Integrative and Holistic approach to treating postpartum depression. Symptoms can be reduced with a combination of medications, dietary adjustments, supplements, and lifestyle changes.
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
- Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
Safety Considerations in the use of Psychotropic Medication in Children and T...Stephen Grcevich, MD
This presentation for the medical staff of Child and Adolescent Behavioral Health in Canton, OH is an introduction to basic safety concerns and monitoring associated with the use of psychotropics in children and teens. The presentation was tailored to newly graduated advanced practice nurses.
Integrative and Holistic approach to treating postpartum depression. Symptoms can be reduced with a combination of medications, dietary adjustments, supplements, and lifestyle changes.
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
- Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
Safety Considerations in the use of Psychotropic Medication in Children and T...Stephen Grcevich, MD
This presentation for the medical staff of Child and Adolescent Behavioral Health in Canton, OH is an introduction to basic safety concerns and monitoring associated with the use of psychotropics in children and teens. The presentation was tailored to newly graduated advanced practice nurses.
Kevin W. O'Neil, MD, FACP, CMD and Chief Medical Officer of Internal Medicine and Geriatrics reviews how to navigate the intricacies of substance abuse in older adults.
Neuropharmachology having difficult conversations about medicationsMichael Changaris
This slideshow explores the neurobiologcial structures under pinning clinical change. Overview of pharmacodynamics and pharmacokenetics, and neurotransmitters. Problem based learning exploration of difficult conversations with patients about psychopharmacology and medication management.
Diabetes and Depression Might Be Linked | MetroPlusMetroPlus
Information about possible connections between diabetes and depression from MetroPlus, New York City's affordable health insurance provider. Find out more about depression at http://www.metroplus.org/healthy-living/health-information/behavioral-health or learn more about health insurance from MetroPlus at www.metroplus.org.
Quality use of medicines in geriatric patients with their Physiological changes with aging, altered Pharmacokinetics and Pharmacodynamics with ADR's, Guidelines for prescribing the older people and the role of clinical pharmacist in geriatric prescribing.
Kevin W. O'Neil, MD, FACP, CMD and Chief Medical Officer of Internal Medicine and Geriatrics reviews how to navigate the intricacies of substance abuse in older adults.
Neuropharmachology having difficult conversations about medicationsMichael Changaris
This slideshow explores the neurobiologcial structures under pinning clinical change. Overview of pharmacodynamics and pharmacokenetics, and neurotransmitters. Problem based learning exploration of difficult conversations with patients about psychopharmacology and medication management.
Diabetes and Depression Might Be Linked | MetroPlusMetroPlus
Information about possible connections between diabetes and depression from MetroPlus, New York City's affordable health insurance provider. Find out more about depression at http://www.metroplus.org/healthy-living/health-information/behavioral-health or learn more about health insurance from MetroPlus at www.metroplus.org.
Quality use of medicines in geriatric patients with their Physiological changes with aging, altered Pharmacokinetics and Pharmacodynamics with ADR's, Guidelines for prescribing the older people and the role of clinical pharmacist in geriatric prescribing.
posology is a branch of medical science which deals with dose or quantity of drugs which can be administered to a patient to get the desired pharmacological actions.
The man whose antidepressants stopped workingMajor depress.docxpoulterbarbara
: The man whose antidepressants stopped working
Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice. Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.
Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn't a new problem. However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.
Questions
1.
Do you ever feel that taking your medications is a nuisance or inconvenience? Do you have a difficult time remembering to take your medications or forget?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.
2.
Does your prescribed medications and treatment regimen still leave you feeling depressed? Do you have a difficult time adhering to a prescribed regimen?
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.
•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.
3.
Have the side effects of your medications been difficult to cope with or manage? Do you sometimes stop taking your medications because of the adverse effects?
Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking. Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).
Important People
Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient's circumstances and preferences (Smith, 2013). The patient is married, so I would address additional questions to his wife. After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking? If she knew why he was taking them? Informed and en.
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
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.
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Reducing the risk of medication alcohol interactions in older adults march 2015
1. REDUCING THE RISK OF
MEDICATION-ALCOHOL
INTERACTIONS IN OLDER ADULTS
Patricia W. Slattum, PharmD, PhD, CGP
Virginia Commonwealth University
pwslattu@vcu.edu
2. Objectives
Identify
medications that
may interact with
alcohol and
potential outcomes
in older adults.
