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Medication Use in the Elderly

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1. CRACKCast E182 – Drug Therapy in the Geriatric Patient

, as it will no doubt help you on your next shift. Shownotes – Rosen’s In Perspective The elderly are coming in droves! Drug therapy issues are particularly challenging in older adults because of altered pharmacokinetics and pharmacodynamics compared to younger adults. In addition, they take more medications, have more comorbidities, and are at increased risk for adverse drug effects because of the physiologic changes of aging As a result, medication selection and dosing need to be age-adapted for optimal patient (...) –disease interactions, drugs which increase risk the of falls, and drugs which duplicate therapy. REMEMBER: Unlike the Beers List, the STOPP criteria have been significantly associated with avoidable adverse drug events in older people that cause or contribute to hospitalization. Please refer to Table 185.4 from Rosen’s 9 th Edition for a more comprehensive summary of the top ten STOPP criteria Long-term use of benzodiazepines Duplicate prescriptions from the same drug class Proton pump inhibitor

2018 CandiEM

2. Long-Term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review

website at www.effectivehealthcare.ahrq.gov. Search on the title of the report. Persons using assistive technology may not be able to fully access information in this report. For assistance contact epc@ahrq.hhs.gov. Suggested citation: Fink HA, MacDonald R, Forte ML, Rosebush CE, Ensrud KE, Schousboe JT, Nelson VA, Ullman K, Butler M, Olson CM, Taylor BC, Brasure M, Wilt TJ. Long-Term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review. Comparative Effectiveness (...) Angela M. Cheung, M.D., Ph.D. Senior Scientist Departments of Medicine and Medical Imaging of University of Toronto Toronto, Ontario, Canada Carolyn J. Crandall, M.D., M.S., FACP* Professor of Medicine David Geffen School of Medicine at University of California, Los Angeles Los Angeles, CA Andrea Z. LaCroix, Ph.D. Professor and Chief of Epidemiology Family Medicine and Public Health at University of California, San Diego San Diego, CA Eric S. Orwoll, M.D. Professor of Medicine Oregon Health & Science

2019 Effective Health Care Program (AHRQ)

3. Brivaracetam add-on therapy for drug-resistant epilepsy. (Abstract)

. This review investigates the use of brivaracetam as add-on therapy for epilepsy.To evaluate the efficacy and tolerability of brivaracetam when used as add-on treatment for people with drug-resistant epilepsy.We searched the following databases on 9 October 2018: the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL); Medline (Ovid) 1946 to 8 October 2018; ClinicalTrials.gov; and the World (...) Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). Originally we also searched SCOPUS as a substitute for Embase, but this is no longer necessary, because randomised and quasi-randomised controlled trials in Embase are now included in CENTRAL.We sought randomised controlled trials with parallel-group design, recruiting people of any age with drug-resistant epilepsy. We accepted studies with any level of blinding (double-blind, single-blind, or unblind).In accordance

2019 Cochrane

4. Oral non-steroidal anti-inflammatory drug therapy for lung disease in cystic fibrosis. (Abstract)

in people with cystic fibrosis.Two authors independently assessed trials for inclusion the review and their potential risk of bias. Two authors independently rated the quality of the evidence for each outcome using the GRADE guidelines.The searches identified 17 trials; four are included (287 participants aged five to 39 years; maximum follow-up of four years) and one is currently awaiting classification pending publication of the full trial report and two are ongoing. Three trials compared ibuprofen (...) Oral non-steroidal anti-inflammatory drug therapy for lung disease in cystic fibrosis. Progressive lung damage causes most deaths in cystic fibrosis. Non-steroidal anti-inflammatory drugs (such as ibuprofen) may prevent progressive pulmonary deterioration and morbidity in cystic fibrosis. This is an update of a previously published review.To assess the effectiveness of treatment with oral non-steroidal anti-inflammatory drugs in cystic fibrosis.We searched the Cochrane Cystic Fibrosis

2019 Cochrane

5. Felbamate add-on therapy for drug-resistant focal epilepsy. (Abstract)

Felbamate add-on therapy for drug-resistant focal epilepsy. This is an updated version of the Cochrane Review previously published in 2017.Epilepsy is a chronic and disabling neurological disorder, affecting approximately 1% of the population. Up to 30% of people with epilepsy have seizures that are resistant to currently available antiepileptic drugs and require treatment with multiple antiepileptic drugs in combination. Felbamate is a second-generation antiepileptic drug that can be used (...) as add-on therapy to standard antiepileptic drugs.To evaluate the efficacy and tolerability of felbamate versus placebo when used as an add-on treatment for people with drug-resistant focal-onset epilepsy.For the latest update we searched the Cochrane Register of Studies (CRS Web), MEDLINE, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP), on 18 December 2018. There were no language or time restrictions. We reviewed the reference lists of retrieved studies

