Medication Overload: America's Other Drug Problem | Lown Institute PART 2 Drivers of Medication Overload
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Polypharmacy and the Senior Citizen: the Influence of Direct-To-Consumer Advertising
2021;69:19-25 CLINICAL GETRIATRICS - ORIGINAL INVESTIGATION doi: 10.36150/2499-6564-447 Polypharmacy and the senior citizen: the influence of direct-to-consumer advertising Linda Sperling, DHA, MSN, RN1, Martine B. Fairbanks, Ed.D, MA, BS2 1 College of nursing, University of Phoenix, Arizona, USA; 2 College of doctoral studies, University of Phoenix, Arizona, USA Background. Polypharmacy, or taking five or more medications dai- ly, can lead to poor medication compliance and an increased risk for adverse drug-to-drug interactions that may eventually lead to death. The study was designed to explore the questions of how age, the re- lationship between the physician and patient, and television, radio, magazines and modern electronic technology, such as the Internet, affect patients’ understanding of their medical care. Two main areas addressed in this research study included the pharmaceutical indus- try’s influence on consumer decisions to ask a physician for a particular medication, and the prescribing practices of the physician. Methods. This qualitative phenomenological study began with pre- screening volunteer residents in a nursing home to discover poten- tial participants who met the criteria of using five or more medicines daily. We then interviewed 24 participants who met the criteria, using semi-structured interview questions. Results. Four core themes emerged from this study: professional trust, professional knowledge, communication deficit, and direct-to-consum- Received: April 30, 2020 er advertising. Participants reported trusting their doctors and taking Accepted: November 2, 2020 medications without question, but most knew why they were taking the Correspondence medications. Participants also reported seeing ads for medications, but Linda Sperling DHA, MSN, RN only one reported asking a physician to prescribe the medication. -
ADHD Parents Medication Guide Revised July 2013
ADHD Parents Medication Guide Revised July 2013 Attention-Deficit/Hyperactivity Disorder Prepared by: American Academy of Child & Adolescent Psychiatry and American Psychiatric Association Supported by the Elaine Schlosser Lewis Fund Physician: ___________________________________________________ Address: ___________________________________________________ ___________________________________________________ ___________________________________________________ Phone: ___________________________________________________ Email: ___________________________________________________ ADHD Parents Medication Guide – July 2013 2 Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by difficulty paying attention, excessive activity, and impulsivity (acting before you think). ADHD is usually identified when children are in grade school but can be diagnosed at any time from preschool to adulthood. Recent studies indicate that almost 10 percent of children between the ages of 4 to 17 are reported by their parents as being diagnosed with ADHD. So in a classroom of 30 children, two to three children may have ADHD.1,2,3,4,5 Short attention spans and high levels of activity are a normal part of childhood. For children with ADHD, these behaviors are excessive, inappropriate for their age, and interfere with daily functioning at home, school, and with peers. Some children with ADHD only have problems with attention; other children only have issues with hyperactivity and impulsivity; most children with ADHD have problems with all three. As they grow into adolescence and young adulthood, children with ADHD may become less hyperactive yet continue to have significant problems with distraction, disorganization, and poor impulse control. ADHD can interfere with a child’s ability to perform in school, do homework, follow rules, and develop and maintain peer relationships. When children become adolescents, ADHD can increase their risk of dropping out of school or having disciplinary problems. -
Opioid Weaning Guidance Document Primary Care GENERAL CONSIDERATIONS: 1
Opioid Weaning Guidance Document Primary Care GENERAL CONSIDERATIONS: 1. Determine if the goal is a dose reduction or complete discontinuation of agent(s). 2. Weans should occur gradually to minimize the risk of withdrawal symptoms. Weaning opioids may take 6 months or more depending on the total opioid dose and the individual patient’s response to the opioid wean. There is no need to rush this process as this may only cause more distress for the patient. 3. Optimize non-opioid pain management strategies. This link provides options for non-opioid strategies: https://www.cdc.gov/drugoverdose/pdf/alternative_treatments-a.pdf a. Recommend implementing one non-opioid agent at a time b. Evaluate and discontinue any agents that are ineffective c. Do not exceed maximum recommended doses or combine multiple agents from the same medication class d. Avoid use of benzodiazepines or any sedative hypnotic agents 4. Set expectations and functional goals with patient prior to initiation of the opioid wean. 5. Educate patient on the change in opioid tolerance over time during the opioid wean and risk for overdose if they resume their starting dose or a previously stable higher dose. Discuss/prescribe naloxone to minimize the risk of overdose. 6. Screen for and treat any untreated/under-treated depression. Depression may make the weaning process more challenging. MORPHINE EQUIVALENT DOSE CALCULATOR: 1. Link to calculator: http://www.agencymeddirectors.wa.gov/Calculator/DoseCalculator.htm 2. This calculator can be utilized to determine the current morphine equivalent dose your patient is receiving at baseline. If the goal is for opioid dose reduction, this calculator can also be used to determine your goal “ending” dose. -
