iForumRx.org

Driving + Older Adult + Medications = An Accident Waiting to Happen?

While driving autonomy plays a crucial role in supporting mobility, social connections, and access to healthcare, older adults face elevated risks on the road. Rigorously collected data would equip us to educate patients about potential dangers, help us engage in collaborative discussions with patients and providers about deprescribing, and improve road safety for this vulnerable demographic.

Guest Authors: Mary Eva McClure, PharmD and Tavajay Campbell, PharmD, BCACP, CDCES

Guest Expert:  Michael Brodeur, PharmD, BCGP

Music by Good Talk

On the Look Out for Prescribing Cascades

Is my patient’s forgetfulness due to dementia or diphenhydramine? In older adults, adverse drug events (ADEs) can often be misinterpreted and lead to the initiation of new medications, which carry their own risks of ADEs … that can be misinterpreted as a new problem … leading to even more medications being prescribed.  In this episode, our guests critically examine a study that identified a new prescribing cascade:  gabapentinoid -> diuretics.

Guest Authors: Veronica Arceri, PharmD and Mallory Telese, BA, PharmD, BCACP 

Music by Good Talk

Less Might Be Better: Deprescribing Antihypertensive Medications in Older Adults

Health care professionals often don’t think twice about adding a new medication when a patient is not at goal. But we’re reluctant to stop a medication for a chronic condition when the patient appears to be stable and doing well.  Polypharmacy in older adults is a significant problem.  It’s costly and increases the likelihood of adverse effects. Several observational studies have suggested that lower blood pressure and multiple antihypertensive medications may be harmful in the elderly. Is it possible to discontinue medications without causing serious harm?

Guest Authors: Keturah Weaver Pharm D, BCPS and Daniel Longyhore Pharm D, M.S., BCACP

Music by Good Talk

If Your Heart’s Not into It, Do You Really Need to Take Your Meds?

Dilated cardiomyopathy is the leading cause of sudden cardiac death and heart failure (HF) and the chief indication for cardiac transplantation. However, approximately 40% of patients see a significant improvement in left ventricular ejection fraction and reduction in the left ventricle size over time with pharmacologic treatment. As deprescribing becomes an increasingly important part of our clinical practice, we need more data about how deprescribing impacts outcomes, particularly in chronic diseases such as heart failure.  The recently published TRED-HF is attempted to address this important question: Is the burden of lifelong therapy with medications necessary or worth it in patients with "recovered" dilated cardiomyopathy?

Guest Author:  Jennifer Pruskowski, PharmD, BCPS, BCGP, CPE

Music by Good Talk

Know When to Hold 'Em - Know When to Fold 'Em. Deprescribing in BPH.

A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).  In more symptomatic patients, or patients with confirmed, enlarged prostates, it is recommended to use both medication classes (alpha-1 blocker and 5-alpha reductase inhibitor) to minimize symptoms by relaxing the prostatic smooth muscle and reducing the size of the prostate – producing a potentially synergistic effect.  This study found that withdrawal of alpha 1-blockers after a year of combination therapy did not worsen urinary symptoms, QOL, and voiding or storage function.  This provides evidence that combination therapy may not be needed indefinitely for all patients.

Guest Authors:  Erica Crannage, PharmD and Stephanie Crist, PharmD

Music by Good Talk