Ade Overheads Final

7/23/2019 Ade Overheads Final

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Recognizing

Adverse Drug Events


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ADE Training Overhead 2

Module One: Medications andOlder Adults - Objectives

1. Describe use of medications b older adults.

2. Define t!es of drug interactions and

understand ho" the can occur.#. E$!lain "h it is im!ortant to %no" about druginteractions.

&. 'dentif age-related changes in the bod and

ho" the affect use of medications.(. Outline issues "ith medication use b older

adults) including the !ossibilit that drug effectsma not be identified.


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ADE Training Overhead #

Older Adults and Medications

* Older adults ma%e u! 1#+ of!o!ulation

* Account for:

, About #+ of !rescribedmedications

,About &+ of over-the-countermedications

* At least + ta%e at least one!rescri!tion medication

* 12+ use ten or more !er "ee%


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ADE Training Overhead &

/rescri!tion Drug 0!endingill 'ncrease


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ADE Training Overhead (

ho Ta%es the Most Medications

* omen

* 'ndividuals "ith

multi!le healthconditions

* 3rail elderl

* 4ursing homeresidents


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Medications Most 6ommonl 7sedin the 6ommunit

* Analgesics

* Diuretics* 6ardiovascular

* 0edative-h!notics


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Medications Most 6ommonl 7sedin the 4ursing 9ome

* Anti!schotics

* 0edative-h!notics

* Diuretics* Antih!ertensives

* Analgesics

* 6ardiovascular

* Antibiotics


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ADE Training Overhead

e Must Al"as As%:

* Do the !otential

benefits out"eighthe !otential ris%sfor this individual


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Drug 'nteractions

* Drug-drug interaction: effects of a drugare altered "hen ta%en at the same time"ith one or more other drugs. The drug

does not !erform as e$!ected.

, Example: as!irin and !rescri!tion blood

thinners such as 6oumadin


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Other Drug 'nteractions

* Drugs can interact"ith other things as"ell:

,A !hsicalcondition

, 3ood

,Alcohol


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Antacids (drugs for relief of

acid indigestion,heartburn, and/or sourstomach)

As% a doctor or !harmacist before use if ou

are: Allergic to mil% or mil% !roducts if the

!roduct contains more than ( gramslactose in a ma$imum dail dose

Ta%ing a !rescri!tion drugAs% a doctor before use if ou have: ;idne disease

Antihistamines (drugs thattemporarily relieve runnynose or reduce sneezing,itchy eyes or throat)

As% a doctor or !harmacist before use if ouare ta%ing:

0edatives or tranlaucoma or difficult in urination due to

an enlarged !rostate gland

?reathing !roblems) such as em!hsema)chronic bronchitis) or asthma

hen using this !roduct: Alcohol) sedatives) and tran


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9o" Do Drug 'nteractions Occur

* Ta%ing t"o drugs that affect the bod inthe same "a can ma%e the im!actstronger , an @additive effect

* 0ome drugs cancel each other out

* Drug ma affect the amount of asubstance in the bod "hich then affectsthe "a another drug is !rocessed


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ADE Training Overhead 1#

9o" Do Drug 'nteractions Occur

* An increase or decrease in an of thefollo"ing:

,Absor!tion, Distribution

, Metabolism

,Elimination


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ADE Training Overhead 1&

Absor!tion

* A change in blood flo" to theintestine

* Metabolism changes to thedrug b the intestine

* A change in the s!eed "ith"hich things move through theintestine B@motilitC

* More or less stomach acidit

* 6hanges in the intestinalbacteria


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ADE Training Overhead 1(

Metabolism and Elimination

An increase leads to a decrease

in en=me activit in drug concentration

and effect

A4D

A decrease leads to an increase

in en=me activit in drug concentration

and effect


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Drug 'nteractions 6an 9ave7nintended Effects

* Decreasing the intended effects of thedrug Bdrug is eliminated too fastC

O

* 'ncreasing the negative effects of the drugBcan lead to to$icitC


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E$am!les of Drug-drug 'nteractions

Patientstaking: Who endedup inhospitalwith:

Were: To havetaken thisdrug in pastweek:

>lburide 9!oglcemia 5 times moreli%el

6o-trimo$a=ole

Digo$in Digo$in to$icit 12 times

more li%el

6larithromcin

BA6ECinhibitor

9!er%alemia 2 timesmore li%el

/otassium-s!aring diuretic


18/73


Age-elated 6hanges:Effects on Medications

* Total bod "ater decreases increased serumconcentration of "ater-soluble drugs

* 6hange in bod "eight influences a!!ro!riatedosage and ho" long it stas in bod:, More bod fat !rolonged half-life