Qato Et Al, “Changes in Prescription and Over-The-Counter Medi
Polypharmacy: time to get beyond numbers Invited commentary on: Qato et al, “Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States, 2005 vs 2011” and Jou et al, “Non-disclosure of complementary and alternative medicine (CAM) use to usual care providers: Findings from the 2012 National Health Interview Survey” Michael A. Steinman, MD Division of Geriatrics, University of California, San Francisco and the San Francisco VA Health Care System Word count: 1023 References: 7 Support: Supported by grants from the National Institute on Aging (K24-AG049057-01 and P30- AG044281) Acknowledgement / Disclosure: Dr. Steinman is a consultant for iodine.com, an internet start-up company. Corresponding author: Michael A. Steinman, MD 4150 Clement St, VA Box 181G San Francisco, CA 94121 [email protected] When I tell someone that I am a geriatrician, I often get the same response. I am told half- jokingly that the person needs my services. Then, I am regaled with a story of how the person’s older parent, grandparent, or spouse is prescribed an enormous number of medications, thinks they might be causing problems, and doesn’t know what to do about it. It is this view of polypharmacy that often dominates patients’, and increasingly clinicians’, experience of medication use. This skeptical perspective is largely justified. The number of medications a person uses is by far the strongest risk factor for medication-related problems. As the number of medications rises, adverse drug reactions become more common. Adherence worsens. Out-of-pocket costs rise. -
Medicine Safety “Pharmacovigilance” Fact Sheet
MINISTRY OF MEDICAL SERVICES MINISTRY OF PUBLIC HEALTH AND SANITATION PHARMACY AND POISONS BOARD MEDICINE SAFETY “PHARMACOVIGILANCE” FACT SHEET What is medicine safety? Medicine safety, also referred to as Pharmacovigilance refers to the science of collecting, monitoring, researching, assessing and evaluating information from healthcare providers and patients on the adverse effects of medicines, biological products, herbals and traditional medicines. It aims at identifying new information about hazards, and preventing harm to patients. What is an Adverse Drug Reaction? The World Health Organization defines an adverse drug reaction (ADR) as "A response to a drug which is noxious and unintended, and which occurs at doses normally used or tested in man for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function". Simply put, when the doctor prescribes you medicines, he expects the desirable effects of them. The undesired effects of the medicines is the ADR or, commonly known as “side effects”. An adverse drug reaction is considered to be serious when it is suspected of causing death, poses danger to life, results in admission to hospital, prolongs hospitalization, leads to absence from productive activity, increased investigational or treatment costs, or birth defects. Age, gender, previous history of allergy or reaction, race and genetic factors, multiple medicine therapy and presence of concomitant disease processes may predispose one to adverse effects. Why monitor adverse drug reactions? Before registration and marketing of a medicine, its safety and efficacy experience is based primarily on clinical trials. Some important adverse reactions may not be detected early or may even be rare. -
Beta Blocker
Medication Information Beta Blocker Other names for this medication Acebutol Nadolol Atenolol Pindolol Bisoprolol Propanolol Carvediol Sotalol Labetalol Timolol Metoprolol There are many other names for this medication. How this medication is used This medication causes your heart to beat slower. This helps rest the heart after a heart attack. This medication helps prevent and/or reduce chest pain and irregular heart beats. It does not stop chest pain or angina after the pain has started. Bisoprolol, Carvedilol and Metoprolol can be used to prevent heart failure. They work by relaxing the blood vessels. This allows more blood to go to the heart. The more blood that goes to the heart, the more oxygen the heart gets. This helps the heart work better. Some of these medications are used to treat high blood pressure, migraine headaches and muscle tremors. Beta Blocker How to take this medication Take this medication exactly as directed by your doctor or health care provider. It must be taken regularly, even if you feel well. Do not suddenly stop taking this medication without checking with your doctor or health care provider first. Suddenly stopping this medication can cause: • chest pain • irregular heart beats • high blood pressure. When it is time to stop taking this medication your doctor or health care provider may slowly decrease the amount. If you miss a dose of this medication, take it as soon as possible. However, if it is almost time for the next dose, skip the missed dose and go back to your regular time. Do not take 2 doses at one time. -
