SOME GOOD…SOME BAD…SOME WONDERFUL…

MEDICATIONS &

SUPPLEMENTS

MICHELLE PECK & COMPANYMichelle Peck, MSN, MPH, ANP-BC, GNP-BC, CLNCNurse Practitioner | Nursing Faculty | Legal NurseWEB nursepeck.com

PRESCRIBING CHALLENGES

AGE OVER 60 Adverse drug reactions

increase as the number of

prescribed medications

increases

Adherence to complex,

multiple drugs is difficult:

poor vision, poor memory,

limited funds, etc.

ADVERSE DRUG EVENTS

Multiple medications is

the primary risk factor

Multiple medical

conditions increases

risk

Many reactions

preventable

PRESCRIBING STRATEGIES

Prescribing ALL indicated

medications, may NOT be

the best approach

Triage medications - start

with most needed first,

assess impact and then

add second most

important…

Some conditions assumed

to be “aging” can be drug

effects - confusion, falls,

incontinence

Try Using One Drug to

Treat Multiple Problems

RISK FACTORS FOR ADVERSE DRUG EVENTS INCREASE

> 6 DIAGNOSES

> 12 MED DOSES/DAY

> 9 MEDICATIONS

MULTIPLE PRESCRIBERS

A PREVIOUS REACTION

LOW BODY WEIGHT

AGE > 85 YEARS

KIDNEY, LIVER FUNCTION

BENEFIT VS.

Appropriate medication use requires that benefits of therapy clearly outweigh the associated risks.

Benefit-to-risk ratio is unique to an individual; the very medication and dosage that helps one patient may harm another.

BEER’S CRITERIA

Expert Panel from around the world

Developed this wonderful list of Medications to Avoid if you are over 65

Recently Updated in 2012

Severity ratings of medications on High to Low Scale

Problems grouped based on Disease

Concerns listed independent of Disease

> 65 YEARS AVOID MEDS HIGH ANTI-CHOLINERGIC PROPERTIES

Benadryl

Tricyclic antidepressants

Anti-spasmotics

Anti-psychotics

Anti-parkinsonian and muscle

relaxants

Urinary incontinence medications

AVOID DRUG-DISEASE INTERACTIONS

Avoid NSAIDs (Aleve, Ibuprofen, Advil):

With Stomach, Colon Bleeding & Kidney Disease

Avoid Anticholinergic Medications:

With Prostate/Bladder Outlet Obstruction,

Alzheimer’s Disease & Chronic Constipation

Avoid Benzodiazepines/Tricyclic Antidepressants:

With Falling & Balance Disturbances

How YOU take YOUR medication

matters!

Read the Rx label. Know your pharmacist. Ask questions.

Often taking medications or vitamins with food or drinks

other than water can decrease the effectiveness.

Grapefruit juice should be avoided with medications and

supplements, it severely decreases effectiveness.

WHAT YOU TAKE WITH MEDICATION MATTERS.

Levothyroxine Example:

Only 60-80% is absorbed.

Absorption occurs 3 hours of ingestion.

Maximal absorption when stomach is empty:

Calcium binds and will reduce absorption;

Coffee decreases absorption by 27-36%.

RISKS, ESPECIALLY TO OLDER CONSUMERS

Many supplements contain active ingredients

that have strong biological effects in the body

This could make them unsafe in some situations

St. John’s Wort Example: May reduce the effectiveness

of prescription drugs used for heart disease,

depression, seizures, and certain cancers.

COMPLEMENTARY AND ALTERNATIVE MEDICINE

CAM

What are examples of CAM?

DIETARY SUPPLEMENTS

A DIETARY SUPPLEMENT

A product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients

VITAMINS

MINERALS

HERBS OR OTHER BOTANICALS

AMINO ACIDS

CONCENTRATE, METABOLITE, CONSTITUENT, EXTRACT OR COMBINATION OF INGREDIENTS

Are dangerous supplements marketed and sold to consumers?

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm236774.htm

THE DIRTY DOZENACONITE

BITTER ORANGE

CHAPARRAL

COLLOIDAL SILVER

COLTSFOOT

COMFREY

COUNTRY MALLOW

GERMANIUM

GREATER CELANDINE

KAVA

LOBELIA

YOHIMBE

Why are they still for sale?

Two national retailers we contacted about specific supplements said they

carried them because the FDA has not banned them…

The FDA does not regulate supplements so they cannot

ban them!

You have to be careful about what supplements you take!

Most health care consumers DO NOT inform their

health care providers of their supplement use.

They think that either their provider does not care

or does not need to know.

This bad logic can lead to BIG FAILURE.

DIETARY SUPPLEMENTS

Example: St. John’s Wort can

increase the metabolism of

other drugs making them

less effective…

Example: Kava Kava is associated with liver

toxicity…

Example: Echinacea decreases immune

response with long-term use…

The “G-Team” Ginkgo Biloba, Garlic & Ginger

all have antiplatelet effects and can lead to

uncontrolled bleeding…

TO CHOOSE GOOD SUPPLEMENTS LOOK FOR

U.S.P. notation

GMP or cGMP notation

Consumer Lab seal

Consider manufacturer distributor

Look at brand used in studies reporting positive outcome

Look for third party testing

The USP Verified Mark and What It Means

Contains the ingredients and amounts listed on the label

Does not contain harmful levels of specified contaminants

Will break down and release into the body

Made according to FDA current Good Manufacturing Practices using sanitary and well-controlled procedures

TO CHOOSE A SUPPLEMENT

Look for available quality clinical research

Check for long tradition of use (safety)

Check that active ingredient(s) are identified

Review mechanism of action determined

Verify available from a reliable source

Ingredients and potency documented

Quality assurance documented, seal of approval

What common vitamin deficiency in older adults can cause symptoms of fatigue, memory impairment, irritability, depression and personality changes?

B12

OLDER ADULTS

1.6 to 2.3 times more

likely to have

vitamin B12 deficiency

3.7 to 4 times more

likely to have

vitamin D deficiency

How much daily Vitamin D should you take if you are over 70 years old?

HOW MUCH DAILY VITAMIN D?

Older skin cannot synthesize vitamin D as well Likely to spend more time indoors

Inadequate dietary intakes of vitamin D

51–70 years600 IU

(15 mcg)

600 IU

(15 mcg)

>70 years800 IU

(20 mcg)

800 IU

(20 mcg)

Age Male Female

SAVVY CONSUMERS SHARE INFORMATION WITH THEIR

HEALTH CARE TEAM

1. Please list which supplements you take, how often, and why you take them.

2. Are you currently taking or have you recently taken any over-the-counter medications (e.g., aspirin, cold medicine, stool softener, pain reliever, etc.)?

3. What prescription medication(s) are you currently taking, if any?

SPECIAL THANKS FOR CONTENT & IDEAS

UC IRVINE, REYNOLDS GRANT

UNIVERSITY CINCINNATI/HEALTH ALLIANCE,

REYNOLDS GRANT

THE AMERICAN GERIATRICS SOCIETY, BEER’S CRITERIA

US FOOD AND DRUG ADMINISTRATION