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