- Medication Reconciliation Upon Admission
- Evaluating for Polypharmacy – Beer’s Criteria
- Pharmacologic changes in the elderly
- Pharmacokinetic (PK): Decreased hepatic and renal clearance. Reduction in first pass metabolism. Drug distribution changes due to decreased TBW and lean body mass resulting in relative increase in fat.
- Pharmacodynamic (PD): Exaggerated responses to pharmacologic therapy (therapeutic and adverse effects).
- Avoid Prescribing Defaults:
- NSAIDs can lead to gastritis, which can lead to prescription of PPI
- Diuretics can lead to urinary incontinence, which can lead to prescription of oxybutynin
- HCTZ can lead to hyperuricemia which can lead to prescription of allopurinol
- Discharge Tips for med adherence: provide pillboxes & arrange blister packs for meds
- Recommended Tools: deprescribing.org (App available); medstopper.com
Last update: 2022-06-13 17:45:00