2019 Cochrane

6. The U.S.-FORTA (Fit fOR The Aged) List: Consensus Validation of a Clinical Tool to Improve Drug Therapy in Older Adults. (Abstract)

The U.S.-FORTA (Fit fOR The Aged) List: Consensus Validation of a Clinical Tool to Improve Drug Therapy in Older Adults. Polypharmacy and multimorbidity is a threat to older people; hence, listing approaches should support physicians to optimize medication. The FORTA (Fit fOR The Aged) classification of drug appropriateness for older people provides positive or negative labels: A (A-bsolutely), B (B-eneficial), C (C-areful), and D (D-on't). Based on these categories, FORTA-labeled drug lists (...) %) of the proposed items (n = 243) had to be re-evaluated in the second round as a result of inconsistent rating in the first round.The U.S.-FORTA List addresses the appropriateness of drugs for older people in the United States reflecting country-specific availability, usage, and expert rating. As shown for the FORTA list in Europe, this listing approach is among the few that are clinically validated and improve well-being and geriatric outcomes. The U.S.-FORTA List now largely enhances the global availability

2019 Journal of the American Medical Directors Association

7. The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort - Trial Protocol. Full Text available with Trip Pro

The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort - Trial Protocol. The aim of this trial is to evaluate the effect of SENATOR software on incident, adverse drug reactions (ADRs) in older, multimorbid, hospitalized patients. The SENATOR software produces a report designed to optimize older patients' current prescriptions by applying the published STOPP (...) , select laboratory tests, electrocardiogram, cognitive status and functional status are collected and entered into a dedicated trial database. Patients are individually randomized with equal allocation ratio. Randomization is stratified by site and medical versus surgical admission, and uses random block sizes. Patients randomized to either arm receive standard routine pharmaceutical clinical care as it exists in each site. Additionally, in the intervention arm an individualized SENATOR-generated

2019 BMC Geriatrics Controlled trial quality: predicted high

8. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Full Text available with Trip Pro

Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease, and thereby improve pregnancy outcome. This Cochrane Review is an updated review, first published in 2001 and subsequently updated in 2007 and 2014.To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy.We searched (...) , elective delivery, admission to neonatal or intensive care nursery when other antihypertensive drugs are compared with methyldopa, calcium channel blockers or beta blockers. Impaired long-term growth and development in infancy and childhood was not reported for these comparisons.Antihypertensive drug therapy for mild to moderate hypertension during pregnancy reduces the risk of severe hypertension. The effect on other clinically important outcomes remains unclear. If antihypertensive drugs are used

2018 Cochrane

9. Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients

Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients LABORATORY MEDICINE PRACTICE GUIDELINES EDITED BY LORALIE J. LANGMAN AND PAUL J. JANNETTO Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients Co-Sponsored byLABORATORY MEDICINE PRACTICE GUIDELINES Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients Loralie J. Langman Committee Chair Department of Laboratory Medicine and Pathology Mayo Clinic (...) References 101 Table of ContentsLABORATORY MEDICINE PRACTICE GUIDELINES Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients 5 Executive Summary Introduction The American Association for Clinical Chemistry (AACC) Acad- emy, formerly the National Academy of Clinical Biochemistry (NACB), has developed a laboratory medicine practice guidelines (LMPG) for using laboratory tests to monitor drug therapy in pain management patients. The scope and purpose of this guideline

2018 American Academy of Pain Medicine

10. Are Corticosteroids Superior to Nonsteroidal Anti-inflammatory Drugs in the Treatment of Acute Gout? (SRS Therapy)

Are Corticosteroids Superior to Nonsteroidal Anti-inflammatory Drugs in the Treatment of Acute Gout? (SRS Therapy) TAKE-HOME MESSAGE Corticosteroids provide pain relief similar to that of nonsteroidal anti- in?ammatory drugs for acute gout, with fewer adverse effects. Are Corticosteroids Superior to Nonsteroidal Anti-in?ammatory Drugs in the Treatment of Acute Gout? EBEM Commentators Joseph W. Watkins IV, MD Rawle A. Seupaul, MD Department of Emergency Medicine University of Arkansas (...) of gout. Part 2: therapy and antiin?ammatory prophylaxis of acute gouty arthritis. Arthritis Care Res. 2012;64:1447-1461. 6. Riedel AA, Nelson M, Wallace K, et al. Prevalence of comorbid conditions and prescription medication use among patients with gout and hyperuricemia in a managed care setting. J Clin Rheumatol. 2004;10: 308-314. 7. Wolters Kluwer. Ibuprofen. Available at: http://online.lexi.com/lco/action/doc/ retrieve/docid/gdh_f/132785?hl=6351. Accessed November 18, 2017. 8. Wolters Kluwer

