1. 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)

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

3. 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

4. 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

5. 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

6. 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”

7. 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

8. 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

9. 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

10. 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

11. 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:

12. 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.
Phone : (214) (office & cell)