, ess lean bod mass increased drug concentration

* Digestive sstem changes affect the s!eed of

drugs getting into bloodstream


19/73


Age-elated 6hanges:Effects on Medications

* 0lo"er circulation ma dela drugs gettingto liver and %idnes

* 0lo" do"n of liver and %idnes affectstime it ta%es for medication to brea% do"nand leave bod

*ess absor!tion from transdermal !atches* Drug @rece!tor sites ma be different inolder adults


20/73


9o" ?od and Medications 'nteract

* /harmaco%inetics , "hat the boddoes to the medication

Babsor!tion)etc.C

* /harmacodnamics , "hat themedication does to the bod


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@Anticholinergic Effects

* Dr mouth

* Dr s%in

* 6onsti!ation* 7rinar retention

* Ata$ia

* 6an also bring on dementiaFdelirium


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Other 'ssues ith Medication 7seand Older Adults

* A!!ro!riateness

* Multi!le medicalconditions

* Multi!le !hsicians* /ol!harmac

* 7nderuse

* 6ost

* 4oncom!liance

* ac% of research


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0ignals of /ossible Medication/roblem

* 3alls

*estlessness* 6onfusion

* oss of memor

* 6onsti!ation

* 0lee! disorders

* eight loss

* ?o"el changes

* 'ncontinence

* Di==iness


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evie" of 'ssues

* 6hronic health conditions are commonamong older !eo!le.

* There are !hsical changes that come"ith aging that affect ho" the medicationsare !rocessed b the bod.

* Drug effects a!!ear un!redictabl andma be assumed to be another health!roblem or @just old age.


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The Main /oints

* Medications are not to be given ortaken lightly especially by olderpeople!

* "t is harder #or older bodies toprocess and $etabolize $edications!

* "t is all too easy to $istake a

$edication proble$ #or anotherhealth proble$%

* &ene#its vs! risks


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Module T"o:Adverse Drug Events - Objectives

1. Define @adverse drug event) both !reventableand non-!reventable) and give e$am!les.

2. 7nderstand the difference bet"een an adversedrug event and side effects.

#. 0tate "h it is im!ortant to %no" about adversedrug events) ho" common the are) and ho"dangerous the can be.

&. Discuss drug allergies) "hat causes them) and

identif common sm!toms.(. ;no" the term @ana!hla$is.5. /rovide at least three e$am!les of strategies to

!revent adverse drug events.


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Definitions

* 0ide effect: an action of a drug other thanthe one for "hich it is being used.

* Adverse drug event BADEC: injur resulting

from the medical use of a drug., /reventable ADE: those that result from a

medication error in !rescribing) dis!ensing)administering) or monitoring

, 4on!reventable ADE G Adverse drug reaction.An injur resulting from the medical use of adrug "here no error is involved


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0ide Effects vs. ADEs

Ta%e medication

0m!toms , 0ide effects

'njuries , Adverse drug events

/reventable:Adverse drug event

4ot ,!reventable:Adverse drug reaction

Error

Hes 4o


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h Do e 4eed to;no" About ADEs

* Most common t!e of adverse event in hos!ital

* About 1F# of drug-related hos!itali=ations and Idrug-related deaths occur in !eo!le over age 5

* # to 1+ of all hos!ital admissions for older!atients are due to ADEs

* e!orted incidence higher for older adults, 2 to 1+ in ounger adults

, 2 to 2(+ in older adults* 'n stud of elderl veterans) #(+ had at least

one ADE in !ast ear) and J of those re


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9os!itals and ADEs

* ate of ADEs in older hos!itali=ed !atients G2 to 1(+

* 'n 1&) it "as estimated that ADEs ran%edbet"een the fourth and si$th leading causes of

death in the 7.0.* 2 millionK !atients have severe ADEs ever ear

* Due to ADEs) for ever 1) !atients admittedto the hos!ital:

, # "ill die, 1 "ill suffer serious long-term disabilit

* Estimated cost of in!atient ADE ranges fromL1) to L()


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ADE Training Overhead #1

Drug Allergies - Ana!hla$is

* AnaphylacticBan-uh-fuh-A;-ti%Creaction: A severe allergicreaction that can be life-

threatening* are res!onses but dangerous

* Medical hel! is needed andshould be sought immediatel.