AVANDIA (Rosiglitazone Maleate Tablets), for Oral Use Ischemic Cardiovascular (CV) Events Relative to Placebo, Not Confirmed in Initial U.S
HIGHLIGHTS OF PRESCRIBING INFORMATION ----------------------- WARNINGS AND PRECAUTIONS ----------------------- These highlights do not include all the information needed to use • Fluid retention, which may exacerbate or lead to heart failure, may occur. AVANDIA safely and effectively. See full prescribing information for Combination use with insulin and use in congestive heart failure NYHA AVANDIA. Class I and II may increase risk of other cardiovascular effects. (5.1) • Meta-analysis of 52 mostly short-term trials suggested a potential risk of AVANDIA (rosiglitazone maleate tablets), for oral use ischemic cardiovascular (CV) events relative to placebo, not confirmed in Initial U.S. Approval: 1999 a long-term CV outcome trial versus metformin or sulfonylurea. (5.2) • Dose-related edema (5.3) and weight gain (5.4) may occur. WARNING: CONGESTIVE HEART FAILURE • Measure liver enzymes prior to initiation and periodically thereafter. Do See full prescribing information for complete boxed warning. not initiate therapy in patients with increased baseline liver enzyme levels ● Thiazolidinediones, including rosiglitazone, cause or exacerbate (ALT >2.5X upper limit of normal). Discontinue therapy if ALT levels congestive heart failure in some patients (5.1). After initiation of remain >3X the upper limit of normal or if jaundice is observed. (5.5) AVANDIA, and after dose increases, observe patients carefully for signs • Macular edema has been reported. (5.6) and symptoms of heart failure (including excessive, rapid weight gain; • Increased incidence of bone fracture was observed in long-term trials. dyspnea; and/or edema). If these signs and symptoms develop, the heart (5.7) failure should be managed according to current standards of care. -
Pharmaceutical Sales Representatives
[Chapter 4, 28 April] Chapter 4 Pharmaceutical sales representatives Andy Gray, Jerome Hoffman and Peter R Mansfield The presence of pharmaceutical industry sales representatives almost seems a fact of life at many modern medical centres and universities around the world. Many medical and pharmacy students come into contact with pharmaceutical industry sales representatives during their training. Later on in the careers of many health professionals, encounters with sales representatives can occur on a daily basis, taking up a substantial portion of a busy health professional s time. However, health professionals have a choice in the matter - they may choose not to see pharmaceutical sales representatives at all or they may attempt to manage such interactions.’ This chapter aims to provide information to help you make up your own mind on this issue. This choice has important consequences for health professionals practice and patients, so requires careful consideration. ’ Aims of this chapter By the end of the session based on this chapter, you should be able to answer a series of questions on your interactions with sales representatives: In what ways, if any, might I hope to benefit from meeting with sales representatives? How are sales representatives selected, trained, supported and managed? What information do sales representatives provide? How might contact with sales representatives influence me in a positive or negative way? Should I have contact with sales representatives at all? Is it possible, if I choose to have contact with sales representatives, to minimise the potential harm and maximise the potential benefit for my professional development and practice? This chapter presents evidence that we believe can be helpful in addressing these questions, and ends with a series of activities that will allow students to work on the issue in more depth. -
(12) United States Patent (10) Patent No.: US 8,357,723 B2 Satyam (45) Date of Patent: Jan
US008357723B2 (12) United States Patent (10) Patent No.: US 8,357,723 B2 Satyam (45) Date of Patent: Jan. 22, 2013 (54) PRODRUGS CONTAINING NOVEL "Nitric Oxide Donors and Cardiovascular Agents Modulating the BO-CLEAVABLE LINKERS Bioactivity of Nitric Oxide: An Overview” by Louis J. Ignarro, et al., Circulation Research, vol. 90, No. 1, pp. 21-22 (Jan. 11, 002). (75) Inventor: Apparao Satyam, Mumbai (IN) “Bis3-(4-substituted phenyl)prop-2-enedisulfides as a new class of (73) Assignee: Piramal Enterprises Limited and antihyperlipidemic compounds' by Meenakshi Sharma, et al., Apparao Satyam, Mumbai (IN) Bioorganic and Medicinal Chemistry Leters, vol. 14, No. 21, pp. (*) Notice: Subject to any disclaimer, the term of this 5347-5350 (Nov. 1, 2004). patent is extended or adjusted under 35 Abstract Only "Spectrophotometric determination of binary mix U.S.C. 154(b) by 0 days. tures of pseudoephedrine with some histamine H1-receptor antago nists using derivative radio spectrum method' by H. Mahgouh, et al., (21) Appl. No.: 12/977,929 J. Pham Biomed Anal, vol. 31, No. 4, pp. 801-809 Mar. 26, 2003. (22) Filed: Dec. 23, 2010 Peter D. Senter et al., Development of Drug-Release Strategy Based (65) Prior Publication Data on the Reductive Fragmentation pf Benzyl Carbamate Disulfides. Journal of Organic Chemistry, 1990, 55, 2975-2978. Published by US 2011 FO269709 A1 Nov. 3, 2011 American Chemical Society (USA). Related U.S. Application Data Vivekananda M. Virudhula et al., Reductively Activated Disulfide Prodrugs of Paclitaxel. Biorganic & Medicinal Chemistry Letters, (62) Division of application No. 1 1/213,396, filed on Aug. -