Describe risk
factors for adverse
events from
alcohol and
medication
interactions among
older adults.
Discuss treatment
issues in pain,
falls, depression
and insomnia
when alcohol and
medication
interactions play a
role.
Using case
studies, develop
strategies to
manage alcohol
and medication
interactions in
older adults.
3. Case
Study
BW
BW
no longer drives, but has three sons
living nearby who help with errands such
as grocery shopping and doctor
appointments.
93 year old white
male
lives with his wife
independently in a small
apartment.
married for 71
years
is blind and has
significant
functional
limitations.
requires BW’s
assistance with
activities of daily
living.
4. Case BW
BW suffers
from
CHF
atrial fibrillation
osteoarthritis
recently diagnosed with depression
His current
medications
include:
Furosemide 40 mg BID
Potassium 20 mEq BID
Digoxin 0.125 mg QD
Warfarin 4 mg QD
Sertraline 50 mg QD
Acetaminophen 500 mg QID prn
5. Case BW
His warfarin therapy has been difficult
to manage.
His INR has fluctuated above and
below the target range.
Told his doctor that he wanted to stop
taking all of these medications and
was tired of the monitoring and dosing
changes.
His functional status has begun to
decline and his family hired a
companion service to assist him 3
mornings each week.
Over the past several
months:
6. After working at the home for 2 weeks, the
companion reported to the son that there were
empty alcohol bottles in the trash.
BW has a long history of episodes of alcohol
misuse, but had been abstinent for almost 15 years
after falling down the stairs and breaking his arm
while intoxicated.
The son had purchased a bottle of alcohol for his
father recently because some friends were planning
to visit.
Case BW
7. Case BW
1 week
After the third fall he was
transported to the ER and
was admitted for
heart failure exacerbation.
8. Case BW
The sons called a family
meeting to discuss living
arrangements for BW
They discover that each of
them has been purchasing
alcohol for their father over the
past few months.
Neighbors and grandchildren
have also purchased alcohol
for him. After some investigating it
appears that he may have
been drinking as much as 9 oz
of bourbon daily.
9. • Our bodies experience physical changes as we age.
• These changes can impact:
How well medications get into and out of the body.
How the body responds to medications.
The Aging Body and Medications
10. Body fat increases and body water decreases as
a percent of body weight.
• Example: Alcohol
Delafuente JC. Consult Pharm 2008, 23:324-34.
Changes in Body Composition with
Aging
Alcohol goes into
body water.
With less water,
blood alcohol
concentrations
are higher.
11. Most drugs leave the body through the liver and kidney.
Delafuente JC. Consult Pharm 2008, 23:324-34.
Changes in the Kidney and Liver
with Aging
• Liver and kidney function decline with aging.
• Drugs take longer to get out of the body.
• Older adults may need lower doses or a longer time
between doses.
12. Bowie M, Slattum P. J Geriatr
Pharmacother 2007;5: 263-303
Changes in Drug Response with
Aging
Older adults may
• Have decreased functional ability
before taking the medication.
• Be more sensitive to medications.
• Be less able to compensate for
the effects of medications.
This may result in
unwanted effects of
medications.
13. Altered mental status/confusion
Fatigue
Falling
Constipation
Urinary Incontinence
Depression
Dizziness
Tangiisuran B, et al. Age and Ageing 2009;38:358-359. Weingart SN, et al. Arch Intern Med 2005;
165:234-240. Schmader KE, et al. Am J Med 2004;116:394-401.
Adverse events often mistaken for normal aging!
Atypical Presentation of Adverse
Drug Events in Older Adults
14. • Prevalence increases as number of prescribed
drugs increases
• 5 to 7 drugs = 4 fold greater risk
• 8 to 10 drugs = 8 fold greater risk
• Cannot prevent all drug interactions!
