Walking the Fine Line
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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. -
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. -
Pharmacokinetic Interactions of Drugs with St John's Wort
http://www.paper.edu.cn Pharmacokinetic interactions of Journal of Psychopharmacology 18(2) (2004) 262–276 © 2004 British Association drugs with St John’s wort for Psychopharmacology ISSN 0269-8811 SAGE Publications Ltd, London, Thousand Oaks, CA and New Delhi 10.1177/0269881104042632 Shufeng Zhou Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore. Eli Chan Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore. Shen-Quan Pan Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore. Min Huang Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510089, PR China. Edmund Jon Deoon Lee Department of Pharmacology, Faculty of Medicine, National University of Singapore, Singapore. Abstract There is a worldwide increasing use of herbs which are often cancer patients receiving irinotecan treatment. St John’s wort did not administered in combination with therapeutic drugs, raising the alter the pharmacokinetics of tolbutamide, but increased the incidence potential for herb–drug interactions. St John’s wort (Hypericum of hypoglycaemia. Several cases have been reported that St John’s wort perforatum) is one of the most commonly used herbal antidepressants. A decreased cyclosporine blood concentration leading to organ rejection. literature search was performed using Medline (via Pubmed), Biological St John’s wort caused breakthrough bleeding and unplanned pregnancies Abstracts, Cochrane Library, AMED, PsycINFO and Embase (all from their when used concomitantly with oral contraceptives. It also caused inception to September 2003) to identify known drug interaction with serotonin syndrome when coadministered with selective serotonin- St John’s wort. The available data indicate that St John’s wort is a reuptake inhibitors (e.g. -
CYP3A4 Mediated Pharmacokinetics Drug Interaction Potential of Maha
www.nature.com/scientificreports OPEN CYP3A4 mediated pharmacokinetics drug interaction potential of Maha‑Yogaraj Gugglu and E, Z guggulsterone Sarvesh Sabarathinam1, Satish Kumar Rajappan Chandra2 & Vijayakumar Thangavel Mahalingam1* Maha yogaraja guggulu (MYG) is a classical herbomineral polyherbal formulation being widely used since centuries. The aim of this study was to investigate the efect of MYG formulation and its major constituents E & Z guggulsterone on CYP3A4 mediated metabolism. In vitro inhibition of MYG and Guggulsterone isomers on CYP3A4 was evaluated by high throughput fuorometric assay. Eighteen Adult male Sprague–Dawley rats (200 ± 25 g body weight) were randomly divided into three groups. Group A, Group B and Group C were treated with placebo, MYG and Standard E & Z guggulsterone for 14 days respectively by oral route. On 15th day, midazolam (5 mg/kg) was administered orally to all rats in each group. Blood samples (0.3 mL) were collected from the retro orbital vein at 0.25, 0.5, 0.75, 1, 2, 4, 6, 12 and 24 h of each rat were collected. The fndings from the in vitro & in vivo study proposed that the MYG tablets and its guggulsterone isomers have drug interaction potential when consumed along with conventional drugs which are CYP3A4 substrates. In vivo pharmacokinetic drug interaction study of midazolam pointed out that the MYG tablets and guggulsterone isomers showed an inhibitory activity towards CYP3A4 which may have leads to clinically signifcant interactions. Te use of alternative medicine such as herbal medicines, phytonutrients, ayurvedic products and nutraceuticals used widely by the majority of the patients for their primary healthcare needs. -
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. -
Polypharmacy in the Elderly Educational Format Faculty Expertise Required Expertise in the Field of Study
2019 AAFP FMX Needs Assessment Body System: Geriatrics Session Topic: Polypharmacy in the Elderly Educational Format Faculty Expertise Required Expertise in the field of study. Experience teaching in the field of study is desired. Preferred experience with audience Interactive REQUIRED response systems (ARS). Utilizing polling questions and Lecture engaging the learners in Q&A during the final 15 minutes of the session are required. Expertise teaching highly interactive, small group learning environments. Case-based, with experience developing and Problem- teaching case scenarios for simulation labs preferred. Other Based workshop-oriented designs may be accommodated. A typical OPTIONAL Learning PBL room is set for 50-100 participants, with 7-8 each per (PBL) round table. Please describe your interest and plan for teaching a PBL on your proposal form. Learning Objective(s) that will close Outcome Being Professional Practice Gap the gap and meet the need Measured Family physicians have 1. Use evidence-based criteria (e.g. Learners will gaps in knowledge and BEERS, STOPP, START) to submit written performance in evaluating evaluate for potentially adverse drug commitment to for potentially adverse drug events, among elderly patients change statements events, among elderly receiving multiple medications. on the session patients receiving multiple 2. Develop a systematic approach, evaluation, medications. including applicable REMS, to indicating how Family physicians have managing elderly patients with they plan to gaps in knowledge and -
