Preventing Falls Helping patients to manage their medicines Jayne Agnew Pharmacy SHSCT

Causes of falls There are many causes of falls. Medicines can be a cause in a variety of ways e.g. it may be an unwanted effect (side effect) of the medicine. Studies have shown that taking more than four medicines can increase the risk of falls, no matter what the medicines are.

Unwanted effects of medicines include: A sudden drop in blood pressure on standing Poor balance Confusion Drowsiness Dizziness Blurred vision

Medicines that can cause falls Sleeping tablets and nerve tablets e.g. temazepam, diazepam, zopiclone, zimovane. These can make people drowsy and clumsy. Psychotropic medicines e.g. chlorpromazine. These are used in patients who can be very agitated. These can cause confusion and low blood pressure.

Medicines that can cause falls Medicines that affect blood pressure e.g. blood pressure medicine, angina medicine. Some antidepressants e.g. fluoxetine, citalopram and parkinsons medicines e.g. Madopar can lower blood pressure.

Medicines that can cause falls Some antidepressants can cause drowsiness e.g. amitriptyline, dosulepin. These medicines can also be used to treat nerve pain. Epilepsy medicines can slow down reaction times and increase risk of falls e.g. Tegretol® (carbamazepine), Epilim® (sodium valproate). Some epilepsy medicines can be used to treat nerve pain e.g. Lyrica® (pregabalin).

Medicines that can cause falls Fluid or water tablets (diuretics) e.g. furosemide. If taken late in the day the patient may have to get up to use the toilet during the night and increase their risk of a fall. Strong painkillers e.g. morphine, codeine, tramadol, BuTrans®, Transtec® – these can cause low blood pressure and dizziness.

Alcohol Alcohol can cause drowsiness and dizziness. It interacts with many medicines and can make unwanted effects of medicines worse.

What can patient’s do? Talk to their doctor or pharmacist if they experience unwanted effects from their medicines. Ask their doctor or pharmacist to review their medicines every six to twelve months. This should include medicines the patient buys e.g. pain killers, herbal medicines. Are they all needed?

Medication review Does the patient know why they are talking each of their medicines? Are all the medicines still needed? Is the patient experiencing any side effects? Are all the medicines still working? Are any blood tests needed e.g. Kidney function? Are the medicines the best medicines for the patient? Could any of the medicines be changed to ones that will work just as well but could save the NHS money (Northern Ireland Formulary)

What can patient’s do? Patients should not stop or change the dose of a medicine prescribed by a doctor without talking to their doctor first. Know all the medicines they are taking: Why are they taking it What does it do How and when should they take it What possible unwanted effects could it cause

What can patient’s do? Talk to their doctor or pharmacist before adding any new medicines. Carry an up to date list of all the medicines that they are taking. They can show this to their doctor or pharmacist when they visit them. Never use another person’s medicines.

What can patient’s do? Develop a system that helps them to take their medicines as prescribed e.g. reminder charts, alarms. Return any medicines they are no longer taking to their community pharmacist. If they are admitted to hospital they should check when they are going home that they understand what changes have been made to their medicines. Drink enough water. Dehydration can cause dizziness.

Medicines used to strengthen bones Calcium and vitamin D e.g. Calceos, Natecal D3, Adcal D3, Calcichew Hormone replacement therapy in women

Medicines used to strengthen bones Patient’s with osteoporosis will usually be prescribed a bone tablet e.g. risedronate (Actonel) or alendronic acid (Fosamax) taken once a week or Bonviva taken once a month

Things to remember about bone tablets Calcium tablets should not be taken at the same time as risedronate or alendronic acid. Patient should take their calcium at lunchtime on the day they take their bone tablet. Take your risedronate or alendronic acid should be taken on an empty stomach at least 30 minutes before breakfast. It should be taken with a glass of water and the patient should stand or sit upright for 30 minutes after taking it.

Medication adherence support pilot Assessment tool Simplify medication regimen Medicine education Encourage active family/caregiver involvement Provision of Medication list Provision of compliance aid Reminder charts

Medication adherence support pilot Easy open containers Synchronisation of medication quantities Collection of medications/ delivery solution Change to medication timing Bespoke reminder system e.g. Text messages, phone calls Large print and audio labels Audio patient information leaflets,t ranslations

Medication reminders Medication reminder watch Daily medication reminder Smartphone medication adherence Apps e.g. Pill reminder App, Drugs.com Medication Guide

Compliance aids Pill popper Pill cutter

Compliance aids Haleraid Turboaid Opticare Opticare artho

Compliance aids Community pharmacists receive no payment to supply these Reusable compliance aids – family member or patient can fill Non reusable compliance aids

Compliance aids Clear print and large print labels Audio labels Talking label voice recorder Braille labels Tactile labels

Compliance aids Tablet crushers Patients need to check if their medicine can be crushed Some medicines should never be crushed e.g. modified release preparations, enteric coated preparations

MUR (Medicines Use Review) service Service provided by most community pharmacies Diabetic and respiratory patients on multiple medicines Aim of MUR is to help patients use their medicines more effectively Establishes patient’s actual use, understanding and experience of taking their medicines Identifies, discusses and resolves poor or ineffective medicine use e.g. ‘using preventer inhaler only if chest is bad’ Identifies side effects and drug interactions that may affect a patient’s compliance with their medicines Follow up consultation 4 weeks later if needed

Medicines Management Service Some local pharmacies provide a medicines management service It is a service where the community pharmacist will do a detailed review of a patient’s medicines and answer any queries they have about their medicines.