multiple medication intake in elderly

1. POLYPHARMACY
Pr Dr M. A. BADR

2. Definition

3. Prevalence

4. Possibilities
• Drug Drug interaction
• Drug disease interaction
• Adverse drug effects ADE
• Inappropriate drug
• Expenses
• Quality of life

6. Drug effect
• Pharmacokinetics
• Pharmacodynamic
• Pharmacogenomic

7. Duration drug exerts effect
• Volume distribution
• Metabolism of the drug
• Clearance of the drug

8. Drug metabolism
• Phase I cytochrome P-450 zyme
system,oxidation,reduction,hydrolysis
• Phase II conjugation,glucoronidation,sulfation

9. Elderly contribution factors
• Communication barriers
• Decline renal hepatic functions
• Decreased lean body mass &total body H2O
• Pathophysiologic alterations involved with
disease &comorbidities

10. Other patient factors
• Communication barriers
• Misunderstanding the use
• Duplication
• Over the counter medicine,herbal

11. Commonly prescribes medications
• CVS
• Diabetes
• HTN
• OA
• Sedatives
• GIT preparation
• Over the counter med

12. Inappropriate medications
• Lack of proven benefit, contraindicated in
elderly, high risk medications
• Dosages and duration too short too long
• Complicated drug regimen affecting
compliance
• Multiple medicine by diff specialists for
concurrent conditions
• Medication to treat ADE of another med

13. Drug drug interaction
• ADE ‘s dose related
• Hepatic renal impairements
• ADE in long term care setting (duration)
• Inadequate monitoring

14. ACOVE
Assessing Care of Vulnerable Elders
project
• Documentations of indication and response of
new therapy
• Education patient/relatives ADE
• Maintain a current medication list , alternative
• Periodically review the ongoing need for a
drug therapy

15. Recommendations to reduce errors
• Name, brand , generic , dose ,frequency, route
• Look alike
• Over the counter drugs (brown bag check up)
• Medication organizers and family share

16. Role of the pharmacist
• Review current drugs, clear informations
• Stepwise approach to prescribing
• DS unecessary therapy
• Consider ADE for development of any new
symtoms
• Consider nonpharmacologic approach
• Simplicity of the dosing schedule
• Substitute with safer alternatives

17. Recommendations
• Need new tailored guidelines for the elderly
• Clinical pharmacist and multidisiplinary appr
• Maintenance or palliative or preventive
treatment
• Appropriate or inappropriate revise lists
• COPE and physician assistance

18. THANK YOU