Optimizing Medication Therapy in Elderly Patients Essay Paper

Introduction

The management of elderly patients poses unique challenges, particularly in the field of medication therapy. Together with the advancing age comes an increased likelihood of multiple comorbidities, frailty, and altered pharmacokinetics, all of which can significantly impact medication management. Polypharmacy, the concurrent use of multiple medications, is common in this population and can lead to adverse drug events, drug interactions, and decreased quality of life. In order to mitigate these risks, the American Geriatrics Society (AGS) developed the Beers Criteria, a comprehensive list of potentially inappropriate medications (PIMs) for use in older adults (Joseph & Dellinger, 2013). In this essay I will examine two case studies of elderly patients, T.M. and G.O., and provide medication reconciliation utilizing the BEERS Criteria to identify potentially inappropriate medications and discuss strategies for optimization. Optimizing Medication Therapy in Elderly Patients Essay Paper

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Case Analysis

Case 1: T.M.

T.M. is a 70-year-old Caucasian female with a history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and osteoarthritis. She presents to the primary care office accompanied by her son due to three falls in the past month. T.M.’s current medication regimen includes:

ASA 81mg PO QD

Lisinopril/HCTZ 10-25mg PO DQ

Glimepiride 2mg PO BID

Rosuvastatin 10mg PO QD

Novolog 3 units TID before meals

Oxycodone 2mg PO Q4H for pain

Naproxen 200mg PO Q6H for pain Optimizing Medication Therapy in Elderly Patients Essay Paper

Utilizing the BEERS Criteria, several potentially inappropriate medications in T.M.’s regimen are identified. The medication reconciliation process for T.M. involves a thorough review of each medication’s indication, efficacy, safety profile, and potential for drug interactions (National Library of Medicine, 2019). Given her recent falls and the potential contribution of her medication regimen, the following recommendations can be made:

Discontinue Oxycodone and Naproxen drugs. Both medications pose a high risk of adverse events, including sedation, dizziness, gastrointestinal bleeding, and renal impairment, all of which can contribute to falls in older adults. Alternative non-opioid analgesics with a lower risk of adverse effects, such as acetaminophen or topical agents, should be considered for pain management. Optimizing Medication Therapy in Elderly Patients Essay Paper

Reevaluation of Glimepiride and Insulin Therapy Glimepiride by doctors. The drugs carries an increased risk of hypoglycemia in older adults, particularly those with renal impairment. Considering T.M.’s age and comorbidities, alternative antidiabetic agents with a lower risk of hypoglycemia, such as metformin or a dipeptidyl peptidase-4 (DPP-4) inhibitor, may be more appropriate. Additionally, her insulin regimen should be adjusted based on her glycemic control targets and the risk of hypoglycemia.

Review the Indication for ASA and Lisinopril/HCTZ. The indications for ASA and Lisinopril/HCTZ should be clarified, and their necessity in T.M.’s regimen should be reevaluated, particularly in light of her recent falls and potential risks associated with these medications. Educate on Medication Safety and Falls Prevention. T.M. and her son should be educated about medication safety, including the risks of falls associated with certain medications and strategies for falls prevention. This may include environmental modifications, exercise programs, and medication adjustments to minimize fall risk. Optimizing Medication Therapy in Elderly Patients Essay Paper

In summary, optimizing T.M.’s medication therapy requires a comprehensive approach that considers her medical history, current medication regimen, and individualized risks and benefits. By addressing potentially inappropriate medications and implementing evidence-based recommendations, healthcare providers can improve medication safety and enhance T.M.’s quality of life while reducing the risk of adverse drug events.

Case 2: G.O.

G.O. is an 85-year-old Hispanic male presenting with a complex medical history, including type 2 diabetes mellitus, chronic kidney disease stage II, hypertension, hyperlipidemia, atrial fibrillation, anxiety, history of chronic UTIs, and Alzheimer’s disease. His current medication regimen comprises:

Amiodarone 200mg PO BID Optimizing Medication Therapy in Elderly Patients Essay Paper

Nortriptyline 25mg PO QD

ASA 81mg PO QD

Lorazepam 1mg PO BID

Metoprolol 50mg PO QD

Simvastatin 10mg PO QD

Nitrofurantoin 100mg PO QD

Haldol 0.5mg PO BID

Using the BEERS Criteria, several potentially inappropriate medications in G.O.’s regimen are identified. The medication reconciliation process for G.O. involves a thorough review of each medication’s indication, efficacy, safety profile, and potential for drug interactions (Eyaleh et al., 2018). Given his extensive medical history and the potential for medication-related adverse events, the following recommendations can be made: Optimizing Medication Therapy in Elderly Patients Essay Paper

Reevaluate Amiodarone and Nortriptyline Therapy. Both amiodarone and nortriptyline carry significant risks of adverse effects, particularly in older adults. Alternative agents with a more favorable safety profile should be considered, and the indications for these medications should be carefully reassessed. Minimize Benzodiazepine and Antipsychotic Use. Benzodiazepines and antipsychotics are associated with an increased risk of sedation, confusion, falls, and cognitive impairment in older adults. Their use should be minimized or avoided where possible, with consideration given to non-pharmacological approaches or alternative agents.

