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Polypharmacy in The: The Bagful of Pills: Elderly
Polypharmacy in The: The Bagful of Pills: Elderly
Polypharmacy in the
Elderly
Oana Marcu DO
Swedish Family Medicine
March 7, 2006
Objectives
Discuss
Definitions
Polypharmacy: use of more then 5 medications
inappropriate prescribing of duplicative
medications where interactions are likely
Adverse Drug Reaction (ADR):
drug interaction that results in an
undesirable/unexpected event that requires a
change in management
Consequences:
Economic
In
Absorption
Distribution
Metabolism
Excretion
Evaluate the pharmacokinetic characteristics of
each medication carefully
Start low, go slow!
Geriatric Rx Principles
- NSAIDs
- Narcotics
- Muscle relaxants
Narrow Therapeutic
Index
- digoxin
- phenytoin
- warfarin
- theophylline
- lithium
Cardiovascular
- Antihypertensives
- Calcium channel
blockers
- Propranolol
- Diuretics
Psychotropics
- TCAs
- Antipsychotics
- Benzodiazepines
- Sedative/Hypnotics
SO
There
CARE: Avoiding
Polypharmamcy
Caution
and Compliance
CARE: Avoiding
Polypharmamcy
Adjust
the Dose
Absorption
Distribution
Metabolism
Excretion
CARE: Avoiding
Polypharmamcy
Review
Regimen Regularly
CARE: Avoiding
Polypharmamcy
Educate
HCPR :
http://caretransitions.org/document/phr.pdf
Patient should bring this with them to every
medical visit and present it to their provider
Each provider should update list with any
changes
identifying information
Doctors contacts
Caregiver contacts
Past Medical History and Allergies
List of all medications, dose, reason they are
taking it and whether it is new!
Questions
Which of the pharmacologic parameters may
be associated with ADRs in the elderly?
a) Altered free serum concentration of drug
b) Diminished volume of distribution
c) Altered renal drug clearance
d) Prolonged absorption due to decreased
gastric mobility
e) All of the above
Questions
Which of the following is (are) examples of
ADRs in elderly?
a) Drug side effects
b) Drug toxicity
c) Drug disease interaction
d) Drug-drug interaction
e) All of the above
Questions
Which of the following combinations are most
commonly associated with ADRs in elderly?
a)
Cardiovascular drugs, psychotropics, and
antibiotics
b)
Cardiovascular drugs, psychotropics, and
analgesics
c)
Gastrointestinal drugs, psychotropics, and
analgesics
d)
Gastrointestinal drugs, psychotropics, and
antibiotics
Case
80 yr. widow who now lives with her daughter comes to
your office to establish care and complains of being a
nervous wreck and not being able to turn off her mind for
the past 2 yrs. She brings with her a bag of all her meds.
PMHx: CHF, irritable bowel syndrome, depression, HTN,
recurrent UTIs, stress incontinence, anemia, occipital
headaches, osteoarthritis, generalized weakness
Meds: sucralfate 1gm TID, cimetidine 300mg QID, enteric
asa 325mg, atenolol 100mg, digoxin 0.25, alprazolam
0.5mg, naproxen 500mg TID, oxybutynin 5mg BID,
dicyclomine 10mg TID, lasix 40mg , Tylenol #2 prn
Case
Mrs. Jones is a 72 yr living in an assisted living facility
where she has been recently complaining of
increasing confusion, lightheadedness in the am
and difficulty sleeping at night.
PMHx: CHF, NIDDM, OA, glaucoma, depression, and
stress incontinence
Meds: furosemide, timolol gtts, metformin, ibuprofen,
paroxetine, oxybutynin,
propoxyphene/actetaminophen prn pain, and
diphenhydramine prn insomnia
sedative, anticholinergic
properties which effect cognition
Oxybutynin: anticholinergic which is known to
cause confusion at higher doses
Propoxyphene- dangerous narcotic!
Watch for Digoxin toxicity- blurred vision,
CNS disturbances, anorexia
Case
Mr. Wilson is a 81 yr who had an URI and
subsequently was admitted for acute
confusion and disorientation. He then began
wandering and having hallucinations while
spiking a fever.
PMHx: CAD with MI, COPD, DJD,
Hypothyroidism, Depression/anxiety, chronic
anemia and diarrhea, aortic valve
replacement, gout, neuropathy, bilateral total
knee replacements
Meds:
References
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