by PGx Medical | Oct 17, 2016 | Aging Services
Prescribing for older patients presents unique challenges.
Atypical antipsychotic medications, used for the management of the behavioral and psychological symptoms of dementia, are among the drugs most frequently associated with adverse events in long-term care facilities.
Optimizing drug therapy is an essential part of caring for an older person. The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient’s physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation.
But how do you know what a person can metabolize, or receive therapy from, and what they can’t? It’s all kind of a guessing game and you hope that you get it right the first time. Pre-marketing drug trials often exclude geriatric patients and approved doses may not be appropriate for older adults. Many medications need to be used with special caution because of age-related changes in pharmacokinetics (ie, absorption, distribution, metabolism, and excretion) and pharmacodynamics (the physiologic effects of the drug).
Adverse drug events (ADEs) are the serious consequences of inappropriate drug prescribing. The possibility of an ADE should always be top of mind when evaluating an older adult individual; any new symptom should be considered drug-related until proven otherwise.
Atypical antipsychotics:
Atypical antipsychotic medications, used for the management of the behavioral and psychological symptoms of dementia, are among the drugs most frequently associated with adverse events in long-term care facilities. In particular, psychotropic medications are associated with an increased risk for falls. In one meta-analysis of patients age 60 or older, the odds ratio for any psychotropic use among patients who had one or more falls was 1.73 (95% CI 1.52-1.97).
Use of antipsychotic medications in long-term care facilities is widespread. A study of 19,780 older adults with no history of major psychosis prior to long-term care admission found that antipsychotic therapy was prescribed for 17 percent within 100 days of their long-term care admission and for 24 percent within one year.
Pharmacogenetics is one tool that can help determine the right drug, at the right dose, for the right person. This one time test is simple to administer and will give clinical caregivers valuable information for each individual resident in a long-term care community. There is no-cost to the resident and no-cost to the community since it is reimbursed by Medicare B and in select states, Medicaid.
If you would like more information on Pharmacogenetics, or you would like to sign up for an educational webinar, contact: info@pgxmed.com or call 405-509-5112.
Source: uptodate.com
by PGx Medical | Oct 14, 2016 | Uncategorized
“Given the prevalence of hypertension and the fact that effective drugs are so accessible, “treatment of hypertension may prove to be one of the best ways to prevent or delay dementia.” ~AHA
CMS established new national goals for reducing the use of antipsychotic medications in long-stay nursing home residents
In a recent article in MedPage Today, the American Heart Association stated there is compelling evidence that chronic arterial hypertension in mid-life is associated with late-life dementia, including Alzheimer’s disease.
“There is a strong rationale for treating hypertension, taking into account age, brain health, cardiovascular and cerebrovascular health, and other risk factors,” according to Costantino Iadecola, MD, director of the Brain and Mind Research Institute at Weill Cornell Medical College in New York City.
Given the prevalence of hypertension and the fact that effective drugs are so accessible, “treatment of hypertension may prove to be one of the best ways to prevent or delay dementia,” the AHA statement authors wrote.
There are a number of challenges clinicians currently face in treating hypertension, including individualizing blood pressure targets, he added. In an era of “precision medicine,” these targets need to be established on a patient-by-patient basis, Iadecola said, noting that in the elderly, lowering blood pressure can be detrimental.
Control of hypertension is likely to be a fundamental step in the effort to reduce the incidence of AD and other forms of dementia worldwide, Iadecola said.
Results from the long-term randomized controlled Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial would seem to support this, he noted. Those results indicated that control of hypertension and other vascular risk factors as well as physical and mental activity and a healthy diet can prevent or improve cognitive decline in an at-risk population of elderly, Iadecola said.
With these findings, precision medicine, via pharmacogenetic testing can identify which medications work best, or at all, for each individual patient. This is critical when dealing in the long-term care setting. “In an elderly patient you don’t always have the luxury of waiting 3-6 weeks to see if a medication will work,” said Clay Bullard, President of PGx Medical, an Oklahoma based company who travels around the country educating healthcare professionals on the benefits of pharmacogenetic testing.
“Pharmacogenetics eliminates the “guessing game” or trial and error prescribing. With these new findings, it’s more important then ever to treat our aging community with the best tools and resources available, and pharmacogenetics is one of them.” said Bullard.
“Sometimes we get pushback from physicians or the nursing staff, and I ask, “what do you have to lose?” Pharmacogenetic testing is currently reimbursed by Medicare B and in select states, Medicaid.
