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

2. 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.

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

4. 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.

5. 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.

6. 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).

7. 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.

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

9. 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?

10. 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)

11. 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

12. 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.

13. 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.

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

15. 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

16. 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.

17. 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

18. 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

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

20. Compliance aids
Pill popper
Pill cutter

21. Compliance aids
Haleraid
Turboaid
Opticare
Opticare artho

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

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

24. 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

25. 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

26. 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.