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Pharmacists Must Ensure Seniors Don't Receive Inappropriate Prescriptions

By August 26, 2012

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults was first published in 1991. That list of prescription and OTC drugs that put elderly patients at risk for experiencing unacceptable adverse events has been updated almost every year since. You can even download the 2012 Beers List for free.

Too few prescribers appear to have seen this essential patient safety resource, let alone relied on the Beers List while ordering medications for seniors.

Discussing prescriptions with an elderly patient I don't want to be so unfair to some doctors and nurses as to say they don't care about preventing dangerous side effects, but learning that slightly more than one in five prescriptions written for elderly patients are for drugs contraindicted for older people does raise concerns.

It also highlights the essential role pharmacists must play in ensuring patients receive medications that produce optimal health outcomes.

In an article published on the PLoS One website on Aug. 22, 2012, the team lead by University of Amsterdam professor Dedan Opondo noted that an analysis of earlier studies of inappropriate prescribing revealed that the most frequently misprescribed drugs were, in order, propoxyphene, doxazosin, diphenhydramine and amitriptyline.

U.S. pharmacists and patients no longer need to worry about that dubiously top-ranked painkiller since propoxyphene was pulled from the American market in 2010. Many other narcotic analgesics that cause dizziness and slow breathing remain available, however.

Potential problems with the antihypertensive, antihistamine and antdepressant include sever dehydration and fainting, then falling, due to low blood pressure.

A key word here is "potential." Every patient won't experience every side effect from a medication. Another consideration to take is whether the benefits of administering a drug outweigh the risks from doing so. For instance, patients who have not responded to other depression medications may rely on amitriptyline to function well day to day.

Any time your pharmacy receives a prescription order for an older patient, check the Beers List. If the drug shows up, begin a conversation with the patient and prescriber about the risk-benefit calculation.

Photo courtesy of CDC


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