geriatrics
Drug Related Problems in Older Adults
Prevention
To reduce the risk of adverse drug effects in older adults, clinicians should do the following before starting a new drug: Consider nondrug treatment Discuss goals of care with the patient and/or caregivers and establish a timeframe in which benefit from the drug therapy is expected Evaluate the indication for each new drug (to avoid using unnecessary drugs) Consider age-related changes in pharmacokinetics or pharmacodynamics and their effect on dosing requirements Choose the safest possible drug treatment for the indication (eg, for noninflammatory arthritis,acetaminopheninstead of an oral nonsteroidal anti-inflammatory drug [NSAID]) Check for potential drug-disease and drug-drug interactions Start with the lowest effective dose Use the fewest drugs necessary Note coexisting disorders and their likelihood of contributing to adverse drug effects Explain the uses and adverse effects of each drug Provide clear instructions to patients about how to take their drugs (including generic and brand names, spelling of each drug name, indication for each drug, and explanation of formulations that contain more than one drug) and for how long the drug will likely be necessary Anticipate confusion due to sound-alike drug names and pointing out any names that could be confused (eg, Glucophage®and Glucovance®) The following should be done after starting a drug: Assume a new symptom may be drug-related until proven otherwise (to prevent a Drug-disease interactions ). Monitor patients for signs of adverse drug effects, including measuring drug levels and doing other laboratory tests as necessary. Document the response to therapy and increase doses as necessary to achieve the desired effect. Regularly reevaluate the need to continue drug therapy and stop drugs that are no longer necessary or drugs with greater potential risk than benefit. The following should be ongoing: Medication reconciliationis a process that helps ensure transfer of information about drug regimens at any transition point in the health care system. The process includes identifying and listing all drugs patients are taking (name, dose, frequency, route) and comparing the resulting list with the physician’s orders at a transition point. Medication reconciliation should occur at each move (admission, transfer, and discharge). Computerized physician ordering programscan alert clinicians to potential problems (eg, allergy, need for reduced dosage in patients with impaired renal function, drug-drug interactions). These programs can also cue clinicians to monitor certain patients closely for adverse drug effects. 