|The Consultant Pharmacist|
IN THIS ISSUE
June 2018 | Volume 33 | Number 6
Deprescribing is front and center with providers, caregivers, and long-term care organizations.
Helping pharmacists make the best use of their extensive clinical education and skills is a primary focus for pharmacy leaders. The University of Connecticut School of Pharmacy’s PRISM initiative creates opportunities to partner with other health professionals or programs to advance the pharmacist's role in the community. This article discusses progress made in Connecticut’s program and describes others that, if replicated, could significantly improve care for vulnerable populations, especially the elderly. Programs that have been especially useful have emphasized the difference between needing medical versus needing pharmacy services, and created links between community leaders with similar goals.
Using the available evidence, treatment for osteoporosis in the oldest population with a bisphosphonate, such as risedronate, zoledronic acid or alendronate, or denosumab, is a first choice. Cost, tolerability, patient life expectancy, and patient preference should be considered before starting treatment. With the increasing aging population, health care providers will be seeing more research in this area, which is needed to help guide treatment in this population.
This is a case report of a 77-year-old patient with diabetes and peripheral neuropathy and paresthesias in his feet, for which he was treated with pregabalin. During the therapy, his eosinophil level was high (60.3%). Pregabalin was stopped, and after one month his differential eosinophil had dropped dramatically, to 7.3%. Based on the Naranjo Adverse Drug Reaction scale, it is probable that the eosinophilia was induced by pregabalin, as the Naranjo probability score was calculated to be 8.
Older adults in assisted living settings are experiencing polypharmacy at rates slightly higher than those in the community or in some nursing facility settings. None of the predicted variables (age, gender, race, setting, diagnoses, and cognition) was associated with polypharmacy. Provider preferences and practices and resident or family requests may have a greater impact on prescribing and medication use than resident-related factors. Continued research is needed to explore the factors that influence polypharmacy to help guide deprescribing.
Medication can be deprescribed from psychogeriatric patients after medication reviews performed by pharmacists and nursing facility physicians. More than 50% of the advised changes to deprescribe involved 10 drug groups, which raises the question whether the structured medication review can be performed more efficiently by focusing on the most common problems. Reaching agreement with those involved before making changes may be an important factor in the successful deprescribing of inappropriate medications.
New Medicare regulations reduce the drug supply, from 90 days to 30 days, for long-term care residents, participating in Part D who are transitioning to a new plan if their current drugs aren’t on their formulary.
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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.
2018 ASCP Integrated Media Kit
Nonmembers can access online abstracts to journal articles. Full articles are available for $35.00 each.
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