PC ON ELDER PATIENTS

Backgrounds

Multiple diseases

Multiple medications

DIA

approximately 30% of patients age 75 or older with two or more chronic conditions take at least 5 prescription drugs regularly

home residents this number may be as high as 7 or more drugs

Older patients visit multiple physicians for treatment of various conditions

No/ lack of Coordinating medications among pysiciants

Increase risk for adverse drug reactions (ADRs).

Ex. Older patient with hypertension and depression

guanethidine to reduce blood pressure +

tricyclic antidepressant concurrently

Problems

Decrease organ functions

Dose and intervals

Drug interaction

More adverse drug effect

More morbidity and mortality

Problems

Potential / actual compliance

Untreated indication

Drug with no indication

Repeat prescription no longer required

Inappropriate duration of therapy

Discrepancy between doses prescribed and used

Potential drug-disease interaction

Problems

Potential/suspected ADR

Monitoring issues

Potential ineffective therapy

Education required

Inappropriate dosage regime

Age and morbidity realionship

Age related pharmacokinetics and pharmacodynamic

Absorbtion transdermal

Distribution

Factors influence functional age

Nutritional status

Smocking of non smocking

Presence of acute or chronic disease (s)

Acute or chronic therapy

Active or non active habit

Health insurance

Living Dependent or independency in the Family

seven all-too-often-deadly sins of prescribing.

The disease for which a drug is prescribed is actually an adverse reaction to another drug, masquerading as a disease

A drug is used to treat a problem that, although in some cases susceptible to a pharmaceutical solution, should first be treated with commonsense lifestyle changes.

The medical problem is both self-limited and completely unresponsive to treatments such as antibiotics or does not merit treatment with certain drugs.

A drug is the preferred treatment for the medical problem, but instead of the safest, most effectiveand often least expensivetreatment, the physician prescribes one of the Do Not Use drugs listed on this web site or another, much less preferable alternative.

Two drugs interact. Each on its own may be safe and effective, but together they can cause serious injury or death.

Two or more drugs in the same therapeutic category are used, the additional one(s) not adding to the effectiveness of the first but clearly increasing the risk to t

The right drug is prescribed, but the dose is dangerously highhe patient

Example of miss prescribing

The increased use of anti-Parkinsons drugs to treat drug-induced parkinsonism caused by the heartburn drug metoclopramide7 (REGLAN) or by some of the older antipsychotic drugs.

A sharply increased use of laxatives in people with decreased bowel activity that has been caused by antihistamines such as diphenhydramine (BENADRYL), antidepressants such as amitriptyline (ELAVIL)a Do Not Use drugor some antipsychotic drugs such as thioridazine (MELLARIL).8

An increased use of antihypertensive drugs in people with high blood pressure that was caused or increased by very high doses of nonsteroidal anti-inflammatory drugs (NSAIDs), used as painkillers or for arthritis.9

Failing to Treat Certain Problems with Nondrug Treatments

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General services

General services are available such as

Smoking cessation programme

Supervised administration of methadone

Contraception including emergency hormonal contraceptive services

Anticoagulant Monitoring

Medicines Use Review

Pharmacist

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Clinical medication review (CMR)

Pharmacist reviewed the patient, the illness,

and the drug treatment.

Evaluated appropriateness and efficacy of treatments

progress of the conditions

compliance

actual and potential adverse effects interactions

The outcome of the review was a decision about the continuation (or otherwise) of the treatment.

Geriatric Care Principles

spectrum of clinical management not only treatments

interventions for their conditions

Screening, preventive and advanced illness care.

Individualize

Restricted choice of medication

to improve the coordination of treatments.

Pharmaceutical care

Reduce polypharmacy

Ensure appropriate treatment

Help elderly patients understand their medicines

Comorbidity DIA (cont)

Health services

Early (and ongoing) comprehensive multidisciplinary assessment of the biomedical, psychosocial and functional status of the older person

Tailored treatments, diagnostic and therapeutic interventions that focus on the syndromes and diseases associated with ageing

Care planning in consultation with the older person, their family, carer and the community services involved in their care

Specific services

Person-centred practice initial assessment by the interdisciplinary team Mobility, vigour and self care encourage

mobilisation Nutrition - encouragement and support to eat

and drink, Continence encourage use of toilet Medication pharmacy review, Cognition considers, delirium, dementia,

depression

Skin Integrity

Oral health care

QUENTIONS?

Case Nyonya R 63 tahun dengan riwayat heartburn sedang berobat sendiri dengan obat bebas. Akhir-akhir ini ia merasa nyeri d tangan . Dokternya mendiagnosa bahwa dia menderita arthritis dan menulis resep ibuprofen untuknya.

Akan tetapi Mrs. R tidak menjelaskan bahwa ia memnggunakan obat bebas untuk nyeri ulu hatinya. Setelah beberapa minggu menggunakan obat ibuprofen secarav teratur, Mrs. R dia merasa nyeri dadanya semakin bertambah. Dia akhirnya dilarikan ke emergency, tapi setelah menjalani berbagai test, dokter nya menyatakan bahwa ia menderta serangan jantung.

Di samping dokter percaya bahwa ny. R mengalami interaksi obat.

questions

Apa masalah ny R, Apakah masalah tersebut ada kaitannya dengan obat? Obat apa? jelaskanlah

Bagaimana menyelesaikan masalah orang ini?

Apa rencana pelayanan anda?

Perlukan penggantian obat? Obat untuk apa dan apa terapi alternatifnya?

Key

the ibuprofen aggravated her heartburn severely, causing the intense chest pain.To alleviate the condition, the ER doctor contacts Mrs. Rs primary care physician to propose an alternate arthritis drug, which does not

result in gastrointestinal side effects such as heartburn. In addition, he suggests an evaluation to determine the root causes of Mrs. Rs persistent heartburn.