2018 Annals of Emergency Medicine Systematic Review Snapshots

11. American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

released its latest update to one of geriatrics’ most frequently cited reference tools: The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. With more than 90% of older people using at least one prescription and more than 66% using three or more in any given month, the AGS Beers Criteria® plays a vital role in helping health professionals, older adults, and caregivers work together to ensure medications are appropriate. DIGITAL : × Best Value To get the most for your (...) American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Logging In... × Welcome to GeriatricsCareOnline! AGS or ADGAP MEMBER Attention AGS Members! As an AGS Member, you already have an account automatically set up on GeriatricsCareOnline.org. Your username and password are the same that you use to log onto MyAGS. (If you do

2019 American Geriatrics Society

12. Clinical observations on the use of new anti-VEGF drug, conbercept, in age-related macular degeneration therapy: a meta-analysis. Full Text available with Trip Pro

Clinical observations on the use of new anti-VEGF drug, conbercept, in age-related macular degeneration therapy: a meta-analysis. Conbercept is a new anti-vascular endothelial growth factor (VEGF) drug approved for the treatment of age-related macular degeneration (AMD). Although this novel drug has been widely used in clinic, unlike other anti-VEGF drugs, validation and consensus on its method of clinical application and clinical safety have not yet been achieved.Relevant literature (...) was searched on PubMed, Web of Science, China National Knowledge Internet, and Wanfang Data. Stata 12.0 was used for data analysis. Random- and fixed-effect models were employed to evaluate heterogeneity. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were utilized to measure the improvement of AMD patients.In this study, we analyzed conbercept administration and compared its application with other control clinical methods for AMD treatment. Ranibizumab, triamcinolone

2018 Clinical interventions in aging

13. Indications for Drug Therapy for Adults With Hypertension Without Compelling Indications for Specific Agents

people: A subgroup meta-analysis of randomized controlled trials. Lancet 1999;353:793-6. Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM. Blood pressure and survival in the oldest old. J Am Geriatr Soc 2007;55:383-8. Beckett NS, Peters R, Fletcher AE, et al; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887-98. Chow CM, Donovan L, Manuel D, Johansen H, Tu JV; Canadian Cardiovascular Outcomes Research Team. Regional variation (...) , et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 1999;353:793-6. ©2015 . All rights reserved. Unauthorized use prohibited. Hypertension Canada does not provide medical advice, diagnosis or treatment.

2018 Hypertension Canada

14. Drug therapy for chronic idiopathic axonal polyneuropathy. Full Text available with Trip Pro

Drug therapy for chronic idiopathic axonal polyneuropathy. Chronic idiopathic axonal polyneuropathy (CIAP) is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe disability or handicap does not occur, CIAP reduces quality of life. CIAP is diagnosed in 10% to 25% of people referred for evaluation of polyneuropathy. There is a need to gather and review emerging evidence on treatments, as the number of people affected is likely to increase (...) year after the onset of treatment. People with CIAP had to fulfil the following criteria: age 40 years or older, distal sensory or sensorimotor polyneuropathy, absence of systemic or other neurological disease, chronic clinical course not reaching a nadir in less than two months, exclusion of any recognised cause of the polyneuropathy by medical history taking, clinical or laboratory investigations, and electrophysiological studies in agreement with axonal polyneuropathy, without evidence

2017 Cochrane

15. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. (Abstract)

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3-year cycle. The AGS Beers Criteria® (...) is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation.© 2019 The American Geriatrics

2019 Journal of the American Geriatrics Society

16. HIV Antiretroviral Therapy Drugs Induce Premature Senescence and altered Physiology in HUVECs. Full Text available with Trip Pro

HIV Antiretroviral Therapy Drugs Induce Premature Senescence and altered Physiology in HUVECs. Developments in medicine have led to a significant increase in the average human lifespan. This increase in aging is most readily apparent in the case of HIV where antiretroviral therapy has shifted infection from a terminal to a chronic but manageable disease. Despite this advance, patients suffer from co-morbidities best described as an accelerated aging phenotype. A potential contributor (...) is cellular senescence, an aging-associated growth arrest, which has already been linked to other HIV co-morbidities such as lipodystrophies and osteoporosis in response to antiretroviral drugs. We have previously demonstrated that astrocytes senescence in response to antiretroviral drugs. As endothelial cells play a critical role regulating the blood brain barrier (BBB) and senescence could severely impact barrier permeability, we investigate the role of a commonly used combination of HIV reverse