* 6all 11 or ta%e the individual tothe emergenc room.


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Ana!hla$is 0m!toms

* 9ives

* 'tching

* 3eeling "arm

* 3lushing

* hee=ing

* Di==iness or

lightheadedness

* 0"elling in the throat

* 'rregular heartbeat

* 4ausea and vomiting

* Diarrhea

* Abdominal cram!ing


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ADE Training Overhead ##

Most 6ommon 6ul!rits:

* /enicillin-related antibiotics are the N1most common , and !enicillin allergies %ill& !eo!le in the 7.0. ever ear

* 0ulfa drugs

* Anti-sei=ure drugs

*Allo!urinol Ba drug for goutC* Drugs for heart rhthm !roblems

* ocal anesthetics


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ADE Training Overhead #&

Most at is% of Allergic eaction:

* Alread have allergies ingeneral

* Ta%e a drug often

* Ta%e a drug in largedoses

*Ta%e a drug in shotsrather than !ills


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ADE Training Overhead #(

6ommon 0m!toms 3rom ADEs

* 6onfusion

* 4ausea

* Decreased balance* 6hange in bo"el !attern

* 0edation

* Orthostatic h!otension


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6lassifications of ADEs

* 0ignificant ,falls "ithout fractures) oversedation)rashes) hemorrhages not re


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4ursing 9ome 0tud

* 9igh rates of adverse drugevents BADEsC:

, 1. ADEs !er 1 residents,About one-half B.5 !er 1

residentsC "ere !reventable


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3ound Those Most at is%:

* 4e" residents

* esidents "ith multi!le medical conditions

* esidents ta%ing multi!le medications Bfive or

moreC* esidents ta%ing !schoactive medications)

o!ioids) or anti-infective drugs

* Those at lo"er ris%:, esidents ta%ing nutrientsFsu!!lements

, Men


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'n a 6ommunit-?ased 0tud:

* There "ere 1)(2# adverse drug eventsamong #)#8 Medicare !atients

* 2+ "ere considered !reventable

* Overall rate G (.1 !er 1) !erson-ears

* ate of !reventable adverse drug events G1#. !er 1) !erson-ears


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ADEs b 6lassification:

* (8 B#+C "ere categori=ed as serious)life-threatening) or fatal:

* 0ignificant &( B52.+C

* 0evere B2.#+C

* ife-threatening 1#5 B .+C

* 3atal 11 B .8+C


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ADE Training Overhead &1

11 3atalities

* & fatal bleeding

* 1 !e!tic ulcer

* 1 neutro!eniaFinfection

* 1 h!oglcemia Blo" blood sugarC

* 1 drug to$icit relating to lithium

* 1 drug to$icit relating to digo$in

* 1 ana!hla$is

* 1 from com!lications of antibiotic-associated diarrhea

* Of the more severe events) in addition to the fatalities)five B(C resulted in !ermanent disabilit) including astro%e.


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Most 6ommonl 'nvolved Drugs:

* 6ardiovascular 25.+

* AntibioticsFanti-infectives 1&.8+

* Diuretics 1#.#+* 4ono!ioid analgesics 11.+

* Anticoagulants 8.+

* 9!oglcemics 5.+


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Most 6ommon ADEs:

* >astrointestinal tract events22.1+

* ElectrolteFrenal 15.8+

* 9emorrhagic 12.8+

* MetabolicFendocrine .(+

* Dermatologic Bs%inC Fallergic 8.+


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ADE Training Overhead &&

hat ;ind of Errors ed to ADEs

* /rescribing

* Monitoring

* /atient adherence


45/73

ADE Training Overhead &(

'f /rojected toAll Medicare Enrollees:

* 1)) ADEs each ear) among the #million Medicare enrollees

* Of these ADEs:

, More than 1) that "ill be life-threatening

or fatal, More than half of those could have been

!revented


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'ndividuals at 'ncreased is% ofADEs:

* Older) es!eciall age K* More co-morbidit* Multi!le medications

* 'ndividuals ta%ing medications in thesecategories:* Anticoagulants* Antide!ressants* Antibiotics

* 6ardiovascular drugs* Diuretics* 9ormones* 6orticosteroids


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ADE Error /revention for 5(K

Reason "ntervention

Multi!le drug use evie" medication indications

Age-related !hsiologicalterations in metabolism)e$cretion) or drug effects

A!!ro!riate dose adjustments anddecisions) "ith careful considerationof comorbidities

Drug %no"ledge dissemination)allerg chec%ing) and dis!ensing

6om!uteri=ation) !hsician orderentr) decision su!!ort) and bar-coding technolog

7nder!rescribing Avoid age bias

3alls due to medications imit !schoactive !harmacothera!