Grapefruit Juice and Psychotropics: How to Avoid Potential Interactions
Savvy Psychopharmacology Grapefruit juice and psychotropics: How to avoid potential interactions Danielle L. Bishop, PharmD, BCPP s. H, age 42, was given a diagnosis she reports feeling much better during a fol- of bipolar disorder 10 years ago and low-up call and she makes an appointment Mhas been taking carbamazepine, to have her carbamazepine level rechecked 1,200 mg/d, and olanzapine, 10 mg/d, for the in a week. past 2 years. She has not experienced a mood episode while on this regimen, and her car- Although grapefruit products are high in bamazepine level was 9.2 μg/mL 6 months vitamins and low in calories, they can be Vicki L. Ellingrod, ago. The only adverse effect she experienced associated with potentially serious drug PharmD, FCCP was weight gain of approximately 10 lb. interactions. The interaction between Department Editor Ms. H takes a calcium supplement, but no grapefruit juice and the calcium channel other medications. blocker felodipine was discovered inad- Ms. H reports to her psychiatrist that, for vertently >20 years ago; since that time, the past few days, she has been feeling nau- possible interactions with >85 medica- seated, fatigued, and dizzy, but has contin- tions have been identified.1 Interactions ued taking her medications as prescribed. with grapefruit products are complicated Her carbamazepine level is found to be 13.1 μg/mL. Ms. H states she has not started Practice Points any new medications or supplements; her • In general, an entire grapefruit or 8 oz serum creatinine and liver function test of juice is enough to alter a susceptible results are within normal limits. -
Drug Interactions: What You Should Know
DRUG INTERACTIONS: WHAT YOU SHOULD KNOW Council on Family Health Drug Interactions here are more opportunities today than ever before to learn about your health and to take Tbetter care of yourself. It is also more important than ever to know about the medicines you take. If you take several different medicines, see more than one doctor or have certain health conditions, you and your doctors need to be aware of all the medicines you take to avoid potential problems, such as drug interactions. Drug interactions may make your drug less effec- tive, cause unexpected side effects or increase the action of a particular drug. Some drug interactions can even be harmful to you. Reading the label every time you use a nonprescription or prescription drug and taking the time to learn about drug interactions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug interactions fall into three broad categories: ■ Drug-drug interactions occur when two or more drugs react with each other. This drug- drug interaction may cause you to experience an unexpected side effect. For example, mixing a drug you take to help you sleep (a sedative) and a drug you take for allergies (an antihistamine) can slow your reactions and make driving a car or operating machinery dangerous. ■ Drug-food/beverage interactions result from drugs reacting with foods or beverages. For example, mixing alcohol with some drugs may cause you to feel tired or slow your reactions. -
Article Download
wjpls, 2019, Vol. 5, Issue 9, 168-177 Research Article ISSN 2454-2229 Ohieku et al. World Journal of Pharmaceutical World Journal and ofLife Pharmaceutical Sciences and Life Sciences WJPLS www.wjpls.org SJIF Impact Factor: 5.088 DIGOXIN INTERACTIONS WITH MEDICATIONS USED IN CONGESTIVE HEART FAILURES AND OTHER CO-MORBID DISEASES: AN IDENTIFICATION OF PATIENTS REQUIRING CONSTANT DRUG THERAPY MONITORING AND VIGILANCE *John David Ohieku and Muhammad Al-amin Usman Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, PMB 1069, Maiduguri, Borno State, Nigeria. *Corresponding Author: John David Ohieku Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Maiduguri, PMB 1069, Maiduguri, Borno State, Nigeria. Article Received on 20/07/2019 Article Revised on 10/08/2019 Article Accepted on 01/09/2019 ABSTRACT Background: Digoxin has narrow therapeutic index and many drug combinations are capable of affecting both its pharmacokinetic and pharmacodynamics profile, which may lead to lethal outcomes. Objectives: The objectives were to assess potential interactions between digoxin and other medications and to evaluate its degree, clinical outcomes as well as identify patients that may require constant monitoring and vigilance. Methods: The cross- sectional and prospective study involves the evaluation of digoxin interaction with other medications using online drug interaction software checkers developed by Medscape.com, Drug.com, Drugbank.com and Epocrates. -
Polypharmacy & Deprescribing
