|The Senior Care Pharmacist|
IN THIS ISSUE
August 2020 | Volume 35 | Number 8
Why has it been so difficult to gain traction in reducing the serious consequences of adverse drug reactions (ADRs), particularly among the people who are most vulnerable? Pharmacists have a unique place in the clinical setting as the advocates for the adoption of evidence-based care, and they are the well-placed clinical professionals who can detect ADRs and provide guidance about how to address them.
Dr. Olga Hilas, associate professor from St. John's University, reflects on her Pain Management Traineeship with the American Society of Consultant Pharmacists Foundation.
As the number of people taking multiple medications increases, differing approaches to address drug-drug interactions and adverse drug reactions have been debated—but not solved—espite excellent criteria to stop the use of potentially inappropriate medications.
Digital therapeutics (DTx)—treatment or therapy that uses digital health technologies to spur changes in patient behavior—increasingly are making their way into the health care environment. These technologies, whether they are apps, software programs, or sensors, are helping patients adhere to treatments and lifestyle changes, set and meet viable care goals, and avoid costly emergency department visits and hospitalizations. At the same time, DTx are helping practitioners ensure the best possible outcomes; streamline costs; monitor patient progress; and receive, analyze, and share data.
Beta-blockers are a major component of therapy in numerous cardiovascular diseases that have a higher incidence in older people. Along with polypharmacy and neurocognitive decline, potentially limiting reliable medication adherence, older patients may be more sensitive to the hypotensive and bradycardic effects of beta-blockers. Additionally, because of a lack of success of traditional management methods, evidence of newer therapies such as high-dose insulin euglycemia therapy and intravenous lipid emulsion has shown success in various patient cases. This review summarizes the mechanisms and effects of beta-blocker toxicity and reviews management strategies in older people.
Lefamulin: A Review of Newly Approved Antibiotic Treatment for Community-Acquired Bacterial Pneumonia
Lefamulin, newly approved by the Food and Drug Administration, is a novel systemic, semi-synthetic pleuromutilin class of antimicrobials that has been shown to be effective against common respiratory pathogens associated with community-acquired bacterial pneumonia (CABP). CABP, a common infection among older people, leads to an increase in hospitalizations and mortality. Therefore, the use of lefamulin could be beneficial for CABP treatment in patients who are 65 years of age or older. Lefamulin is available in both intravenous and oral formulations. This medication offers the benefit of not having any cross-resistance to other antibiotics and is highly concentrated in lung tissues. Lefamulin is unique because it has an induced-fit mechanism of action that inhibits bacterial protein synthesis. The clinical efficacy of lefamulin has demonstrated noninferiority to current standard-of-care for CABP, and patients, generally, have tolerated it well.
The Food and Drug Administration issued several warnings recently regarding the use of fluoroquinolones because of a variety of serious toxicities. Risk of adverse reactions increases in older people because of the physiological changes that come with aging, the increased likelihood of concurrent comorbidities, and the use of multiple medications. Because of these risk-enhancing factors, fluoroquinolone use, particularly in older people, should be scrutinized and used only when no other therapeutic alternatives exist.
Inpatient falls continue to have detrimental effects on patient care and recovery. Because controllable and uncontrollable factors impact fall rates, predicting which patients are at the greatest risk can be challenging. One method includes the incorporation of student learners to help identify which patients are at the greatest risk for falls. In this pharmacist intern-led falls-prevention initiative did not provide a statistically significant reduction in falls. While the scoring metric was helpful in reviewing charts to make recommendations for interventions, the assigned score did not correlate as expected to incidents of falls.
Nursing facilities have suffered the double injury of an immediate reduction in occupancy and the reputational harm of the high number of COVID-19 deaths and infections.
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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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