IC1 DRP in Older Persons Flashcards
what is the purpose of MAI?
medication appropriateness index
measures the appropriateness of prescribing for elderly patients
what are the components of MAI?
1) indication
- consider needs vs wants (of BOTH patient, prescriber, and sometimes caretaker)
2) efficacy
- has patient taken this medicine before?
- if not taken –> refer to guidelines (is it efficacious?)
- if taken –> has it been effective for the patient?
3) drug disease interactions
4) drug drug interactions
5) dosing
6) instructions –> correct?
7) duplications, duration, cost effectiveness?
what are the missing components from the MAI
- untreated indications
- ADR
- failure to receive drug
what counts as drug related problem?
indication
- untreated indication
- improper selection (not effective? contraindication?)
- no indication
dose
- overdose or UNDERdose
interactions
- drug food, lab, drug
adr
- patient specific outcomes
failure to receive drugs
- did not receive the correct drug
- non adherence
- poor technique
- poor storage
what to consider during an adverse drug reaction (esp for elderly patients)
what is the course of action for ADR?
determine timeline
- when was the drug taken?
- any new drugs introduced before the drug was introduced OR before the ADR event?
if so…
TAKE AWAY medicine and see what happens?
DO NOT
- cause a prescribing cascade by using another drug to treat the side effects (unless the medication is needed)
what is “patient specific” reason…
caused by patient indication,
drug efficacy,
DDI,
ADR,
drug-disease interaction
what are the components of pharmaceutical care framework when choosing / reviewing drugs for a patient
1) what matters most / what is important to
- patient
- caregiver
- physician
2) explicit criteira / high alert
3) implicit criteria
- use MAI
4) successful delivery of the drug
what are ADLs
DEATH
dressing
eating
ambulating (transfer)
toileting
hygiene (grooming)
what are IADLs
SHAFTTT
shopping
housekeeping
accounting
food prep
taking meds
telephone
transport
what is comprehensive geriatric assessment
1) functional status
- relies on ADLS and IADL
- attempt to reverse any deficits in functional status (and enhance QOL)
2) medical status
- conduct detailed ROS
- assess and address chronic conditions
- identify potential geriatric sx (falls, incontinence, polypharmacy)
- tailor medical interventions to optimise overall wellbeing
3) mental status
- assess if cognitive impairment (e.g., AMD, MOCA, MNSE) == determine cause (delirium? drug induced?) .
- eval mood and emotional status to identify signs of depression or anxiety
- consider impact of cognitive/mood status on med adherence and self care
4) medication/nutrition status
- MAI , PCP
- assess nutritional status and identify deficiencies/malnourishment
5) socioeconomic resources
- identify social support systems
- eval living conditons/safety concerns
- address financial barriers
when is CGA most beneficial?
patients with CFS ≥ 4
not helpful if very weak or very frail (CFS 8 and 9)
how to read CFS
1: very fit
2: fit (no active disease sx but exercise only occasionally)
3: medical problems are well controlled, not regularly active
4: symptoms limit activities
5: evident slowing, need help with IADL
- cannot do alone, may need help
6: need help with all OUTSIDE activities and keeping house BUT may still be independent (minimal assistance) with INSIDE activities
7: completely dependent but stable (not at risk of dying within 6 months)
8: completely dependent and approaching end of life
9: terminally ill
dementia framework
ABCEDF
1) accurate diagnosis of dementia
2) BPSD?
3) caregiver stress
4) drugs and disabilities
- does caregiver have the skills/equipment/resources to help patient
5) EOL discussion and equipment
6) financial support
- what the patient needs to reduce stress
dementia classifications and how it affects pharmacological management
what meds cannot give for what types of dementia
frontotemporal
- do not benefit from AchEi (no evidence; may worsen?)
LBD, PDD
- do not give anti dopaminergic agents due to risk of neuroleptic sensitivity syndrome OR worsening PD with PDD.
