Skills Workshop M1 Aging Week November 2012

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Presentation transcript:

Skills Workshop M1 Aging Week November 2012 Polypharmacy Skills Workshop M1 Aging Week November 2012

Objectives Discuss basic principles for safe prescribing for elderly patients. Describe the categories of medications most likely to cause adverse reactions or drug interactions for the elderly.

Why worry about this in the elderly? They are prescribed more medication More medication= more drug interactions Body changes with aging: Decreased renal function Higher proportion of body fat Changes in liver metabolism Higher proportion of fat: careful with drugs that are lipophilic (e.g. valium) Renal function: reduce dose (or don’t prescribe) some medicines that are renally cleared: aminoglycosides, nonsteroidal anti-inflamatories.

Adverse Drug Reactions- Risk Factors >6 concurrent chronic diagnoses ≥12 doses of medications/day ≥9 medications Previous adverse reaction Low body weight Age >85 Creatinine clearance <50 ml/min Adverse drug reactions: Defined as injury from a medication. Low creatinine clearance correlates with poor renal function Geriatrics Review Syllabus- American Geriatrics Society

Use with caution: Antihypertensives/diuretics Antiarrhythmics Psychoactive medication (benzodiazepines, antipsychotics) Narcotics NSAIDs Anticholinergics (Benadryl/Diphenhydramine, oxybutinin) Antihypertensives: mention the potential for falls from low blood pressure Antiarrhythmics: mention digoxin NSAIDs: nonsteroidal antiinflamatories. Mention ibuprofen and naproxen.

Principles of prescribing Start low and go slow! Do benefits outweigh risks? Before starting a medication for a symptom- is it a side effect of a drug? Will there be drug interactions? Does the patient understand how to take the medication?