The Consultant Pharmacist


December 2017 | Volume 32 | Number 12

Author Interviews

Comparison of Two Versions of the Beers Criteria and Adverse Outcomes in Older Hospitalized Patients

Time to Reset and Recharge

Nursing facilities are in the process of implementing new federal regulations, many of which involve the use of medications that affect consultant pharmacists.

Member Snapshot

Don Bastain: Becoming a Consultant Pharmacist Consultant pharmacists should think beyond the four walls of their nursing facility practices.

Medication Refusal: Resident Rights, Administration Dilemma

Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it.

Balanitis: A Unique Presentation of Diabetes in an Elderly Male

Uncontrolled diabetes increases the risk of several types of infections, including genital infections. Men with uncontrolled and/or undiagnosed diabetes may present with balanitis or balanoposthitis; therefore, it is important for pharmacists to recognize these as possible presenting symptoms of diabetes. It is essential for pharmacists to recognize possible presenting signs of diabetes in elderly patients, and subsequent provision of diabetes management strategies becomes an important part of pharmacist- provided care.

A Brief Review of Caprylidene (Axona) and Coconut Oil as Alternative Fuels in the Fight Against Alzheimer’s Disease

Two currently available modalities, the medical food caprylidene and coconut oil, seek to target the pathologic mechanism behind decreased glucose utilization in the brain, or “type 3 diabetes mellitus.” These products seek to achieve this by increasing circulating ketone bodies, which can be used as a nonglucose energy source in the brain. However, as with many alternative therapies, those with Alzheimer's disease and their support systems may convey noticeable benefits. Unfortunately, currently, the data for safety and efficacy are limited.

Comparison of Two Versions of the Beers Criteria and Adverse Outcomes in Older Hospitalized Patients

Hospitalized older adults who were prescribed a drug on the Beers criteria (BC) list—drugs inappropriate for older adults—had an increased hospital length of stay; however, there was no statistically significant difference in adverse drug reaction or in-hospital mortal- ity, regardless of the BC version used (2003 vs. 2012). Future studies are warranted to more accurately establish the effectiveness of the BC and its iterations in reducing adverse outcomes and to evaluate the effects of pharmacist interventions using the BC to reduce potentially inappropriate medication use in a hospitalized geriatric population.

Determination of Anticholinergic Medication Use in Patients Prescribed Medications for the Treatment of Dementia

The issue of concomitant prescribing of medications for the treatment of dementia and anticholinergics needs further research and study. This case series shows the incidence almost double that in the literature. Further research is warranted to ascertain the true risk of this combination to patients, preferably by reviewing pharmacy claims data. The impact on outcomes is also unknown; practitioners should continue to monitor potential drug-drug interactions and provide therapeutic alternatives.

Congress Quiet on Long-Term Care, but Agencies Continue to Work

Congress and federal agencies respect the profession of consultant pharmacy and expect us to engage with new solutions to persis- tent problems.


The Consultant Pharmacist® is the official monthly peer-reviewed journal of the American Society of Consultant Pharmacists (ASCP). It is the only journal dedicated exclusively to the medication therapy needs of seniors. ASCP members receive The Consultant Pharmacist® as a member benefit. All articles (2004 to present) are free online for members.

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