Appropriate Prescribing and Important Drug Interactions in Older Adults
69
Citation
69
Reference
10
Related Paper
Citation Trend
Keywords:
Beers Criteria
Beers Criteria
Geriatric Care
Cite
Citations (46)
The administration of many drugs at the same time or the administration of an excessive number of drugs can cause the potentially serious drug-drug interactions and adverse drug events. Adverse drug events and serious harms occurs at all ages, although they are more commoner in older people, who are more vulnerable to drug toxicity because of age related physiologic changes and increased risk of disease associated with aging and because of polypharmacy. The objective of this study was to identify the degree of polypharmacy and the frequency of potential drug- drug interactions in the medication regimen of elderly patients. This is a cross – sectional observational study conducted in the general medicine department of a tertiary care teaching hospital over a period of 6 months. Sample size of 150 cases of elderly patients was collected from general medicine ward and was reviewed for polypharmacy and potential drug-drug interactions. From among the 150 cases collected, 65(43%) cases were identified with polypharmacy out of which 23(35%) were male and 42(65%) were female. The average number of drug prescribed per patient was 6.05. Among 150 cases, 71(47%) cases were identified with 152 potential drug-drug interactions out of which 8 cases (11%) were with clinically observed adverse drug reaction due to drug interactions. Majority of the potential drug-drug interactions were pharmacodynamic in nature (67%). It was observed that out of 152 pDDIs identified,17(11%) were major, 110(72%) were moderate and 25(16%) were minor in severity.
Pharmacotherapy
Regimen
Cite
Citations (0)
Deprescribing
Discontinuation
Beers Criteria
Adverse drug event
Cite
Citations (0)
Beers Criteria
Acute care
Cite
Citations (46)
Introduction: Many older patients experience polypharmacy and risk taking potentially inappropriate medications (PIMs) leading to adverse events. Recent studies have demonstrated the association between frailty and an increase in PIMs among community-dwelling older people and those with cancer. We evaluated whether frailty in hospitalised older patients is associated with polypharmacy and PIMs.
Methods: A cross-sectional study of inpatients aged ≥70 years admitted to one UK hospital. Frailty was assessed using the Fried Frailty Phenotype and FRAIL Scale. Polypharmacy and hyper-polypharmacy were defined as the concomitant use of five + and 10 + medications, respectively. PIMs were identified using the Beers and STOPP criteria.
Results: 201 participants (median age 80.7 years; 120 (60%) men) were recruited. 1738 medications were prescribed in this cohort, median 9 medications/ patient. Frailty was identified in 56% and 36% using the Fried Frailty Phenotype and FRAIL scale, respectively. Polypharmacy (46%) and hyper-polypharmacy (41%) were also common. Frailty using both scales was significantly associated with polypharmacy (P< 0.001). The Beers’ criteria identified 90 PIMs in 57 (28%) patients. 33 (58%) received one and 24 (42%) received 2+ PIMs. 108 PIMs in 76 (38%) patients were identified using the STOPP criteria. 53 patients (70%) received one and 23 (30%) received 2+ PIMs. Both frailty tools were significantly associated with PIMs using the STOPP criteria but not using the Beers’ criteria.
Conclusion: Frailty in older inpatients was significantly associated with polypharmacy and PIMs using the STOPP criteria. Structured medication review is essential for older people in hospital.
Beers Criteria
Cross-sectional study
Concomitant
Cite
Citations (0)
Polypharmacy, defined as concurrent of five or more drugs, can occur in patients of all ages. Polypharmacy may be appropriate or inappropriate. Appropriate polypharmacy is defined as use of the correct drugs under appropriate conditions [in order] to treat the right diseases. A prescribed drug becomes inappropriate when its benefits no longer outweigh its risks. Inappropriate polypharmacy has been shown to increase the risks of hospitalization, adverse drug events, clinically relevant drug interactions, and all-cause mortality. Many tools are available to aid physicians in identifying inappropriate polypharmacy. Implicit tools, such as the Medication Appropriateness Index (MAI), provide guidance to be used alongside clinical judgement. Explicit tools, such as the American Geriatrics Society (AGS) Beers Criteria, provide lists of potentially inappropriate drugs and recommend alternatives. Collaboration with pharmacists is important in assessing drug appropriateness. It has been shown to reduce drug-related problems, emergency department visits, and hospitalizations and to improve overall patient health. A patient-centered, team-based approach is recommended in the process of deprescribing inappropriate drugs. Deprescribing should be approached in the same stepwise manner as prescribing of new drugs, and should include patient agreement to changes, evidence-based rationales, and of dosage tapering strategies.
Deprescribing
Beers Criteria
Adverse drug event
Cite
Citations (3)
Background: Polypharmacy is the use of five or more types of drugs in a therapy simultaneously. The use of polypharmacy therapy increases the potential for drug-drug interactions. In COVID-19 therapy, the use of varied antiviral and non-antiviral medications allow for increased polypharmacy and potential drug interactions. Objective: To determine the relationship between polypharmacy and drug-drug interactions in COVID-19 therapy. Method: This is an analytical observational study with retrospective data retrieval using secondary data sources. The sampling technique used purposive sampling with a total of 91 samples. Tracing potential drug interactions was reviewed through the Micromedex 2.0 application and the results obtained were analysed with the Spearman correlation analysis test. Result: The results of data obtained from non-polypharmacy events was 3.20% and polypharmacy events was 96.80%. The potential for drug interactions was at the Contraindicated category (3.78%), the Major Category (66.19%), the Moderate category (27.87%) and the Minor category (2.16%). The results from the test showed a very strong positive correlation between polypharmacy and potential drug interactions characterised by a p-value of 0.0001 and a correlation coefficient of 0.874. Conclusion: The higher the increase in polypharmacy, the higher the potential for drug interactions. Handling of drug interactions that occur can be given by giving a pause in the time of drug use, dose adjustment, and drug turnover.
Pharmacotherapy
Drug repositioning
Cite
Citations (0)
Polypharmacy and Potentially Inappropriate Medication (PIM) are major public health concerns. They are associated with higher morbi-mortality and a socio-economic burden. The medication review is a solution to limit PIM, especially in the elderly, and in cases of poly-morbidity. Many tools are available to support medication review. We will introduce here the Beers criteria, the PRISCUS list, the STOPP/START criteria, the MAI (Medication Appropriateness Index) and the Good-Palliative-Geriatric Practice Algorithm.
Beers Criteria
Medication Reconciliation
Cite
Citations (0)
Polypharmacy, defined as the use of five or more medications, is becoming increasingly prevalent in older adults throughout the United States. Depre-scribing, along with the use of existing tools, such as the American Geriatrics Society Beers Criteria, can help guide health care providers in reducing the risks associated with polypharmacy such as side effects and drug interactions. The framework of deprescribing and the use of existing guidelines and resources are valuable in guiding health care providers in addressing polypharmacy. [Journal of Gerontological Nursing, 45(1), 9-15.].
Deprescribing
Beers Criteria
Gerontological nursing
Cite
Citations (11)
Beers Criteria
Reimbursement
Pharmacotherapy
Cite
Citations (68)