The use of medications in elders is complex, with many factors contributing to medication problems. Polypharmacy (or “polymedicine”) is a broad term that can include the use of unnecessary and/or potentially inappropriate medications (PIMs). Age-related pharmacokinetic and pharmacodynamic changes – in addition to coexisting conditions (including physical disability and cognitive impairment) – contribute to a higher risk of adverse drug events. There are also more subtle underlying factors. Older individuals are frequently excluded from pre-marketing clinical trials and, as a result, approved indications and doses for medications may not be applicable to this population. The usefulness of clinical practice guidelines may be limited as well, because they are often based on evidence from studies that excluded either all older adults or older adults with multiple coexisting conditions.
This issue presents a brief update of age-related pharmacokinetic and pharmacodynamic considerations, drugs that should be avoided in older patients, and drugs that are likely to interfere with cognition and memory. Finally, you’ll find practical tips on drug therapy for several health conditions that are common in elders. Throughout, our goal is to provide you with practical tools you can use to optimize drug therapy for our elderly population.
- Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, and Registered Nurses
CE activities for Pharmacists and Pharmacy Technicians:
This continuing education (CE) activity meets the requirements of all state boards of pharmacy for approved continuing education hours. CE credit is automatically reported to CPE Monitor.
The American Nurses Credentialing Center (ANCC) for formally approved continuing education (CE) hours, and CE hours of pharmacotherapeutics.
The American Academy of Nurse Practitioners Certification Program (AANPCP) for acceptable, accredited CE.
- The ANCC requires all advanced practice nursing certificants (CNSs and NPs) to complete 25 CE hours of pharmacotherapeutics as a portion of the required 75 continuing education hours.
- Pharmacology CE is recommended by the AANPCP and will be required for Certificants renewing certification starting January 2017.
- Most State Boards of Nursing require a minimum number of pharmacy contact hours to renew an advanced practice license.
Requirements for CE Credit
- Discuss the Beers criteria for potentially inappropriate medications (PIMs) in elders. List 2 PIMs in each of 3 different classes that should be avoided in elders.
- List at least 4 drug classes that have strong anticholinergic properties. List at least 4 other drug classes that can impair cognition in elders. Give 1-2 examples of drugs in each class.
- Discuss at least 1 important drug therapy management strategy in elders for each of the following: dementia, depression, insomnia, and seizure disorders.
Pamela Mausner, MD
Brief Bio : Pamela Mausner, MD; Medical Writer/Editor and Healthcare Advocate; and Associate Editor, The Rx Consultant.
Disclosure : Dr.Mausner reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appear in this issue.
R. Ron Finley, BS Pharm, RPh, CGP
Brief Bio : R. Ron Finley, BS Pharm, RPh, CGP, Clinical Pharmacist, UCSF Memory and Aging Center, San Francisco, and Consultant Pharmacist, Brain Health Center, Sutter Health, Davies Campus, San Francisco, CA.
Disclosure : Ron Finley is a member of the Speakers Bureau for Novartis Pharmaceuticals. Dr Finley report no financial or personal relationship with any commercial interest producing, marketing, reselling, or distributing a product or service that appears in this issue.
Tracy Farnen, PharmD
Brief Bio : Tracy Farnen, PharmD; Managing Editor, The Rx Consultant.
Disclosure : Dr. Farnen reports no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appear in this issue.