|The Senior Care Pharmacist|
IN THIS ISSUE
April 2020 | Volume 35 | Number 4
Pharmacists around the world can expect to be affected by the coronavirus, especially those who provide care for older people who are at a much higher risk for grave consequences from the virus. It is critical that pharmacists maintain awareness of the evolving pandemic and access reliable information to remain familiar with developments.
Pharmacists serving older individuals should be encouraged to avoid prescribing cascades by recommending medication discontinuation or dose reduction, whenever possible.
Anticoagulation is almost always required as a part of treatment for atrial fibrillation, but it is also one of the most potentially dangerous pharmacologic strategies. Recently, a number of guidance documents have been released with respect to anticoagulation. Some elements of the guidelines potentially create conflicting considerations for clinicians charged with selecting the safest and most effective anticoagulation protocol, especially for patients older than 75 years of age.
Five new drugs for medical problems often affecting the elderly and marketed in the United States in 2019 have been considered in this review. The uses and most important properties of these agents are discussed, and a rating for each new drug is determined. Advantages, disadvantages, and other important information regarding each new drug are identified and used as the basis for the rating. The drugs considered include new agents indicated for the treatment of patients with Parkinson’s disease, rheumatoid arthritis, chronic obstructive pulmonary disease, osteoporosis in postmenopausal women, and chronic idiopathic constipation.
Despite advances in the treatment of many infectious diseases, Mycobacterium avium complex (MAC) lung disease continues to rise in prevalence, especially among older persons and in certain geographic areas of the country. Amikacin liposome inhalation suspension (ALIS) has been shown to increase culture conversion rates when added to guideline-based therapy in adults with difficult-to-treat MAC lung disease. ALIS is associated with high rates of pulmonary and auditory adverse reactions and a low risk of renal adverse reactions. ALIS may be an attractive treatment option for older adults who are at high risk for nephrotoxicity.
Hepatic encephalopathy is a complication of decompensated liver disease that has a negative impact on quality of life. For several decades, maintenance therapy with lactulose has been considered the standard of care, but emerging data from clinical trials demonstrate that other therapeutic options may be available and could have a better tolerability profile than lactulose. This brief review will discuss the pathophysiology of hepatic encephalopathy and proposed mechanisms of action of zinc and probiotics in this context, discussing the findings of key trials.
Glucagon and the Autoinjector Pen: Newly Approved Novel Dosage Forms for Management of Severe Hypoglycemia
Older individuals are at increased risk for adverse outcomes associated with hypoglycemia, particularly in situations where a lack of awareness may arise because typical symptoms are not necessarily present. Novel dosage forms of glucagon that have recently been approved for marketing in the United States allow glucagon to be delivered more easily, which may positively impact effective treatment of severe hypoglycemia among older people. Nasal glucagon and glucagon auto-injection “pens” are as effective as glucagon kits and increase the likelihood glucagon will be appropriately used by patient caregivers.
This appears to be the first study explicitly investigating practicing hospital pharmacists’ attitudes and beliefs in relation to the caution exercised when processing geriatric and pediatric medication orders. Pharmacists responding to the survey almost exclusively reported that they use more caution when processing pediatric orders than they do with geriatric medication orders, including more frequent use of drug information resources and placing a greater degree of importance on medication prevention guidelines. This study highlights the gaps in real-world practice that can easily be addressed through increased pharmacist caution and focuses on the older population.
Despite initial worries, the new patient-driven payment model appears to have resulted in increased revenue for nursing facilities.
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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.
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