Mallet L, et al. Lancet 2007;370:185-91.
http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/ucm096391.pdf
Drug Interactions
15. • Patient groups at increased risk:
– Older adults taking multiple medications
– Those seeing more than one doctor
– Those being infrequently or inadequately monitored
– Those with impaired liver or kidney function
• Dietary supplements, herbal products and over-the –
counter medications and alcohol must also be
considered.
• Pharmacists look for drug interactions when filling
prescriptions.
Mallet L, et al. Lancet 2007;370:185-91.
Drug-Drug Interactions
16. Harmful interactions: Mixing alcohol with Medicines Brochure
https://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm
Drug-Alcohol Interactions
Mixing certain medications
with alcohol can cause
adverse events
Mixing alcohol with
sedatives, pain
medications or other
drugs acting on the
brain can result in
increased sedation,
unsteadiness or falls.
Mixing alcohol with
aspirin, ibuprofen,
naproxen or similar
drugs can increase
risk of
gastrointestinal
bleeding.
Mixing alcohol with
blood pressure
lowering medications
can cause blood
pressure to go too
low.
OTHER
19. • Many medications recommended to manage
pain in older adults interact with alcohol:
– Acetaminophen
– Nonsteroidal Anti-inflammatory Drugs
– Opiate analgesics
• Some patients may be using alcohol to
self-treat pain.
Pain
20. CASE
STUDY
LR
LR
When her daughter tries to discuss this
with her, she claims that this is “normal” for
someone her age and to stop worrying her.
LR brings up the issue of dry mouth with each of her
three doctors, but the only recommendations she
has received is to suck on hard candy and drink
more fluids.
LR doesn’t feel that these
measures really help.
LR’s daughter requests a medication
assessment to determine if her medications
may be contributing to her dry mouth.
PRIMARY COMPLAINT:
DRY MOUTH
lives alone in her own home
has difficulty with instrumental activities
of daily living such as paying her bills
and shopping for groceries.
dozes off frequently during the day and seems
unsteady on her feet.
21. Her current medication regimen:
CASE: LR
TIME MEDICATION WHEN STARTED
MORNING 1 Gabapentin (Neurontin®) 800 mg 2 years ago
1 Potassium chloride 20mEq 4 years ago
1 Furosemide (Lasix®) 20mg 4 years ago
½ Metoprolol 25mg 8 years ago
NOON 1 Duloxetine (Cymbalta®) 60mg 3 weeks ago
1 Gabapentin (Neurontin®) 800 mg 2 years ago
2 Oxaprozin (Daypro®) 600 mg 1.5 years
NIGHT 2 Quetiapine (Seroquel®) 25mg 1 year ago
1 Amitriptyline 50mg 3 months ago
1 Temazepam (Restoril®) 15 mg 10 years ago
1 Gabapentin (Neurontin®) 800mg 2 years ago
½ Metoprolol 25mg 8 years ago
1 Duloxetine (Cymbalta®) 60mg 3 weeks ago
22. • During an interview, LR admitted to
changing the administration times of some
of her medications and to consuming
“some” alcohol most days of the week.
• She also takes 1000 mg of acetaminophen
in the morning and before going to bed in
the evening each day.
CASE: LR
23. What are the signs that LR may be
experiencing medication-related problems?
1. New complaint of dry mouth
2. Difficulty with instrumental activities of daily living
3. Dozing off during the day
4. Unsteady on her feet
5. Living alone
What strategies may be used to help LR?
CASE: LR
24. • Alcohol interacts with all classes of
antidepressants.
• Major depression and alcohol use disorder:
either doubles the chance of having the other.
• There appears to be a causal link between
alcohol use disorder and major depression.
• Best treatment approaches for the older adult
are still unknown.
Boden and Fergussen. Addiction 2011;106:906-914.
Depression
25. Mohanty M, Slattum PW. Age in Action 2011; Summer
CASE
STUDY
SP
SP
After moving to a senior living center, she started
drinking more heavily leading to several falls and a
fractured arm.
82 year old female
Diagnosed with depression and
treated with antidepressants in the
past
Has Chronic Obstructive
Pulmonary Disorder
(COPD)
Was a smoker for the
last 40 years and a
moderate alcohol drinker
26. Her prescriptions consisted of 11 medications:
• advair (combination of fluticasone & salmeterol),
tiotropium, albuterol, montelukast, and Mucinex
(guaifenesin and pseudoephedrine) for COPD
• paroxetine for depression
• simvastatin for cholesterol
• supplements (iron and calcium)
• also taking digoxin for congestive heart failure and
primodine for tremor.