Delirium due to medications A!!ro!riate drug and dosingindications and non!harmacologicala!!roaches to insomnia


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The Main /oints

* Adverse drug events are co$$on

* Adverse drug events can be

dangerous

* 'ever take use o# $edications lightly especially a$ong older adults%

* &ene#its vs! risks

M d l Th 0 i l ' ith


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Module Three: 0!ecial 'ssues ithMedications - Objectives

1. E$!lain "h some medications are considered!otentiall ina!!ro!riate for older !eo!le.

2. ?e familiar "ith the ?eers list of !otentiall

ina!!ro!riate medications and ho" it "asdevelo!ed.

#. Describe the safe use of over-the-counter !ainrelievers.

&. 7nderstand concerns about use of insulin fordiabetes.

(. Discuss safet issues "ith cholesterol lo"eringmedications.

/ t ti ll ' i t


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/otentiall 'na!!ro!riateMedications for Older Adults

* 9ave a ris% of adverse outcomes thatout"eighs the !otential benefit for most

older !atients.

* There are other alternative medications

that are less li%el to cause !roblems andbe more effective.


51/73

ADE Training Overhead (1

?eers ist

* Effort led b Dr. Mar% ?eers

* /anel of e$!erts in geriatric medicine and!harmacolog

* 11 , 3irst !ublished for nursing homeresidents

* 18 , E$!anded to cover all older adults

* 2# , 7!dated

' i t M di ti


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'na!!ro!riate Medicationsfor Older Adults

* 4ot all !hsicians agree on the criteria

* 7se continues to be a serious !roblem:,Adverse drug reactions

, orse !hsical function

, E$cess healthcare use


53/73

ADE Training Overhead (#

0tud B3eb. 2&C 0ho"ed:

* 'na!!ro!riate medications "ere !rescribed forolder !atients in + of their doctor visits in 2

* Most li%el:

, 'f on multi!le medications, omen t"ice as li%el

* Most common:, /ain reliever !ro!o$!hene BDarvonC

,Antihistamine hdro$=ine BPistaril) Atara$C,Antian$iet dia=e!am BPaliumC

,Antide!ressant amitri!tline BElavilC

, 7rinar tract rela$er o$butnin BDitro!anC


54/73

ADE Training Overhead (&

0tud BAug. 2&C 0ho"ed:

* oo%ed at medication records for over 8()older !atients for 1

* 3ound 21+ filled a !rescri!tion for one or moreina!!ro!riate medications, + filled one !rescri!tion

, 15+ filled t"o or more

, &+ filled three or more


55/73

ADE Training Overhead ((

0tud BAug. 2&C 0ho"ed:

* T"o medications res!onsible for 2.(+ of totalclaims for ?eers list drugs:, amitri!tline BElavilC

, dia=e!am BPaliumC

* Others among the most common:, ccloben=a!rine B3le$erilC

, do$e!in B0ine


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Qhan A!!ro!riateness6lassification

* AA G Al"as should be avoided

* A G arel a!!ro!riate

* 0' G 0ome indications

* 46 G 4ot classified

* 3ound among older !atients:, #+ using at least one of the 11 AA medications

, + using at least one of the A medications

* Most li%el:, Multi!le medications

, /oorer health

0h ld @Al ? A id d f


57/73


0hould @Al"as ?e Avoided for5(K

* ?arbituates

* 3lura=e!am BDalmaneC

* Me!robamate BMilto"n and E


58/73


@arel A!!ro!riate for 5(K

* 6hlordia=e!o$ide BibriumC

* Dia=e!am BPaliumC

* /ro!o$!hene BDarvon !roductsC

* 6ariso!rodol B0omaC

* 6hlor=o$a=one B/arafle$C

* 6cloben=e!rine B3le$erilC

* Meta$alone B0%ela$inC* Methocarbamol Boba$inC


59/73


OT6 /ain elievers

* Analgesics

* Anti!retics

* 4onsteroidal anti-inflammatordrug B40A'DC

* Acetamino!hen


60/73


Dangers of OT6 /ain elievers

* Aceta$inophen, too much can lead toliver damage) es!eciall if !erson ta%es #Kalcoholic drin%s a da

