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12 Cards in this Set
- Front
- Back
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Definition of Polypharmacy
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use of more then 5 medications
inappropriate prescribing of duplicative medications where interactions are likely |
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Definition of Adverse Drug Reaction (ADR):
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drug interaction that results in an undesirable/unexpected event that requires a change in management
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5 reasons adverse drug reactions occur
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Drug-drug interactions -Drugs that interfere with warfarin and cause increases in INR and bleeding risk!
Drug-disease interactions -Not appropriately adjusting dosing for renal dysfunction Drug-food interactions-Diet interfering with warfarin levels Drug side effects Drug toxicity- Drug toxicity especially in drugs with low therapeutic index |
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The most consistent risk factor for adverse drug reactions is
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number of drugs being taken
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Unique Pharmacokinetics: normal part of the aging process:Absorption
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Decreased gastric acid alters absorption of some medications
Decreased gastric mobility can increase absorption Age-related gastrointestinal tract and skin changes seem to be of minor clinical significance for medication usage, however there is a decrease in gastric acid and motility |
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Unique Pharmacokinetics: normal part of the aging process:Distribution
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Distribution:
10-15% decrease in Total Body Water and lean body mass: water soluble drugs have poor distribution in adipose cause increasing serum concentrations Increased body fat: lipid soluble drugs accumulate and prolong duration of action Decreased serum albumin: increases free serum concentrations which makes lab levels more challenging to interrupt 10-15% decrease in Total Body Water and lean body mass: water soluble drugs have poor distribution in adipose cause increasing serum concentrations Increased body fat: lipid soluble drugs accumulate and prolong duration of action Decreased serum albumin: increases free serum concentrations which makes lab levels more challenging to interrupt |
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Unique Pharmacokinetics: normal part of the aging process:Metabolism
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Reduced metabolism within the liver and diminished enzyme activity increases serum drug effects
Though liver function tests are unchanged with age, there is some overall decline in metabolic capacity. Decreased liver mass and hepatic blood flow Highly variable, no good estimation algorithm |
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Unique Pharmacokinetics: normal part of the aging process: Excretion
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Diminished kidney function (GFR): calculate creatinine clearance
(((140-age) x weight in kg)/72 x serum creatinine) x 0.85 (for women) Age-related decreased renal blood flow and GFR is well-established. Decreased lean body mass leads to decreased creatinine production. |
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Factors contributing to Polypharmacy
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Underreporting symptoms
Use of multiple providers Use of others’ medications Limited time for discussion, diagnostics Limited knowledge of geriatric pharmacology |
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Factors contributing to Non-adherence
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Large number of medications
Expensive medications Complex or frequently changing schedule Adverse reactions Confusion about brand name/trade name Difficult-to-open containers Rectal, vaginal, SQ modes of administration Limited patient understanding |
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Prescribing Pearls to avoid polypharmacy
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Use single daily dose regimens when able
Limit the use of PRN medications Consider all new medicines as a therapeutic trial Discontinue a drug if it is ineffective or intolerable adverse effects occur Provide legible written instructions Instruct caregivers as needed Attempt to prescribe a drug that will treat more than one existing problem |
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Patient Education to avoid polypharmacy
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Use one pharmacist/pharmacy
Use your PCP as intended…avoid seeing multiple providers Do not use medications from others Report symptoms All medicines, even over-the-counter, have adverse effects Report all products used |