Lauren W. Mazzurco, DO Polypharmacy & Eastern Virginia Medical School Deprescribing [email protected] • I have no conflicts of interest to disclose Objectives • Describe the concept and impact of polypharmacy in older adults • Review the benefits of and potential barriers to deprescribing • Describe the process of rational deprescribing and demonstrate practical strategies of application to clinical scenarios https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf Scope of the problem • 30% of patients >65 are prescribed >5 medications • ~1 in 5 medications in older adults may be inappropriate • Single most predictor of harm is # of medications 1. QatoDM,AlexanderGC,ContiRM,JohnsonM, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867-2878. 2. RougheadEE,AndersonB,GilbertAL. Potentially inappropriate prescribing among Australian veterans and war widows/widowers. Intern Med J. 2007;37(6):402-405 3. SteinmanMA,MiaoY,BoscardinWJ,Komaiko KD, Schwartz JB. Prescribing quality in older veterans: a multifocal approach. J Gen Intern Med. 2014;29(10):1379-1386 4. BudnitzDS,LovegroveMC,ShehabN,Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365 (21):2002-2012. Quality Value = Cost http://ihpi.umich.edu/news/older-americans-don’t-get-–-or-seek-–-enough-help-doctors-pharmacists-drug-costs- poll-finds. Accessed -
Assessment Report on Hypericum Perforatum L., Herba
European Medicines Agency Evaluation of Medicines for Human Use London, 12 November 2009 Doc. Ref.: EMA/HMPC/101303/2008 COMMITTEE ON HERBAL MEDICINAL PRODUCTS (HMPC) ASSESSMENT REPORT ON HYPERICUM PERFORATUM L., HERBA 7 Westferry Circus, Canary Wharf, London, E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 75 23 70 51 E-mail: [email protected] http://www.emea.europa.eu © European Medicines Agency, 2009. Reproduction is authorised provided the source is acknowledged TABLE OF CONTENTS I. REGULATORY STATUS OVERVIEW...................................................................................4 II. ASSESSMENT REPORT............................................................................................................5 II.1 INTRODUCTION..........................................................................................................................6 II.1.1 Description of the herbal substance(s), herbal preparation(s) or combinations thereof 6 II.1.1.1 Herbal substance:........................................................................................................ 6 II.1.1.2 Herbal preparation(s): ................................................................................................ 7 II.1.1.3 Combinations of herbal substance(s) and/or herbal preparation(s)........................... 9 Not applicable. ................................................................................................................................9 II.1.1.4 Vitamin(s) ................................................................................................................... -
PREVENTING CHRONIC DISEASE PUBLIC HEALTH RESEARCH, PRACTICE, and POLICY Volume 17, E22 MARCH 2020
PREVENTING CHRONIC DISEASE PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY Volume 17, E22 MARCH 2020 ORIGINAL RESEARCH Relationship Between Polypharmacy and Quality of Life Among People in 24 Countries Living With HIV Chinyere Okoli, MSc1; Patricia de los Rios, MSc2; Anton Eremin, MD3; Gary Brough, BA4; Benjamin Young, MD, PhD2; Duncan Short, PhD1 Accessible Version: www.cdc.gov/pcd/issues/2020/19_0359.htm Methods Suggested citation for this article:Okoli C, de los Rios P, We analyzed data for 2,112 adult PLHIV on antiretroviral therapy Eremin A, Brough G, Young B, Short D. Relationship Between (ART) in 24 countries who completed the 2019 Positive Perspect- Polypharmacy and Quality of Life Among People in 24 Countries ives survey. Polypharmacy was defined as taking 5 or more pills a Living With HIV. Prev Chronic Dis 2020;17:190359. DOI: https:// day or currently taking medications for 5 or more conditions. Out- doi.org/10.5888/pcd17.190359. comes were self-rated overall health, treatment satisfaction, and self-reported virologic control. New treatment concerns were is- sues not prioritized at ART initiation but now deemed paramount. PEER REVIEWED Data were analyzed with descriptive and multivariable statistics. Summary Results What is already known on this topic? Overall prevalence of polypharmacy was 42.1%. People reporting People living with HIV (PLHIV) have greater incidence of comorbidities and polypharmacy had significantly poorer health outcomes independ- higher prevalence of polypharmacy, most commonly defined as taking 5 or ent of existing comorbidities; their odds of treatment satisfaction, more medications concurrently, than the general population. optimal overall health, and virologic control were lower by 27.0% What is added by this study? (adjusted odds ratio [AOR] = 0.73; 95% CI, 0.59–0.91), 36.0% PLHIV reporting polypharmacy had significantly worse overall health out- (AOR = 0.64; 95% CI, 0.53–0.78), and 46.0% (AOR = 0.54, 95% comes, including significantly lower prevalence of self-reported virologic control and treatment satisfaction.