However, during the interview she did not mention a history
of tremor or heart failure.
Mohanty M, Slattum PW. Age in Action 2011; Summer
CASE: SP
27. • What were the signs that SP might be
experiencing a medication-related problem?
1. Falls
2. Fracture
3. Living in a senior living center
4. Smoking
5. Depression
• What recommendations do you have for SP?
CASE: SP
28. • Alcohol interacts significantly with sedatives
used to treat insomnia.
• Alcohol worsens sleep disorders.
• Options:
– Treat underlying health conditions
– Evaluate medications as a contributor
– Sleep hygiene: daytime exercise, limit caffeine,
exposure to natural light during day, limit napping
during the day, etc.
Insomnia
29. Mohanty M, Slattum PW. Age in Action 2011; Summer
CASE
STUDY
OP
OP
80 year old female
Lives in an assisted
living community.
At the time of her
medication review by a
pharmacist, her family
expressed concerns that
she had been “loopy and
out of it” recently.
Experienced a fall in the
evening but was not injured.
There hadn’t been any recent
changes in her medications, but
during the pharmacist’s interview, OP
mentioned drinking wine in the
evening.
The medication technician,
who often works on OP’s
floor, stated that OP “stays
up all night drinking wine
and watching TV then
sleeps throughout the day.”
The medication technician was not
sure how much she drinks nightly or
whether she was drinking more than
usual.
OP was taking 16
scheduled prescription
medications and 5 as
needed medications.
30. Her scheduled prescriptions included:
– lisinopril, nadolol, and amlodipine for hypertension
– furosemide for edema
– levothyroxine for thyroid replacement
– albuterol for asthma
– pantoprazole for gastroesophageal reflux disease (GERD)
– solifenacin for urinary incontinence
– citalopram, bupropion, and quetiapine for depression
– trazodone for insomnia and depression
– tramadol for pain
– supplements of potassium and Vitamin D
Mohanty M, Slattum PW. Age in Action 2011; Summer
CASE: OP
31. What are the signs that OP may be experiencing
a medication-related problem?
1. Falls
2. Living in an assisted living facility
3. Being "loopy and out of it"
4. Excessive daytime sleepiness
5. Watching TV all night
What recommendations do you have?
CASE: OP
32. Improving the Quality of Medication Use in
Elderly Patients: A Not-So-Simple Prescription
“Putting the pieces of the puzzle together to
create a solution remains a formidable, but not
insurmountable task….All the pieces of the
puzzle lie before us; it remains for us to find a
way to fit them together”
Jerry H. Gurwitz, M.D.
Gurwitz JH, Arch Intern Med 2002; 162:1670-3
33. During his hospitalization, BW abstained from
alcohol and his medications were adjusted.
After returning home
• His CHF symptoms and mood improved.
• His gait, balance and functional status
improved.
• His family support and companion services
were expanded to assist with medication
adherence and to monitor for alcohol use.
REVISITING CASE: BW
34. The National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Drinking Guidelines for Older Adults (over 65 y/o) recommends:
Responsible Drinking
Consider concurrent
medications
No more than 7 drinks per week
(one drink per day)
Maximum of 2 drinks on
special occasions
Somewhat lower
limits for women
35. • Stay engaged
• Exercise the body
• Eat well
• Read warning labels
• Don’t mix alcohol and medications before
seeking advice
Wellness Promotion for the Adult
36. Take-away Message for
Family Caregivers
If you are an
adult child,
friend or
caregiver of an
older adult who
is in need of
assistance:
Face the problem
Be direct with the individual
Be supportive without enabling
Offer encouragement and praise
Encourage them to seek help from
community resources
37. Take-away Message for
Professionals
If you are a
professional in
the field:
Discuss alcohol use with clients/patients
Refer to pharmacist or prescriber for advice on
mixing alcohol with specific medications
Learn and use Screening, Brief Intervention,
and Referral to Treatment (SBIRT)
Know your community resources