* '(A"D(, stomach bleeding. 'ncreased

ris%:,Are over 5

, Ta%e !rescri!tion blood thinners Be$am!le)

6oumadinC, 9ave !revious stomach ulcers or otherbleeding !roblems

, Ta%e steroid medications or other 40A'Ds


61/73


Dangers of OT6 /ain elievers

* '(A"D(, also can cause reversibledamage to the %idnes. 'ncreased ris%:

, Over 5

, 9ave high blood !ressure) heart disease) or!re-e$isting %idne disease

, Ta%e a diuretic


62/73


0afe 7se of OT6 /ain elievers

* evie" the A6T'PE '4>ED'E4T0 of andrug being considering

* A !erson "ith an of the ris% factors listed

earlier should tal% to the doctor

* Ta%e medication in the recommendeddoses , do not e$ceed them , and for onl

short !eriods of time.


63/73


'nsulin

* /eo!le "ith diabetes have a !roblem"ith high blood sugar) so the mahave to ta%e insulin

* Too much insulin can cause lo" blood

sugar* Tr to give the !erson a fast-acting

sugar such as orange juice or soda

* 'f it gets too lo") the !erson can

!ass out.* This is an e$ergency% )et help

right away%


64/73


6holesterol-o"ering Drugs

* 6an be ver beneficial for a lot of !eo!le

&*T...

* 6an have dangerous side effects:

, Mositis) a severe muscle inflammation

,6an develo! into rhabdomolsis) "hich canbe fatal


65/73


The Main /oints

* A number of medications are !otentiallina!!ro!riate to use "ith older adults) becausethe ris%s out"eigh the benefits or alternativemedications are available that are safer andFor

more effective.* Even common medications should al"as be

used "ith care

*Again) the im!ortant


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Module 3our: 0afe 7se ofMedications - Objectives

1. 'dentif seven or more


67/73


9o" to >et ?est esults ithMedications

* egible !rescri!tion

* >et !rescri!tions filled at the same !harmac

* Ta%e the medicine in the e$act amount and at the

times that the doctor !rescribes* 7se a !ill organi=er if needed or store all

medications in their original containers

* 0tore medications in a !lace "here the can beeasil seen) but not in the bathroom

* 6ontact the doctor right a"a if the individual hasan !roblems "ith the medicine or an ne"sm!toms


68/73


ules for OT6 Medicines

1. Al"as start b reading the label , all of it.2. oo% for an OT6 medication that "ill treat onl the

current sm!toms.

#. ;no" "hat to avoid "hen ta%ing an OT6 medicine.

&. hen in doubt) as% before using an OT6 medicine.

(. Ta%e the medicine ERA6TH as stated on the label.

5. 7se e$tra caution "hen ta%ing more than one OT6drug !roduct at a time.

8. Do not combine !rescri!tion medicines and OT6 drugs"ithout tal%ing to the doctor first.

. Ma%e sure all doctors have a com!lete list of all themedicines being ta%en.

. Dont use OT6 medicines after their e$!iration date.


69/73


DO 4OT

0to! ta%ing a !rescri!tion medicineunless the doctor sas it is o%a.

Double u! on a dose if one is forgotten.

Mi$ alcohol "ith medicine unless the doctorsas it is o%a.

7se or ta%e medicines in the dar%.

7se or ta%e medicines !rescribed forsomeone else.

>ive ones medicine to someone else.


70/73


Medication ecord

* ;ee! an u!dated record of A++their medicines, including !rescri!tion) over-the-counter)vitamins) and herbal medicines or su!!lements

* Dosage) fre


71/73


4e" @Eas to ead 3ormat

* Must be in standardi=ed eas to follo" format

* 0im!le language must be used) for e$am!le:, @7ses instead of @indications

, @Ma%e "orse instead of @aggravate, @Thro" a"a instead of @discard

, @9el! instead of @assistance

* Must be in !rint that is large enough to readeasil

* 7se gra!hics to ma%e it easier to read


72/73


Drug abels

* Active 'ngredients

* /ur!ose

* 7ses

* arnings

* Directions

* Other 'nformation* 'nactive 'ngredients

* Suestions or 6omments


73/73

@The Three s , Main /oints

* Respectthat OT6s are serious medicine andmust be ta%en "ith care.

* All medications have Risksas "ell as benefits.(Same as the question e !eep as!ing")

* Ta%e Responsibility for learning about ho" tota%e medications safel. 'f in an doubt) as%

healthcare !rovider first.

Documents

Ade Overheads Final