ideally, it would result in “a closed referral loop”, in which the referral appointment is completed and results are then shared with the patient’s referring physician.
Apart from consultants and hospitals, a referral might be considered to family physician colleagues with special interests or expertise, and other members of the primary health care team, such as physiotherapists, dietitians, and social workers.
Ethical Issues in Obtaining Informed Consent.pptxAhmed Mshari
Medical ethics is a set of moral principles, beliefs and values that guide decisions about patient care.
It is an integral part of good medical practice.
The health care professional uses knowledge, experience, and judgment and considers the ethical principles to make decisions on management recommendations.
Medical errors are a growing concern in health care organizations.
No matter how well trained or hard working, healthcare providers make mistakes, just like other professionals.
Some data suggest that medical errors occurs up to 80 times per 100,000 consultations.
Medical errors are the third leading cause of death in the United States.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. By the end of this lecture, you should be able to:
1. Define POLYPHARMACY and its contributing
factors.
2. Describe the Prevalence of Polypharmacy and
its impact on older adults.
3. Discuss the Consequences of Polypharmacy,
including adverse drug reactions and
medication nonadherence.
4. Explore the Principles of Rational Geriatric
Prescribing and their importance in
preventing polypharmacy.
5. Explain the Deprescribing Process and its role
in reducing the risk of adverse drug reactions
and medication-related harm.
Learning Objectives
3. Introduction
The elderly represent one of the fastest
growing segments of the population and
their use of medication is increasing
significantly.
The primary care physician plays an
important role in addressing an array of
pharmaceutical issues and concerns for
elderly patients, including:
Polypharmacy.
Adverse drug reactions (ADRs).
Medications nonadherence.
Undertreatment of certain conditions.
4. Prevalence A large survey estimated that roughly
40% of elderly people take 5 or more
medications.
Nearly, 1 in 20 of these patients risked a
major drug–drug interaction.
Polypharmacy is estimated to cause 10%
of hospital admissions in elderly people.
The WHO estimates that more than half
of all medication-related hospital
admissions in elderly people are
preventable.
Polypharmacy is more common in
women.
The number of medications used by
older adults increases with age.
5. What is
polypharmacy ? 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.
6. Factors leading to
Polypharmacy in elderly
Poor patient education.
Multiple pathology.
Attending multiple specialist
clinics.
Lack of routine review of
medications.
Poor communication between
specialists.
Self-treat with over-the-counter
medications.
7. Prescribing
Cascade
Elderly people can be the victim of
a harmful “Prescribing Cascade”.
This happened when an adverse
drug effect is misinterpreted as a
new medical condition, for which
another drug is then prescribed,
and this new medication in turn
have adverse effects that result in
further prescribing.
It adds an unnecessary burden to
the patient’s already complicated
medication regimen.
Drug 1
Adverse drug effects
misinterpreted as new
medical condition
Drug 2
Adverse
drug effect
9. Age-related
Physiological Changes
Knowledge of the physiologic
changes that occur with aging is
essential when prescribing
medications to elderly patients.
The changes can affect the way the
body absorbs, distributes,
metabolizes and eliminates drugs.
These changes include increased
body fat, decreased body water,
decreased muscle mass, and
changes in renal and liver function.
These changes can cause ADRs in
older people.
10. Using multiple drugs at the same
time doesn't always connote
inappropriate prescribing; it can
actually be reasonable.
Often, 3 medications are needed to
manage symptoms of heart failure
or control high blood pressure to
meet national guidelines.
Patients with type 2 DM often
require at least two medications
for effective glucose control.
11. Polypharmacy
Consequences
Polypharmacy recently became an
important public health problem due
to its many possible negative
consequences, including:
Risk of adverse drug reactions.
Risk of medication nonadherence.
Risk of multiple geriatric
syndromes (e.g., cognitive
impairment, impaired balance and
falls).
Risk of hospitalization and nursing
home placement, and mortality.
Increased health care utilization
and costs.
12. Adverse Drug
Reactions
An ADR is defined as any noxious, unintended,
or undesired response to a therapeutic agent.
They are at least twice as common in elderly
patients as in younger patients.
Polypharmacy is a major risk factor for ADRs.
The probability of ADRs increases with the
number of medications being taken.
The three most common drug classes
associated with ADRs in the elderly are
cardiovascular drugs, psychotropic drugs, and
NSAIDs.
The orthostatic hypotension is potentially the
most serious drug reaction.
Always, consider an ADR as a cause of any new
patient symptom.