For more information on pharmacogenetics or how to implement it into your long-term care community, contact: PGx Medical, info@pgxmed.com or 405-509-5112. PGx will walk you through the process or schedule an educational webinar for your staff.
If you would like to schedule PGx Medical to speak at your upcoming conference or corporate meeting on pharmacogenetics and how it relates to clinical concerns such as falls, dementia, sleep, pain, med management and overall staff efficiencies, send your request (with organization, date, time) to kburleson@pgxmed.com.
Read entire article at MedPageToday
by PGx Medical | Oct 12, 2016 | Aging Services, News
Medication management can reduce interactions and side effects that may lead to falls. Although many medication classes have been linked to falls, the evidence is strongest for a few drug categories.
Avoid prescribing medications for an older person where the risk from side effects outweighs the benefit
According to the CDC, they feel it is MOST important to:
- reduce or eliminate psychoactive drugs, especially any benzodiazepines.
- Eliminate medications if there is no active indication to use them.
- Reduce doses of necessary medications (e.g.,antihypertensives) to the lowest effective dose.
- Avoid prescribing medications for an older person where the risk from side effects outweighs the benefit (e.g., skeletal muscle relaxants).
With even more changes and reductions in psychotropic medications coming in 2018, now is a good time to be proactive and implement programs that can help you achieve these mandates.
Medication Management, via pharmacogenetic testing is a great way to avoid trial and error prescribing and have scientific-based results at your fingertips when treating your residents.
For more information on this Medication Management Program, via pharmacogenetic testing, contact:
PGx Medical, info@pgxmed.com or 405-509-5112. .
source: cdc.gov
by PGx Medical | Oct 10, 2016 | News
No matter what you do as a physician or pharmacist, some patients will respond far better to treatment than others, and some will have adverse side effects.
Clay Bullard, President
PGx Medical
Medications can be very helpful and effective, but in approximately 40% of depression cases, drug therapy is ineffective.
There is pharmacogenetic information available to help align medications with each persons unique genetic profile in these areas: depression, anxiety, pain, cardio, seizure, bipolar and more. But not all pharmacogenetic companies offer you the “whole” picture. Know what you are getting before you test your residents.
PGx Medical travels around the country educating and implementing pharmacogenetics within the field of aging services. “It is a simple process,” said Clay Bullard, President of PGx Medical. “Our program addresses clinical concerns in the long-term care setting such as falls, dementia, sleep, pain, med management and overall staff efficiencies.”
The pharmacogenetic test can be placed in the electronic health record for consulting purposes when ordering future medications.
“This is the way of the future,” said Bullard. “Trial and error medication is difficult on the average person, but can be extremely hard on elderly adults. With pharmacogenetics, you avoid that process and you are able to provide a personalized treatment option.”
For more information on pharmacogenetics and how to educate your staff, or implement the program into your long-term care community, contact, PGx Medical, 405-509-5112 or info@pgxmed.com.
by PGx Medical | Oct 5, 2016 | News
CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia.
CMS established new national goals for reducing the use of antipsychotic medications in long-stay nursing home residents
According to an article in CMS.gov, CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident.
The National Partnership continues to work with state coalitions and nursing homes to significantly reduce the prevalence of antipsychotic use in long-stay nursing home residents. CMS established national goals for reducing the use of antipsychotic medications in long-stay nursing home residents by 30 percent by the end of 2016. These goals build on the progress made to date and express the Partnership’s commitment to continue this important effort.
CMS plans to monitor the reduction of antipsychotics, as well as the possible consequences, review the cases of residents whose antipsychotics are withdrawn to make sure they don’t suffer an unnecessary decline and add the antipsychotic measure to the calculations that CMS makes for each nursing home’s rating on the agency’s Five Star Quality Rating System.
In 2017 those quality measures are predicted to change. Avoiding potentially inappropriate medications in older adults remains important for quality of care for Medicare beneficiaries, according to CMS, Centers for Medicare and Medicaid. Medications will continue to be at the forefront when it comes to star quality measures.
To help with the reduction of antipsychotics, there is a fully reimbursed medication management tool that can help clinicians determine the right drug, at the right dose, for the right person. That tool is called pharmacogenetics.
Pharmacogenetics gives you scientific-based evidence on how each individual person receives therapy from the medication they are taking today, and a roadmap for medications in the future. For more information on how to implement this tool into your nursing home, or request more education on pharmacogenetics, contact: PGx Medical at info@pgxmed.com or 405-509-5112.
PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services.
source: cms.gov
