Scribd Logo
Upload

Welcome to Scribd!

  • PC On Elder Patients 2014

    Uploaded by

    Aci Lusiana
    8 views33 pages
    Pharmaceutical Care on Elder patients

    Original Title

    Pc on Elder Patients 2014

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    Pharmaceutical Care on Elder patients

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    8 views33 pages

    PC On Elder Patients 2014

    Uploaded by

    Aci Lusiana
    Pharmaceutical Care on Elder patients

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 33

    PC ON ELDER PATIENTS

    Backgrounds

    Multiple diseases
    Multiple medications
    DIA
    approximately 30% of patients age 75 or older
    with two or more chronic conditions take at
    least 5 prescription drugs regularly
    home residents this number may be as high as
    7 or more drugs

    Older patients visit multiple physicians for


    treatment of various conditions
    No/ lack of Coordinating medications among
    pysiciants
    Increase risk for adverse drug reactions (ADRs).
    Ex. Older patient with hypertension and
    depression
    guanethidine to reduce blood pressure +
    tricyclic antidepressant concurrently

    Problems

    Decrease organ functions


    Dose and intervals
    Drug interaction
    More adverse drug effect
    More morbidity and mortality

    Problems

    Potential / actual compliance


    Untreated indication
    Drug with no indication
    Repeat prescription no longer required
    Inappropriate duration of therapy
    Discrepancy between doses prescribed and
    used
    Potential drug-disease interaction

    Problems

    Potential/suspected ADR
    Monitoring issues
    Potential ineffective therapy
    Education required
    Inappropriate dosage regime

    Age and morbidity realionship

    Age related pharmacokinetics and


    pharmacodynamic

    Absorbtion transdermal
    Distribution <body fluid vol
    Protein binding alteration <
    Metabolism <
    Excretion <
    Receptor sensitivity

    Factors influence functional age

    Nutritional status
    Smocking of non smocking
    Presence of acute or chronic disease (s)
    Acute or chronic therapy
    Active or non active habit
    Health insurance
    Living Dependent or independency in the
    Family

    seven all-too-often-deadly sins of


    prescribing.
    The disease for which a drug is prescribed
    is actually an adverse reaction to another
    drug, masquerading as a disease
    A drug is used to treat a problem that,
    although in some cases susceptible to a
    pharmaceutical solution, should first be
    treated with commonsense lifestyle changes.

    The medical problem is both self-limited and


    completely unresponsive to treatments such as
    antibiotics or does not merit treatment with
    certain drugs.
    A drug is the preferred treatment for the
    medical problem, but instead of the safest, most
    effectiveand often least expensive
    treatment, the physician prescribes one of the
    Do Not Use drugs listed on this web site or
    another, much less preferable alternative.

    Two drugs interact. Each on its own may be


    safe and effective, but together they can
    cause serious injury or death.
    Two or more drugs in the same therapeutic
    category are used, the additional one(s) not
    adding to the effectiveness of the first but
    clearly increasing the risk to t
    The right drug is prescribed, but the dose is
    dangerously highhe patient

    Example of miss prescribing


    The increased use of anti-Parkinsons drugs to treat drug-induced
    parkinsonism caused by the heartburn drug
    metoclopramide7 (REGLAN) or by some of the older antipsychotic
    drugs.
    A sharply increased use of laxatives in people with decreased
    bowel activity that has been caused by antihistamines such as
    diphenhydramine (BENADRYL), antidepressants such as
    amitriptyline (ELAVIL)a Do Not Use drugor some antipsychotic
    drugs such as thioridazine (MELLARIL).8
    An increased use of antihypertensive drugs in people with high
    blood pressure that was caused or increased by very high doses of
    nonsteroidal anti-inflammatory drugs (NSAIDs), used as painkillers
    or for arthritis.9
    Failing to Treat Certain Problems with Nondrug Treatments

    General services
    General services are available such as
    Smoking cessation programme
    Supervised administration of methadone
    Contraception including emergency hormonal
    contraceptive services
    Anticoagulant Monitoring
    Medicines Use Review

    15

    Pharmacist

    Clinical medication review (CMR)


    Pharmacist reviewed the patient, the illness,
    and the drug treatment.
    Evaluated
    appropriateness and efficacy of treatments
    progress of the conditions
    compliance
    actual and potential adverse effects interactions

    The outcome of the review was a decision


    about the continuation (or otherwise) of the
    treatment.
    16

    Geriatric Care Principles


    spectrum of clinical management not only
    treatments
    interventions for their conditions
    Screening, preventive and advanced illness
    care.
    Individualize
    Restricted choice of medication
    to improve the coordination of treatments.

    Pharmaceutical care
    Reduce polypharmacy
    Ensure appropriate treatment
    Help elderly patients understand their
    medicines

    Comorbidity DIA (cont)

    Health services
    Early (and ongoing) comprehensive
    multidisciplinary assessment of the biomedical,
    psychosocial and functional status of the older
    person
    Tailored treatments, diagnostic and therapeutic
    interventions that focus on the syndromes and
    diseases associated with ageing
    Care planning in consultation with the older
    person, their family, carer and the community
    services involved in their care

    Specific services
    Person-centred practice
    initial assessment by the interdisciplinary team
    Mobility, vigour and self care encourage
    mobilisation
    Nutrition - encouragement and support to eat
    and drink,
    Continence encourage use of toilet
    Medication pharmacy review,
    Cognition considers, delirium, dementia,
    depression

    Skin Integrity
    Oral health care

    QUENTIONS?

    Case
    Nyonya R 63 tahun dengan riwayat heartburn sedang berobat
    sendiri dengan obat bebas. Akhir-akhir ini ia merasa nyeri d
    tangan . Dokternya mendiagnosa bahwa dia menderita arthritis
    dan menulis resep ibuprofen untuknya.
    Akan tetapi Mrs. R tidak menjelaskan bahwa ia memnggunakan
    obat bebas untuk nyeri ulu hatinya. Setelah beberapa minggu
    menggunakan obat ibuprofen secarav teratur, Mrs. R dia merasa
    nyeri dadanya semakin bertambah. Dia akhirnya dilarikan ke
    emergency, tapi setelah menjalani berbagai test, dokter nya
    menyatakan bahwa ia menderta serangan jantung.
    Di samping dokter percaya bahwa ny. R mengalami interaksi
    obat.

    questions
    Apa masalah ny R, Apakah masalah tersebut
    ada kaitannya dengan obat? Obat apa?
    jelaskanlah
    Bagaimana menyelesaikan masalah orang ini?
    Apa rencana pelayanan anda?
    Perlukan penggantian obat? Obat untuk apa
    dan apa terapi alternatifnya?

    Key
    the ibuprofen aggravated her heartburn severely,
    causing the intense chest pain.To alleviate the
    condition, the ER doctor contacts Mrs. Rs primary
    care physician to propose an alternate arthritis
    drug, which does not
    result in gastrointestinal side effects such as
    heartburn. In addition, he suggests an evaluation to
    determine the root causes of Mrs. Rs persistent
    heartburn.

    You might also like