Therapy- Geriatric Medication Assessment

Which medications should be avoided in dementia or cognitive impairment?

Anticholinergics, BZDs, H2RAs, non-BZD hypnotics (zolpidem, eszopiclone, zaleplon), and antipsychotics (chronic and as-needed use)

Which medications should be avoided in delirium?

Anticholinergics, antipsychotics, BZDs, chlorpromazine, corticosteroids, H2RAs, meperidine, and sedative hypnotics

Which medications should be avoided in patients with history of falls or fractures?

Anticonvulsants, antipsychotics, BZDs, non-BZD hypnotics, TCAs, SSRIs, and opioids

Which medications should be avoided in Parkinson's Disease?

Antipsychotics and antiemetics (metoclopramide, prochlorperazine, and promethazine)

What is a gradual dose reduction (GDR)?

Stepwise tapering of a dose to determine if symptoms, conditions, or risks can be managed by a lower dose or if the dose or medication can be discontinued

What are examples of specific therapies often underutilized?

Suboptimal HTN therapy, β-blocker therapy post-MI, osteoporosis treatment and prevention, opioid analgesia and cancer pain, and warfarin in AF

T/F: Approximately 67% of seniors are unable to understand information given to them and 40% of seniors are unable to read prescription labels

True

T/F: STOPP was more sensitive in identifying medication-related ADEs than Beer's in two trials

True

T/F: Screening tools and medication lists are never substitutes for clinical judgment concerning individual patients and are not the final word on appropriateness

True

T/F: Underutilization is more common than overutilization

True

Which university developed several tools to assess self-administration of medications?

University of Maryland

In which populations is the Beers Criteria applicable?

Acute, ambulatory, and institutionalized adults at least 65 years old (does NOT apply to hospice or palliative care)

What does STOPP and START stand for?

*S*creening *T*ool of *O*lder *P*erson's potentially inappropriate *P*rescriptions and *S*creening *T*ool to *A*lert doctors to *R*ight *T*reatment

When is a retrospective drug regimen review performed?

After medication has been discontinued or patient has left facility

What is the endocrine START criteria?

ACEI or ARB for diabetes with evidence of renal disease with or without serum biochemical renal impairment

Which medications should be avoided in syncope?

AChE inhibitors, peripheral α-1 blockers, tertiary TCAs, chlorpromazine, thioridazine, and olanzapine

When should an MRR be performed?

ASAP upon admission to LTC facility and monthly therafter

Which medications should be used with caution in older adults

Aspirin for primary prevention of cardiac events, dabigatran, prasugrel, medications that exacerbate or cause SIADH or hyponatremia, and vasodilators

When is a prospective drug regimen review performed?

At the point of admission to a facility or upon initiation of new medication

What is the urogenital STOPP Criteria?

Avoid bladder antimuscarinics (dementia, narrow angle glaucoma, BPH) and α-blockers (symptomatic orthostatic hypotension or micturition syncope)

Which screening tool is used as a CMS quality metric?

Beer's Criteria

Which screening tools are used to assist in identifying red flags or "warning lights" that might require intervention and look at the total patient picture while considering current guidelines?

Beers List, STOPP Criteria, and START Criteria

Which tools are used to assess health/pharmacy literacy?

CDC and AHRQ

Which patients are at risk for polypharmacy?

Elderly, psychiatric, and comorbidities such as HF, DM, and HTN

What are common risk factors for inappropriate medication use?

Female, older age, and quantity of medications

What are commons reasons for medication nonadherence?

Forgetfulness, side effects, perceived lack of efficacy, and cost

GDR is part of which type of medication review?

MRR

What is the difference between MRR and MTM in LTC?

MRR is a monthly ongoing process for every resident in LTC facility and MTM targets selected Part. D beneficiaries, annual CMR with quarterly targeted reviews, explicit cost-control components, and greater focus on risk-management of high-cost, high-risk beneficiaries

What are the subdivisions of the Beers Criteria?

Medications to avoid in all older adults, medications to avoid in older adults with certain diseases or syndromes, medications that should be used with caution, selected DDIs to avoid in older adults, and medications to avoid or dose adjust with varying levels of kidney function in older adults

Which medications should be avoided in heart failure?

NSAIDs, COX-2 inhibitors, Non-DHP CCBs (HFrEF), Cilostazol, TZDs, and Dronedarone (severe or recently decompensated HF)

What is medication underutilization defined as?

Omission of an indicated and potentially beneficial medication for the treatment or prevention of a disease or condition

What is marginal omission?

Omission of medication because of patient preferences, alternative therapy, goals of care, desire to d/c medication to focus in symptom management at end of life, contraindications

What are some reasons why older adults are more susceptible to preventable ADEs?

Polypharmacy and drug interactions, age-related changes, inappropriate prescribing and lack of monitoring, non-adherence, poor communication between providers, and health literacy

Which antipsychotics can be used in Parkinson's Disease?

Quetiapine, clozapine, and aripiprazole

What are age-related changes that can cause ADEs?

Renal and hepatic dysfunction, memory impairment, hearing and vision loss, declines in body weight, loss of body fluid and more fatty tissue, and increased sensitivity to medications

What is the step-wise approach to optimizing drug regimens?

Review all current drug therapy, discontinue unnecessary therapy, consider ADEs as a potential cause for any new symptom, consider non-pharmacologic alternatives, substitute safer alternatives, and reduce the dose

What is inappropriate medication use defined as?

Risk of AE outweighs potential benefit, using medications at a higher frequency or longer period, using medications with high risk of adverse drug-drug and drug-disease interactions, and underutilization of beneficial medications

Which physiological-systems based screening tool was developed in Europe?

STOPP-START Criteria

Which tools are used to assess adherence?

Script Your Future and Adult Meducation

When is a concurrent drug regimen review performed?

While drug therapy is in progress

How should instructions for de-prescribing be communicated to the patient?

Written instructions

Which medications should be avoided in all older adults?

lol too much for a quizlet term :(

What is the urogenital START Criteria?

α-1 receptor blocker or 5-α reductase inhibitor for symptomatic BPH and topical vaginal estrogen for symptomatic atrophic vaginitis

What is polypharmacy defined as?

≥5 daily medications, use of medication without current indication, use of multiple medications to treat one condition, or use of one medication to treat side effect of another