13. Types of ADRs
Side effects
(dry mouth from tricyclic antidepressants and
hypokalemia from diuretics).
Drug toxicity
(GIT bleeding and renal dysfunction caused by
NSAIDs, and cognitive impairment and falls
caused by CNS depressants).
Drug-drug interaction
(The combined therapy of anticoagulants and
antiplatelet agents can increase the risk of
bleeding).
Drug-disease interaction
(drugs with anticholinergic properties may affect
the cognitive function of patients with Alzheimer
disease).
Drug withdrawal syndromes
(beta blocker withdrawal leads to angina or
tachycardia).
14. Medication
Nonadherence
Forms of nonadherence include:
Forgetting to take medication.
Taking medication at the wrong
dose.
Taking medication at the wrong
time.
Incorrectly administering
medications.
Discontinuing medications
prematurely.
Medication Nonadherence refers to
the failure of a patient to take
medications as prescribed.
17. Interventions to improve
Medication Adherence
Simplifying medication regimens.
Use a medication that can treat
multiple indications.
Try to combine medications into single
pills to reduce pill burden.
Recommending low-cost or generic
alternatives when appropriate.
Educate the patient and caregiver.
Using medication reminders, such as
pillboxes, alarms, or smartphone apps.
Regular medication reviews.
19. Principles of Rational
Geriatric Prescribing
Individualization.
Simplification.
Avoidance of potentially inappropriate
medications.
Monitoring for adverse drug reactions.
Consideration of non-pharmacologic
interventions.
Reasonable therapeutic goals.
Consideration of cost and patient
preferences.
Monitoring parameters.
Involvement of caregivers.
20. Drug initiation in the elderly should be
done cautiously.
Avoid prescribing before a diagnosis is
made.
Review medications before adding a
new medication.
Start one medication at a time.
For each medication, start very low and
go very slow.
Know the actions, adverse effects, and
toxicity of the medications you
prescribe.
Attempt to maximize dose before
switching to another.
Guideline to initiate
new drugs
21. The Deprescribing
process
Review the patient’s medication:
including prescription and over-the-
counter medications, supplements, and
vitamins.
Assess the patient’s response to each
medication.
Develop a deprescribing plan: this may
involve discontinuing certain
medications, tapering the dose of certain
medications, or switching to alternative
medications.
Monitor for any new symptoms or
adverse effects that may arise, and
adjust the plan as necessary.
Involve the caregiver in the
deprescribing process to ensure that it is
safe and effective.
The patient's preferences and goals for
treatment are taken into consideration.
22. Review Checklist
for each medication
Is there an indication for the medication?
Is the medication effective for the condition?
Is the dosage correct?
Is the duration of therapy acceptable?
Are the directions correct and practical?
Are there clinically significant drug-drug
interactions?
Are there clinically significant drug-
disease/condition interactions?
Is there unnecessary duplication with other
medication(s)?
Is this medication the least expensive
alternative?
23. Rational
Prescribing Tools
A number of helpful prescribing tools
for appropriate medication review in
older adults:
The Beers criteria developed by
the American Geriatrics Society.
STOPP (Screening Tool of Older
Person's Prescriptions).
START (Screening Tool to Alert to
Right Treatment).
MAI (Medication Appropriateness
Index).
ARMOR (Assess, Review, Minimize,
Optimize, Reassess).
24. Beers Criteria The Beers Criteria is a valuable tool for
healthcare providers to assess and optimize
medication use in older adults.
It is developed by the American Geriatrics
Society.
It is an expert generated list of medications
that are potentially inappropriate for use in
older adults.
The list is updated periodically according to the
evidence-based recommendations.
It can be helpful in reducing the risk of adverse
drug events and improving patient outcomes.
However, it is important to note that the
criteria should not be used as a substitute for
clinical judgement and individualized patient
care.
25. Medications that should be
avoided in older adults.
Medications that should be used
with caution.
Medications requiring dose
adjustment in older adults with
specific medical conditions.
Medications that may need to be
replaced with safer alternatives.
Recommendations
of Beers Criteria
The Beers Criteria includes
recommendations regarding:
28. Polypharmacy is common among older
adults and can lead to adverse drug
events, increased healthcare costs, and
decreased quality of life.
Rational prescribing and deprescribing
processes are essential for optimizing
medication use in this population.
These processes involve evaluating
medications for appropriateness,
safety, and effectiveness, and
discontinuing or reducing unnecessary
medications.
Incorporating these processes into
clinical practice can lead to better
health and quality of life for older
adults.
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