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25 Cards in this Set
- Front
- Back
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Goals of Geriatric Pharmacotherapy
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Maintain Independence
Prevent Disability Increase Health-Related Quality of Life -Recognize Geriatric Syndromes & Common Conditions -Reduce drug-related problems -Provide a comprehensive geriatric assessment |
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Geriatric Syndromes and Common Conditions
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Common conditions and syndromes may lead to:
Loss of independence, Disability, poor quality of life may be due to an underlying disease process Ex: parkinson’s disease falls fractures loss of mobility loss of independence |
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Common Problems in the Elderly: The I’s of Geriatrics
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- Immobility
-Inanition (malnutrition) - Intellectual impairment - Isolation - Impaction - Impotence - Incontinence - Impaired Senses - Immunodeficiency - Infection - Instability - Insomnia |
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Multiple Coexisting Chronic Illnesses
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May threaten independent living
Difficulty in treatment and following multiple conflicting guidelines Result in polypharmacy |
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Common Coexisting Conditions
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HTN
Diabetes Mellitus Renal Impairment Osteoarthritis Ischemic Heart Disease CHF Osteoporosis Frail Gait |
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Common Coexisting Conditions II
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Alzheimer’s Disease Sleep Disturbance
Chronic Constipation Intellectual Impairment Urinary Incontinence Depression Arterial / Venous Insufficiency Chronic pain Cancer |
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Acute myocardial infarction
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weakness
confusion syncope |
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Congestive Heart Failure
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lethargy
restlessness confusion |
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Respiratory infection
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lethargy
confusion anorexia |
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UTI (urinary tract infection)
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incontinence
nausea confusion abdominal pain |
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Medication – Related Problems (MRPs) in the Elderly
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Adverse drug withdrawal events
Adverse drug reactions Medication – Related Problems (MRPs) in the Elderly Therapeutic Failure In nursing homes - MRP’s may be 50% preventable |
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Risk Factors for Medication-Related Problems
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Overuse (Polypharmacy)
Multiple medical conditions Inappropriate prescribing Underuse Medication Non-adherence |
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Reasons Seniors are at Greater Risk for Medication-Related Problems
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Multiple chronic diseases
Multiple prescribers Multiple medications Types of medications prescribed Under-representation in clinical trials, particularly those over age 75 Shortage of trained professionals in geriatric pharmacotherapy |
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Comprehensive Geriatric Assessment
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Physical functioning
Psychological (cognition/depression) Socio-Economic (social skills/support) Environmental (impact on patient) Functional Status (ADLs & IADLs) |
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Functional Status
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Looks at patient’s ability to live independently
Basic ADLs More complex IADLs Challenge to maintaining and improving functional status |
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The Pharmacist’s Role in the Geriatric Assessment
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Medication History Taking
Communication problems Underreporting, incomplete Altered disease presentation Multiple prescribers, polypharmacy |
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Watch for Signs of Medication-Related Problems
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Confusion
Falls Depression Delirium Insomnia Incontinence Parkisnson’s-like Weakness or lethargy movements Loss of appetite Changes in speech New onset of symptoms |
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Assessment of Drug Therapy
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1. Look for medication-related problems
2. Could current therapy be causing patient’s symptoms or problems? Screen for medications with increased risk for: cognitive impairment falls incontinence weight loss 3. Match medication list with problem / diagnosis list 4. Look for medications without a diagnosis 5. Look for untreated conditions 6. Evaluate monitoring parameters Vital signs Laboratory values Objective documentation (pain scale) 7. Look for drug efficacy and / or toxicity |
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Medication Appropriateness Index
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Is there an indication for the medication?
Is the medication effective for the condition? Is the dosage correct? Are the directions correct? Are the directions practical? Are there clinically significant drug-drug interactions? Are there clinically significant drug-disease interactions? Is there unnecessary duplication with other medication? Is the duration of therapy acceptable? Is this medication the least expensive alternative compared with others of equal utility? |
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Formulating a Therapeutic Monitoring Plan
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Take into account:
-patient’s comorbidities -functional status |
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Consultation with Prescriber
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Optimize drug therapy with prescriber
Sharing of information |
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Misperceptions About Medications
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Cutting back on medications saves money
Non-prescription / herbal products are completely safe If a small amount works, more is better New drugs are better than old drugs |
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Counseling Considerations for the Elderly
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Barriers to communication: patient and/or caregiver
Level of education Lifestyle Lack of understanding / misinterpretation of directions Sensory impairments |
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Reasons for Non-compliance
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Sensory impairments (can’t open container, use eye drop correctly, activate inhaler)
Drug regimen interferes with daily activities Drug regimen is too complex Lack of understanding why the medication is important or the goals of therapy Financial Concerns |
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Summary of the Role of the Pharmacist in Geriatric Care
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Apply pharmacokinetic and pharmacodynamic principles to provide optimal pharmaceutical care
Involve the patient and caregiver in all decisions Interact with other members of the interdisciplinary team Demonstrate empathy and dedication to patients Respect health care wishes: patient vs caregiver vs health care provider |
