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

2. 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.

3. 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.

4. 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

5. 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.

6. 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?