Drug-related problem

Annika Kragh Lund University Faculty of Medicine SE-221 00 Lund Sweden 

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Drug-related problems in the elderly is intended to serve as a source of information and clinical support in geriatric pharmacotherapy for students as well as all health care professionals, e.g. physicians, nurses and pharmacists. Pharmacotherapy is of great importance to all mankind. Drugs are however powerful and must be handled appropriately. This is especially important for elderly patients. 

Drug-related problem is not a major subject in most university programmes in medicine or pharmacy. When there is no specific course, there is often no book covering the topic. In our view, as teachers at various university courses, there has been a shortage of literature that reflects the most important aspects of drug-related problems in the elderly. Medical practitioners, nurses and pharmacists, need to have this knowledge to be able to serve their patients in the best way. 

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Helpline 0845 4500 215 (24-hour advice, information and referral on legal and drug-related problems for users, their families and friends)... 

Develop a therapeutic plan for patients with chronic asthma that maximizes patient response while minimizing adverse drug events and other drug-related problems. 

While generally not of major concern, omeprazole may inhibit the metabolism of warfarin, diazepam, and phenytoin lansoprazole may decrease theophylline concentrations. Drug interactions with omeprazole are of particular concern in patients who are considered slow metabolizers, as are approximately 3% of the Caucasian population. Unfortunately, it is unclear which patients have the polymorphic gene variation that makes them slow metabolizers.17 The metabolism of esomeprazole may also be altered in patients with this polymorphic gene variation. Patients on potentially interacting drugs should be monitored for development of drug-related problems. 

Create a care plan for this patient s psoriasis, including statement of the drug-related problems, goals of therapy, patient-specific detailed therapeutic plan, and monitoring plan and follow-up. 

Based on the information presented, create a care plan for this patient s HIV/AIDS. Your plan should include (a) a statement of the best drug combinations and reasons supporting each drug recommended, as well as any adverse effects or potential drug-related problems, (b) the goals of therapy, (c) a patient-specific, detailed therapeutic plan, and (d) a plan for follow-up to determine whether the goals have been achieved and adverse effects avoided. 

Create a care plan to include (1) monitoring parameters during maintenance therapy, (2) a list of drug-related problems to access toxicity during maintenance therapy, and (3) goals of maintenance therapy. 

More progressive MCOs have moved to concurrent DUR, in which a pharmacist can screen for drug incompatibilities, duplicate prescriptions, and other problems before dispensing the medication. Obviously, the prevention of problems or the intervention directly with patients is attractive. While the identification of drug-related problems is vital to managing pharmacotherapy, intervention with the prescriber or patient also is required. The most common approach to intervening with prescribers and patients is through educational activities. 

Within the broad categories of biological, psychological, and environmental processes, researchers have identified certain factors that seem to increase the risk of experiencing drug-related problems. There are several different categories of risk factors that tend to cluster together. However, many of these risk factors... 

In addition, societal expectations about substance use seem to be related to the susceptibility of societal members to experience drug-related problems. Many respected researchers believe that exposure to responsible substance use in society early in life may promote more moderate substance use in those societies where such behavior is sanctioned. One striking example is the Netherlands, which legalized marijuana use in coffee shops two decades ago but currently has lower marijuana abuse rates than the United States. We have no idea whether this kind of societal exposure would work with more potent substances than marijuana, although the same results have been found for alcohol in France, which has a much lower cirrhosis rate than the United States even... 

In addition to biological and environmental factors that influence the onset and course of drug-related problems, there also are many individual risk factors. These variables can include those related to a person s actions or behavior, those related to the way a person thinks, or those related to the experience of emotions. The next few sections will discuss in detail these personal variables that can be related to drug problems in some people. 

This book covers most aspects of drug-related problems in the elderly. With better knowledge of drug-related difficulties and risks we hope that elderly will have fewer drug-related problems and benefit more from their pharmacotherapy. 

Table 1.1 Some drug-related problems and potential solutions presented in this book...

Drug-related problems and medication errors Wrong drug or dose... 

These drug-related problems have impact on morbidity, mortality and costs... 

Blix HS, Viktil KK, Reikvam A et al. (2004) The majority of hospitalised patients have drug-related problems results from a prospective study in general hospitals. Eur J Clin Pharmacol 60(9) 651-658... 

Hanlon JT, Lindblad Cl, Hajjar ER et al. (2003) Update on drug-related problems in the elderly. Am J Geriatr Pharmacother 1(1) 38-43... 

Abstract Quality of care is complicated, especially in the elderly. For a start we need drugs with evidence for the benefits and risks in the elderly, this is currently not always the case. Thereafter we need to use the drugs in an evidence based way, which may be difficult in the complex health care system. To achieve maximum benefit for the patient (outcome) and society (health-economy) a well planned process is needed. This includes identification, prevention and resolving of the patients drug-related problems decisions and selection of treatment, communication and decisions together with the patient, risk minimisation, and communication within health care. Several of these aspects are presented in this chapter. 

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