Consider Renal Function and Drug Interactions. Given G.O.’s chronic kidney disease and polypharmacy, careful consideration should be given to the renal function and potential drug interactions of his medication regimen. Dose adjustments and close monitoring may be necessary to minimize the risk of adverse events. Address Falls Risk and Cognitive Impairment: G.O.’s history of falls and cognitive impairment due to Alzheimer’s disease necessitate interventions to minimize falls risk and optimize cognitive function. This may include environmental modifications, physical therapy, and cognitive stimulation techniques. Optimizing Medication Therapy in Elderly Patients Essay Paper

In summary, optimizing G.O.’s medication therapy requires a comprehensive approach that considers his extensive medical history, current medication regimen, and individualized risks and benefits. By addressing potentially inappropriate medications and implementing evidence-based recommendations, healthcare providers can improve medication safety and enhance G.O.’s quality of life while reducing the risk of adverse drug events. Collaboration with a multidisciplinary team, including geriatric specialists, pharmacists, and caregivers, is essential to achieve optimal outcomes in the management of elderly patients with complex medical conditions.

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Conclusion

In conclusion, medication reconciliation utilizing the BEERS Criteria is essential for optimizing pharmacotherapy in elderly patients. By identifying potentially inappropriate medications and making evidence-based decisions to minimize the risk of adverse drug events, healthcare providers can improve medication safety and enhance the quality of care for older adults. Moving forward, a patient-centered approach that considers individualized risks and benefits will be crucial in optimizing medication therapy in the elderly population. Through collaborative efforts between healthcare professionals, patients, and caregivers, we can strive to achieve optimal medication management and improve outcomes for our elderly patients. Optimizing Medication Therapy in Elderly Patients Essay Paper

References

Elayeh, E., Bulatova, N., Abuloha, S., Abu Raqeeq, M., & Abdullah, S. (2018). Assessment of appropriate medication- use by 2015 Beers Criteria among elderly critically ill patients in Jordan. Clinical Practice, 15(04). https://doi.org/10.4172/clinical-practice.1000408

Joseph E. Parrillo, F., & Dellinger, R. P. (2013). Critical care medicine: Principles of diagnosis and management in the adult. Elsevier Health Sciences.

National Library of Medicine. (2019). Applying Beers Criteria for elderly patients to assess rational drug use at a University hospital in Northern Cyprus. PubMed Central (PMC). 

For this activity, please review the following two scenarios and analyze the two cases in your submission. Provide medication reconciliation using the BEERS criteria as a guide and discuss which medications should be avoided and why.

1. T.M. is a 70-year-old Caucasian female arrives to your primary care office, along with her son because she has had 3 falls in the past month.

Past Medical History: Hypertension, Hyperlipidemia, Type 2 Diabetes Mellitus, Osteoarthritis

Vital Signs: BP 110/60, Pulse 80, RR 19, BG 184mg/dl

Allergies: NKDA

Current Medications:

ASA 81mg PO QD
Lisinopril/HCTZ 10-25mg PO DQ
Glimepiride 2mg PO BID
Rosuvastatin 10mg PO QD
Novolog 3 units TID before meals
Oxycodone 2mg PO Q4H for pain
Naproxen 200mg PO Q6H for pain Optimizing Medication Therapy in Elderly Patients Essay Paper

2. G.O is an 85-year-old Hispanic male who presents to your primary care office, along with his daughter for a check-up.

Past Medical History: Type 2 Diabetes Mellitus, Chronic Kidney Disease Stage II, Hypertension, Hyperlipidemia, Atrial Fibrillation, Anxiety, History of Chronic UTI’s, Alzheimer’s Disease.

Allergies: Amoxicillin (Hives)

Current Medications:

Amiodarone 200mg PO BID
Nortriptyline 25mg PO QD
ASA 81mg PO QD
Lorazepam 1mg PO BID
Metoprolol 50mg PO QD
Simvastatin 10mg PO QD
Nitrofurantoin 100mg PO QD
Haldol 0.5mg PO BID Optimizing Medication Therapy in Elderly Patients Essay Paper