AgentCaterpillarMaster252 3 Prescribing for the Elderly Part 1: Review of Pharmacology Basics…3
Prescribing for the Elderly
Part 1: Review of Pharmacology Basics
Before you begin the case studies, please answer the following:
1. What is pharmacodynamics?
2. What is pharmacokinetics?
3. How does aging affect pharmacodynamics and pharmacokinetics?
Part 2: Application of BEERS List in prescribing for the elderly
For each of the three case studies complete the following:
1. For each of the drugs in the case, indicate if they are on the BEERS list.
For each drug that is on the BEERS list complete the following questions:
2. What is the recommendation on the BEERS list regarding the use of this drug? Avoid/ Avoid with certain parameters? Acceptable with certain parameters. ( Be sure and apply the information to your case client)
3. What is the potential problems associated with this medication for older adults as noted on the BEERS list? For example does the drug cause excessive fatigue
4. What recommendation do you have regarding the continuation or replacement of this drug? State your rationale. If you recommend changing the drug, what drug would you potentially recommend changing to?
5. What table from the BEERS list did you find your information?
The following table may be of help in organizing your medications and may be used in place of a question answer format. You can copy and paste for use in each of the case studies.
Medication
On Beers list ( yes or no)
If on Beers list, recommendation regarding use of the drug ( avoid, avoid with parameters) If with parameters identify the parameters)
What is the rationale ( potential side effects) for being concerned about this drug
What recommendations do you have regarding this drug ( discontinuance, reduced dose, replace with) State your rationale
Table number where you found your information
Case 1
RK is a 75 year old female who recently suffered a fall. She is being admitted to home health care for physical therapy. On admission you note she is slightly confused. She has a history of diabetes (adult onset), hypertension, and hyperlipidemia. She has no known allergies.
Her medication list is:
Aspirin 81 mg qd Oxycodone 5 mg q 6 h prn pain
Glimepiride 4 mg before breakfast APAP 650 mg q 4 h for pain/ fever
Simvastatin 20mg qd Multivitamin qd
Novolog sliding scale
Case 2
AG is a 78 year old male whom you are seeing for a medication review. His past medical history includes atrial fibrillation, CVA, diabetes (adult onset), hypertension, hyperlipidemia, hypothyroidism, and BPH. He has no known allergies. His weight is 84.5 kgm
Significant lab values include: Serum Cr. 1.2 mg/dl; A1C 7.4% Use the Cockroft Gault tool to determine the creatinine clearance. (You can Google it)
Current medications include:
Digoxin 187.5 mcg qd Levothyroxine 50 mg qd
Toprol XL 50 mg qd Finasteride 5 mg qd
Alfuzosin ER 10 mg qd Insulin Glargine 25 U. SQ qd
Aspirin 81 mg qd Novolog sliding scale
Rivaroxaban 29 mg qd Gabapentin 600 mg qd
Case 3
GE is a 93 year old female who presents in your office with weight fluctuations and 2+ edema to her lower legs. Her weight is 58 kgm.
Past medical history includes: CHF, hypertension, hyperlipidemia, osteoarthritis, and chronic kidney disease
Significant lab values include: Ejection fraction 28%, Serum Cr. 1.2 mg/dl, K 5.2 mEq/L. Calculate the creatinine clearance using the Cockroft Gault tool (you can google it).
Allergies: Ciprofloxin
Current Medications:
Diltiazem ER 240 mg qd Ibuprofen 600 mg q 6 h prn
Lasix 40 mg qd Atorvastatin 40 mg qd
Lisinopril 10 mg qd Triamterene/ HCTZ 37.5/25 mg qd
General Questions:
1. Often the elderly are placed on anti-anxiety or anti-depressants. What are some common medications often prescribed for these issues? What medications would be “safe” for an elmdder person? If you wanted to de- prescribe an anti- depressant, how would you do that?
2. What would you tell a patient who has medications on the BEERS list that you wish to discontinue. Please remember that you do not want the patient to think that the previous provider made an error in ordering the medication or it may be that the patient has been on the medication for years and does not understand why it needs to be changed. How would you explain this to the patient?
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