|The Senior Care Pharmacist|
IN THIS ISSUE
September 2019 | Volume 34 | Number 8
All medications have a profile of benefits and risks. Pharmacists and other providers use this information to make decisions about treatment and, in the best of circumstances, providers engage in shared decision making and discuss this information with patients in the spirit of patient-centered care. As pharmacists we have much work to do in this arena, as older adults are often prescribed medications that have a high risk of serious adverse events.
Approved for only two uses, but used off-label for many others, gabapentin can induce euphoria at high doses. In older adults, clinicians prescribe it for seizures, pain, migraine, and aggression associated with dementia, among other things. Gabapentin’s rapid onset of action, side effect profile, limited drug-drug interactions, and extensive pharmacokinetic data on renal impairment have made prescribers comfortable using it in older adults. However, with its off-label use growing exponentially and closely paralleling the opioid epidemic, pharmacists are likely witnessing the beginning of a growing problem in both addiction management and geriatric health care.
Upper Gastrointestinal Bleeding in a Male Patient Taking Megestrol Acetate and Rivaroxaban: A Case Report
Despite the predominant evidence for prothrombotic potential with megestrol acetate (MGA), this report offers the possibility that MGA may also pose significant bleeding risk with concomitant anticoagulants. Patients taking MGA should be closely monitored for hemostatic changes, coagulopathy, and progestin-anticoagulant interactions throughout transitions of care.
Many long-term care facilities have traditionally, and currently, used a “list format” of allergies in, or on, the resident’s chart. This approach is incomplete as it rarely provides detailed information about the reaction to a particular drug. Senior care pharmacists and their students can play a role within long-term care facilities by helping ensure the optimal selection of drugs by providing a detailed allergy assessment that documents detailed reaction information, whenever possible.
This study evaluated prescribing practices for elderly patients started on apixaban in multiple practice settings. The results found when initiating apixaban for older adults, prescribers are oftentimes starting doses that are inconsistent with package insert labeling. This research supports the fact that pharmacists can play a vital role in anticoagulation stewardship by verifying apixaban doses for accuracy.
The majority of long-term proton-pump inhibitors (PPIs) assessed for this study were prescribed without an appropriate indication. Long-term PPI therapy should be evaluated on a regular basis to determine if the patient has an appropriate indication in order to minimize polypharmacy and reduce risk of adverse effects. With the implementation of a pharmacist-driven PPI stepdown protocol, a majority of patients were able to tolerate the PPI step-down with the use of alternative acid-suppression therapy.
The promise of the new “big data” movement is to gather huge datasets, pass them through various filters, and find patterns that are not obvious but may hold the key to new treatments that are more effective than the ones we’re using today.
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The Senior Care Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists (ASCP). It is the only journal dedicated exclusively to the medication therapy needs of older adults. ASCP members receive The Senior Care Pharmacist® as a member benefit. All articles (2004 to present) are free online for members.
2019 ASCP Integrated Media Kit
Nonmembers can access online abstracts to journal articles. Full articles are available for $35.00 each.
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