What’s New in Medication Management: Focus on Older Adults and Caregivers Tuesday, April 30, 2013 12:00 Noon CDT Mike Varnell, RPh, CSA (214) 215-1826 mikevarnell@gmail.com

Words to Live By… “Don’t run with scissors!” “Watch where you’re going!” “Beware of multiple medications!” “Start low and go slow”

Multiple Medications = Polypharmacy The excessive or unnecessary use of medication Using more than 5 medications at one time Taking a medication for no therapeutic reason Taking more than one medication for same condition Taking medication to treat side effects of another med

Terminology for Drug Related Problems ADE - Adverse Drug Events ARs - Adverse Reactions PIMs - Potentially Inappropriate Medications These challenges can directly contribute to: Falls - Hypotension Fractures - Cognitive dysfunction Electrolyte imbalances -  Hospitalizations Heart Failure Ex.)  response to beta agonists and beta blockers  response to opiates, benzodiazepines and warfarin

Medication Management – Nursing Perspective Numerous challenges  risk of ADRs: Use of multiple medications (RX and OTC) Coexisting illnesses (i.e. – COPD / CHF / Diabetes) Physiological changes from the aging process

Common myths about medications “If it is OTC, it must be safe for me to take” “If one tablet is good, two is better” “It works for Dad, so it will work for me”

Potential reasons for polypharmacy Failure to d/c medications as intended by prescriber Medication being prescribed by multiple providers Failure of provider to do regular DRRs (Drug Regimen Reviews) Utilizing multiple pharmacies Poor compliance with medication regimes

Beers List www.dcri.org/trial-participation/the-beers-list Best known list of medications deemed inappropriate for use in the elderly These medications have evidence to support they cause SEs due to physiological changes Two examples of anticholinergics on the list: - Diphenhydramine (Benadryl) - Amitriptyline (Elavil) These agents are known to cause cognitive problems, constipation, urinary retention and glaucoma interference

Nonlinear vs. Linear Pharmacokinetics Pharmacokinetics – what the body does to a drug: - Absorption / Distribution / Metabolism / Elimination Linear Pharmacokinetics – assumes doubling the dosage doubles the medication present in the blood Nonlinear Pharmacokinetics – assumes doubling the dosage may increase to a greater amount, depending on other meds the individual is taking Most guidelines for meds were developed using linear vs. non-linear Nurses need to take in account OTC meds also being taken including vitamins and herbals looking for drug interactions

LIGHT Approach Nurses can advocate for the use of LIGHT approach: Life Expectancy (LE) by estimating avg. LE of patient Impact of other conditions (aging process, chronic conditions) Goals of the patient and goals of care Helping patient develop care plan to meet their preferences Time required to determine if benefit from medication occurs

Brown Bag Medication Review Patients bring all medications, including RXs, OTCs, vitamins, herbals, supplements, et al for review and discussion Reviewing medications in this way assists with: - Answering questions and increasing compliance - Identify errors in administration / assess possible drug interactions Download Brown Bag Medication Review toolkit: www.ohiopatientsafety.org/meds/default.htm

Be a Patient Medication Advocate Encourage patients to consolidate care providers Ensure patients have a delivery system for managing meds Review all acute changes in each patient as a potential ADE Mike Varnell, RPh, CSA 3 Star Healthcare, Inc. Email: mikevarnell@gmail.com Phone : (214) 215-1826 (office & cell)