Steven Atkinson – Geriatric Pharmacology: Maximizing Safety & Effectiveness

Outline

Aging and Pharmacodynamics Aging and Pharmacodynamics

• Effects of Aging on Drug TherapyEffects of Aging on Drug Therapy
• Variations in Drug Half-life and ClearanceVariations in Drug Half-life and Clearance
• Drug Dosing in Chronic Kidney DiseaseDrug Dosing in Chronic Kidney Disease
• Common Inappropriate & Over-prescribed DrugsCommon Inappropriate & Over-prescribed Drugs
• Identifying Subtle Clues to Prevent an Adverse Drug ReactionIdentifying Subtle Clues to Prevent an Adverse Drug Reaction

Drug-Drug InteractionsDrug-Drug Interactions

• The P450 SystemThe P450 System
• The Magic Drug Number in the ElderlyThe Magic Drug Number in the Elderly
• The Top 10 Medications to AvoidThe Top 10 Medications to Avoid
• The Top 10 Drug-drug InteractionsThe Top 10 Drug-drug Interactions
• Drugs Associated with Weight LossDrugs Associated with Weight Loss

Strategies to Avoid Adverse Drug EventsStrategies to Avoid Adverse Drug Events

• Identifying Subtle Clues to Prevent an Adverse Drug ReactionIdentifying Subtle Clues to Prevent an Adverse Drug Reaction
• Individualizing a Monitoring PlanIndividualizing a Monitoring Plan
• Mandatory Gradual Dose Reduction (GDR)Mandatory Gradual Dose Reduction (GDR)
• The Garfinkel Method for Drug DiscontinuationThe Garfinkel Method for Drug Discontinuation

The “BEERS Criteria”The “BEERS Criteria”

• What are the Experts Saying?What are the Experts Saying?
• Follow the Criteria OR go with your Instincts?Follow the Criteria OR go with your Instincts?
• When Inappropriate Drugs are OKWhen Inappropriate Drugs are OK

STOPP and STARTSTOPP and START

• New RecommendationsNew Recommendations
• Guidelines by Body SystemGuidelines by Body System
• Putting it all Together – Still a Puzzle?Putting it all Together – Still a Puzzle?

Controversial Vitamins & Herbal SupplementsControversial Vitamins & Herbal Supplements

• Is your Multivitamin killing you?Is your Multivitamin killing you?
• After 19 years, the Research is inAfter 19 years, the Research is in
• Advising your Patients AppropriatelyAdvising your Patients Appropriately
• The Vitamins that Help & the Ones that HurtThe Vitamins that Help & the Ones that Hurt

PsychopharmacologyPsychopharmacology

• Selecting the Right MedicationSelecting the Right Medication
• Challenges in LTCChallenges in LTC
• Black Box WARNINGSBlack Box WARNINGS

Dementia, Depression & DeliriumDementia, Depression & Delirium

• The 3 “Ds” in GeriatricsThe 3 “Ds” in Geriatrics
• Drugs that Cause Cognitive ImpairmentDrugs that Cause Cognitive Impairment

Prescribing Challenges & SolutionsPrescribing Challenges & Solutions

• Cardiovascular Cardiovascular
  • Digoxin, Amiodarone & the Risk of OrthostatsisDigoxin, Amiodarone & the Risk of Orthostatsis
  • The New Anti-Hypertensive GuidelinesThe New Anti-Hypertensive Guidelines
• Neurological Neurological
  • The Risk of “Sleepers”: Zolpidem, Eszopiclone, ZaleplonThe Risk of “Sleepers”: Zolpidem, Eszopiclone, Zaleplon
• Endocrinology Endocrinology
  • “Doc I’ve got a Low ‘T'”“Doc I’ve got a Low ‘T'”
  • Eliminating Sliding ScalesEliminating Sliding Scales
• Gastrointestinal Gastrointestinal
  • Risks of Proton-pump-inhibitors (PPIs)Risks of Proton-pump-inhibitors (PPIs)
  • Best Antiemetic ChoicesBest Antiemetic Choices
• Anticholinergics Anticholinergics
  • Associated PsychosisAssociated Psychosis
  • Increased Anxiety and AgitationIncreased Anxiety and Agitation
• Antithrombotics Antithrombotics
  • Is Aspirin Still Recommended?Is Aspirin Still Recommended?
• Anti-Infectives Anti-Infectives
  • Antibiotic StewardshipAntibiotic Stewardship
  • Drug Resistance ConcernsDrug Resistance Concerns
  • Major Contributors to CdiffMajor Contributors to Cdiff
• Pain Meds Pain Meds
  • Newest Guidelines for Opioid DiscontinuanceNewest Guidelines for Opioid Discontinuance
  • Alternatives to OpioidsAlternatives to Opioids