Opioid Overdose TOOLKIT: Information for Prescribers TABLE of CONTENTS
S A M H S A Opioid Overdose TOOLKIT: Information for Prescribers TABLE OF CONTENTS INFORMATION FOR PRESCRIBERS OPIOID OVERDOSE 3 TREATING OPIOID OVERDOSE 7 LEGAL AND LIABILITY CONSIDERATIONS 9 CLAIMS CODING AND BILLING 9 RESOURCES FOR PRESCRIBERS 9 ACKNOWLEDGMENTS, ETC. 11 n Acknowledgments n Disclaimer n Public Domain Notice n Electronic Access and Copies of Publication n Recommended Citation n Originating Office Also see the other components of this Toolkit: . Facts for Community Members . Five Essential Steps for First Responders . Safety Advice for Patients & Family Members . Recovering from Opioid Overdose: Resources for Overdose Survivors & Family Members INFORMATION FOR PRESCRIBERS pioid overdose is a major public health problem, accounting for TAKE SPECIAL PRECAUTIONS almost 17,000 deaths a year in the United States [1]. Overdose WITH NEW PATIENTS. Many experts Oinvolves both males and females of all ages, ethnicities, and recommend that additional precautions demographic and economic characteristics, and involves both illicit be taken in prescribing for new patients opioids such as heroin and, increasingly, prescription opioid analgesics [5,6]. These might involve the following: such as oxycodone, hydrocodone, fentanyl and methadone [2]. 1. Assessment: In addition to the patient Physicians and other health care providers can make a major history and examination, the physi- contribution toward reducing the toll of opioid overdose through the cian should determine who has been care they take in prescribing opioid analgesics and -
Pharmacology 101
Pharmacology 101 Tyler Fischback, PharmD, BCPS, DPLA Clinical Pharmacy Manager Confluence Health Wenatchee, WA Objectives • Define Pharmacology, Pharmacokinetics and Pharmacodynamics • Understand how drug interactions work • Understand how some specific drugs behave in the body (opioids, benzodiazepines, amiodarone) • Apply pharmacology principles into practice Medication Errors and Adverse Drug Events • Error: An error of commission or omission at any step along the pathway that begins when a clinician prescribes a medication and ends when the patient actually received the medication. • ADE: Harm experienced by a patient as a result of exposure to a medication. ADE does not necessarily indicate an error or poor care. However, ~1/2 of ADEs are preventable. Anyone here ever seen a medication error or adverse drug event? Anyone here ever made a medication error? How many different prescription medications are available on the U.S. market? 1,000 So, it’s no surprise why we see so many problems………………… EXCEPT……. The real number is 10,000 Adverse Drug Events • ~1/3 of U.S. adults use 5 or more medications • Annually, ADE = 700,000 ER visits and 100,000 hospitalizations • So, is pharmacology important to your work? • Additionally, 5% of hospitalized patient experience an ADE during their stay • High risk: Anticoagulants, Opioids, Insulin, Cardiac, and Transitions of Care Adverse Drug Events, cont. • Elderly are more susceptible • Pediatrics patients more susceptible (weight-based dosing), especially liquids • Caregivers and patients admittedly -
Donzelot, Anti-Sociology
An Anti- sociology JACQUES DONZELOT What was it that brought a man, one day, to stretch out on the analyst's couch to relate the details of his life? This is in a sense the question Michel Foucault raised in Madness and Civilization. In order to solve this problem, Foucault described an historical sequence of three centuries during which time the division separating madness and normality was plotted. The results of his investigation show psychoanalysis to be situated at the outermost point of the confinement trappings without foregoing its fundamental implications: "Freud did deliver the patient from the existence of the asylum within which his 'liberators' had alienated him; but he did not deliver him from what was essential in this existence ... he created the psychoanalytical situation in which, by an inspired short-circuit, alienation becomes disalienation, but the doctor as alienating figure remains the key to psychoanalysis." Yes, one could tell his life history on the couch. But in such conditions as this, Foucault wonders, what was to be understood? Foucault's impertinent conclusion directed at psychoanalysis was to please Gilles Deleuze and Felix Guattari to such an extent that they used it as a starting point for their own book and were able to systematically demolish psychoanalysis, construct a new theory of desire and, while they were at it, sketch the evolution of mankind from its origins to the present day. Each of these three aspects has been spoken about differently. The first aspect has been overly discussed, owing, it would D&G systematically seem, to the book's satirical demolish psychoanalysis, style aimed at ridiculing construct a new theory of psychoanalysis.