2018 Mechanisms of Ageing and Development

17. Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update

of characteristics of this systematic review on treatment of patients with early rheumatoid arthritis Population Key Inclusion Criteria: Adult outpatients, 19 years of age or older, with an early RA diagnosis, defined as 1 year or less from disease diagnosis Key Exclusion Criteria: Adolescents and adults with RA greater than 1 year from diagnosis ES-2 Drug Therapies Approved by FDA for RA Included in the Review Corticosteroid: Methylprednisone, prednisone (PRED), prednisolone (PNL) Conventional synthetic DMARD (...) at: www.effectivehealthcare.ahrq.gov. Search on the title of the report. Persons using assistive technology may not be able to fully access information in this report. For assistance contact epc@ahrq.hhs.gov. Suggested citation: Donahue KE, Gartlehner G, Schulman ER, Jonas B, Coker-Schwimmer E, Patel SV, Weber RP, Lohr KN, Bann C, Viswanathan M. Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update. Comparative Effectiveness Review No. 211. (Prepared by the RTI International–University of North Carolina

2018 Effective Health Care Program (AHRQ)

18. Newer Drugs for Type 2 Diabetes: An Emerging Adjunctive Therapy to Insulin for Type 1 Diabetes?

Diabetes Canada, have acknowledged that there may be a role for adjunctive therapy in some T1D patients. 10,23,40 In the US, pramlintide acetate injection (Symlin) is the only noninsulin drug approved for adjunctive treatment of T1D. 13,29 Metformin, a T2D medication, is mentioned by Diabetes Canada and the American Diabetes Association for off-label use to reduce insulin requirements and total cholesterol/low-density lipoprotein ratios, 10,17,23 with the caveat that it does not improve hemoglobin A1C (...) , and weight gain may also occur with intensive insulin therapy. Phase II-IV clinical trials have investigated the use of glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium glucose cotransporter-2 (SGLT-2) inhibitors, and dual sodium glucose transporter-1 and sodium glucose transporter-2 (SGLT-1/SGLT-2) inhibitors as adjunctive therapy with insulin for adult patients with T1D. Available data suggest that these drugs may reduce A1C by 0.1 to 0.6% and total daily

2018 CADTH - Issues in Emerging Health Technologies

19. CRACKCast E179 – Drug Therapy in Pregnancy

are some “D” drugs Amiodarone All NSAIDS in the 3rd trimester Carbamazepine Paroxetine Sulfonamides Tetracyclines [3] List 5 dangerous medicines to be avoided if breastfeeding Concerns exist for: Amiodarone Chemotherapeutic/antineoplastic agents Chloramphenicol Ergotamine Gold salts Phenindione Radioactive pharmaceuticals Retinoids Tetracyclines (chronic > 3 weeks) Certain psychotropic medications Codeine Pseudoephedrine Copied from: For more resources on this, see: [4] List 4 dangerous antibiotics (...) health care providers assess the benefits and risks in counseling pregnant and nursing women who are taking medications. The rule requires the removal of letter categories and mandates labeling that includes a summary of risks of drug use during pregnancy and lactation, a discussion of the data supporting that summary, and any relevant information to help health care providers make informed decisions and counsel patients. Drugs already approved before this rule will be phased in gradually. So, when

2018 CandiEM

20. Baroreflex activation therapy for drug-resistant hypertension. A single technology assessment

post-implant and the month 12 visit. Health economic documentation The submitter performed a cost-effectiveness analysis for evaluating the cost-effectiveness of Baroreflex activation therapy for drug-resistant hypertension. They considered varation in outcomes and costs according to which treatment strategy a drug-resistant hypertension patient undergoes. A Markov cohort model was used to estimate the cost-effectiveness of the new technology compared to current practice, optimal medical therapy (...) to the hypertensive state (as in scenario 2). The calculated ICER increased to NOK 856,312 per QALY gained. All the scenario analyses showed a less cost-effective result than presented in the submission. One-way sensitivity analysis showed that the results were most sensitive to changes in the age of the patient population, the costs related to the Barostim therapy (battery, system and replacement), and the 6-month probability of hypertensive crisis in the optimal medical therapy arm. The patient’s age had

2017 Norwegian Institute of Public Health

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