identifying & preventing adverse drug events in the elderly€¦ · identifying &...
TRANSCRIPT
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Identifying & Preventing Adverse Drug Events In the Elderly
Tanya Vadala, Pharm.D.
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Atlantic Quality Innovation Network (AQIN)
The federally funded Medicare Quality Innovation Network – Quality
Improvement Organization (QIN-QIO) for New York State, the
District of Columbia, and South Carolina.
Led by IPRO.
Partners include
Delmarva Foundation in the District of Columbia and
The Carolinas Center for Medical Excellence in South Carolina.
One of 14 QIN-QIOs operating across the U.S.
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Atlantic Quality Innovation Network (AQIN)
Works toward better care, healthier people and communities, and
smarter spending
Catalyzes change through a data-driven approach to improving
healthcare quality.
Collaborates with providers, practitioners and stakeholders at the
community level to share knowledge, spread best practices and
improve care coordination.
Promotes a patient-centered model of care, in which healthcare
services are tailored to meet the needs of patients.
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Objectives
Define adverse drug event (ADE)
Discuss patient specific factors that contribute to ADEs
in seniors
Identify ADEs of commonly prescribed meds
Apply knowledge to avoid future ADEs
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Adverse Drug Event Definition
ANY undesirable experience associated with the use of
a medical product in a patient
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Contributing Factors
Kidney function
Liver function
Multiple medications
Multiple health conditions
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Most Common ADE Medications
Blood thinners
Diabetes medications
Opioids (controlled substance pain reliever)
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Blood Thinners
Coumadin (warfarin or jantoven)
Eliquis
Pradaxa
Xarelto
Plavix (clopidigrel)
Aspirin
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Concerns with Blood Thinners
Adherence
Blood work
Drug/Food interactions
Drug/Drug interactions
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Adherence
Is the patient taking the medication as prescribed?
Are doses missed?
Does the pharmacy have the medication in stock?
Has the prescriber changed your dose since writing the
prescription?
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Blood Work
Coumadin, warfarin, and jantoven require regular blood
level monitoring
Do you know how often you need to have your blood
tested?
Do you know what range your blood work should be in?
When was your last blood draw?
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Drug/Food Interactions
Coumadin, warfarin, and jantoven all have interactions
with certain foods and vitamins
Are you aware of the foods that should be avoided or
eaten with consistency and moderation?
Are you willing to abide by these dietary considerations
for the entire time taking this medication?
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Drug/Food Interactions
Foods or vitamins containing vitamin K
What happens if you have too much of a food
containing vitamin K?
What contains vitamin K?
• Leafy greens – kale, spinach, brussels sprouts, collard and
mustard greens, chard, and green tea
• Cranberry juice
• Alcohol
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Warfarin/Antimicrobial Interactions
This Does NOT include all possible interactions
Antimicrobials include:
• Antibiotics
• Antifungals
• Antivirals
• Anti-infectives
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Antibiotics
Amoxicillin
Ampicillin
Augmentin (amoxicillin/clavulanic acid)
Avelox (moxifloxacin)
Bactrim (sulfamethoxazole/trimethoprim)
Biaxin (clarithromycin)
Cipro (ciprofloxacin)
Dicloxacillin
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Antibiotics
Doxycycline
Ery-Tab (erythromycin)
Levaquin (levofloxacin)
Minocycline
Ofloxacin
Pen VK (penicillin)
Tetracycline
Zithromax (azithromycin)
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Antifungals
Diflucan (fluconazole)
Griseofulvin
Itraconazole
Ketoconazole
Miconazole
Terbinafine
Voriconazole
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Antivirals
Aptivus (tipranavir)
Crixivan (indinavir)
Invirase (saquinavir)
Lexiva (fosamprenavir)
Norvir (ritonavir)
Prezista (darunavir)
Tamiflu (oseltamivir)
Viracept (nelfinavir)
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Other Anti-infectives
Flagyl (metronidazole)
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What to look for…
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Signs of Bleeding
Increased bruising
Bleeding gums/nose
Bright red blood in stool
Black (tarry) stool
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Signs of Clotting
Stroke
• Facial drooping
• Numbness or weakness on one side of the body
Arm
Leg
Entire side of body
• Speech difficulty
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Signs of Clotting
Heart Attack
• Chest pain
• Arm pain
• Trouble breathing
• Tightness in chest
• Nausea
• Cold sweat
• Lightheaded
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Signs of Clotting
Deep Vein or Arterial Thrombosis (clot)
• Pain in an extremity
• Swelling
• Redness
• Numbness
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Diabetes Medications
Almost all diabetes medications
Includes oral and injectable medications
Too many to list
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Concerns with Diabetes Medications
Blood sugar levels going too LOW
• Blood sugar = blood glucose
• Low blood glucose = hypoglycemia
Adherence
Blood work
Drug/drug interactions
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Low Blood Sugar
Even taking diabetes medications correctly can lead to
low blood sugar
Can be dangerous…even life threatening
At home monitoring can help identify and prevent low
blood sugar
Knowing the signs and symptoms of low blood sugar is
key!
