Medication Issues in the Elderly Keith T. Breedlove, PharmD Clinical Pharmacist Broughton Hospital

Problems with medication management are the primary reason that people can no longer live on their own. Medication errors lead to: placement in nursing homes and readmission to the hospital within 30 days due to drug interactions or not following prescription instructions. The average senior takes between 13-19 medications daily.

Dispose of expired and unused medications by: Trash Flushing Medication Dropboxes ( local pharmacies or Sheriff’s Dept.)

Tips to Improve Medication Compliance A. Use a personal medication record – see example. Be sure to update after doctor’s appointments and or hospital visits. B. Pill boxes C. Med Sync: getting medications filled all at one time. D. Dispill: medications packaged into individual doses. E. Reminder Apps: My Med Schedule Plus

Lisinopril (Zestril) 10mg 1000mg 40mg 2 puffs 12.5mg Medication Name   Medication Name Dosage How Often Time of Day Start/Stop Dates Reasons for Use 1 Lisinopril (Zestril) 10mg Once daily Morning 1/1/19 BP 2  Metformin (Glucophage) 1000mg Twice daily Morning & bedtime  Diabetes 3  Atorvastatin (Lipitor) 40mg Cholesterol 4  Albuterol inhaler (ProAir) 2 puffs Every 4 hours as needed As needed wheezing 5  Amlodipine (Norvasc) 1/8/19 6  HCTZ 12.5mg 1/9/19 7 8 9

Medications to avoid in the elderly: Medications that increase risk of falls Medications that cause increased confusion Medications that cause increased drowsiness Examples of common medications to avoid (Beers List) Diphenhydramine (Benadryl)-sedation/confusion Certain antidepressants (Elavil, Pamelor, Paxil)-cause sedation and low BP, confusion Benzodiazepines (Ativan, Klonopin, Xanax)-cause cognitive impairment, falls, fractures, motor vehicle accidents

(August 15, 2016) Recent article in the Washington Post… This is America’s other drug problem — polypharmacy,” said Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica, Calif. “There are a lot of souvenirs from being in the hospital: medicines they may not need,” said David Reuben, chief of the geriatrics division at UCLA School of Medicine. “And the problem is huge Ken Covinsky, a researcher and physician at the University of California at San Francisco, said many doctors who prescribe drugs in hospitals don’t consider how long those medications might be needed. “There’s a tendency in medicine every time we start a medicine to never stop it,” Covinsky said.

Deprescribing – getting rid of unnecessary medications Reduces the risk of drug interactions Decreases cost Reduces risk of side effects Less medications to keep up with There’s a tendency in medicine every time we start a medicine to never stop it.” Ken Covinsky, UCSF