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Signs & Symptoms of Low Blood Sugar
Confusion*
Sweating/chills*
Shaking*
Dizziness*
Nervousness/anxiety*
Nausea*
Rapid heart beat
Seizures
Irritability*
Headache*
Weakness*
Tiredness*
Blurred/impaired vision
Lack of coordination
Anger or sadness
Unconsciousness
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* Most Common
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How to Treat Low Blood Sugar
Consume 15-20 grams of glucose or simple
carbohydrates
Check your blood glucose after 15 minutes
If blood glucose is still low, REPEAT
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Examples of 15 grams of glucose/simple carbohydrates
Glucose tablets (see instructions on package)
Glucose gel (see instructions on package)
4oz (½ cup) of juice or regular soda (NOT diet)
1 tablespoon sugar, honey, or corn syrup
Hard candies, jelly beans, or gumdrops (see package to
determine how many to consume)
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Tips for Avoiding Low Blood Sugar
Take medications exactly as prescribed
If you miss a dose, do NOT double up on the next dose
Monitor blood sugar as directed by your prescriber
Learn to recognize the signs of low blood sugar early
so you can treat it before it becomes worse
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Causes of Low Blood Sugar
Taking more of your medication than is prescribed
Not eating your normal amount of food
Being sick
Increase in physical activity from normal
Taking medications that interact with your diabetes
medications
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Interactions/Medications
Taking multiple diabetes medications
• Additive effect of lowing blood sugar
Antibiotics
Alcohol
**Not an all inclusive list**
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Help Yourself!!
Wear a med alert bracelet or something that will alert
others that you are diabetic in case you become
unconscious
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Opioids
• Used to treat moderate to severe pain
• Need to be used with caution in the elderly
• Controlled substances
• Have abuse and addiction potential
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Concerns with Opioids
Opioids can cause…
• Drowsiness
• Dizziness
• Confusion
• Decreased breathing
• Lowered blood pressure
• Nausea
• Constipation
ALL of these INCREASE risk of FALLS
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How to Avoid Opioid Issues
• ONLY take if absolutely necessary
• Take as little as possible to treat pain
• Do NOT take any medication that is not prescribed to
you
• Do NOT share your medication with others
• Store your medication in a safe/secure place
• Dispose of medication properly
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What now??
You know 3 drug classes that are associated with high
incidence of ADEs
You know what symptoms to look for
BUT
What do you do…
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When You Recognize a Sign/Symptom?
• Immediately treat to avoid worsening of problem
• Notify your doctor and/or pharmacist
• If severe, go to nearest emergency room
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How to Prevent ADEs
• Only take medication prescribed for you
• Do NOT share your medications with others
• Take your medications exactly as prescribed
• Never skip a dose or increase a dose unless
instructed to do so by your physician
• Ask your pharmacist or doctor before taking any over
the counter or herbal medications
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How to Prevent ADEs
ALWAYS have a list of your medications with you
The list should include up-to-date info on:
• Medication name
• Strength
• How often you take it
• Why you take it
• Prescriber
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How to Prevent ADEs
Inform EVERY physician of ALL medications you are
currently taking
• Including over the counter and herbal medications
Get ALL medications from the same pharmacy
• If you have to use different pharmacies, tell each
pharmacist ALL of the medications you are taking
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How to Prevent ADEs
ASK QUESTIONS!!!!!
Be your own advocate
Don’t expect your prescriber to ask all the right
questions
Don’t expect your prescriber to know all the
medications you are taking
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How to Prevent ADEs
KNOW your medicine!
KNOW your pharmacist!!
Ask questions about your medications
Confirm with your pharmacist that all new prescriptions
are okay with what you are currently taking
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Choose the best answer
Alice is on warfarin and started an antibiotic 4 days
ago. Now she is having black, tarry stools. What
should she do?
A. Wait and see if it goes away in a couple days
B. Call her doctor
C. Go to the emergency room
D. Stop taking the antibiotic
E. Stop taking her warfarin
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Choose the best answer
What could Alice have done to prevent this from
happening?
A. Tell the prescriber she is a warfarin patient
B. Tell the pharmacist she is a warfarin patient
C. Give a list of all her meds to the prescriber
D. Ask the pharmacist if the antibiotic interacts with any
of her medications
E. All of the above
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This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation Network -
Quality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with
the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The
contents do not necessarily reflect CMS policy.11SOW-AQINNY-TskC.3-17-05
Thank You!
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For more information
Tanya Vadala, Pharm.D.
Pharmacist
(518) 320-3534
IPRO CORPORATE HEADQUARTERS
1979 Marcus Avenue
Lake Success, NY 11042-1002
IPRO REGIONAL OFFICE
20 Corporate Woods Boulevard
Albany, NY 12211-2370
www.atlanticquality.org
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