Inappropriate drugs

Keywords Inappropriate drugs Beer s criteria Antipsychotics Benzodiazepines Anticholinergic drugs NSAID... 

Having more than one prescriber increases the risk of inappropriate drug use (Piecoro et al. 2000, Dhalla et al. 2002). Thus, it is important that frail elderly have a physician that has knowledge of the patient s entire pharmacotherapy. It also emphasises the need for communication between different care givers. 

Piecoro LT, Browning SR, Prince TS et al. (2000) A database analysis of potentially inappropriate drug use in an elderly medicaid population. Pharmacotherapy 20(2) 221-228 Ray WA, Thapa PB, Gideon P (2000) Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc 48(6) 682-685... 

Blalock SJ, Byrd JE, Hansen RA et al. (2005) Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults. Am 1 Geriatr Pharma-cother 3(3) 168-179... 

Delirium often has a multifactorial cause (Box 6.1). Elderly patients with severe illness or who are already cognitively impaired are vulnerable to delirium. Malnutrition or dehydration may further enhance the risk. The most common causes for delirium are drugs and diseases. Frail elderly who are vulnerable to delirium may be pushed into delirium by one dose of an inappropriate drug or by e.g. urinary retention whereas younger individuals are far more resistant. 

EBM (3), inappropriate drugs (4), correct dose (2), food interactions (8), personalised medicine (10), renal elimination (2), common conditions (5), neuro-psychiatric disorders (6)... 

Any of the above used in isolation may lead to an inaccurate assessment and hence potentially inappropriate drug use. A patient with the same LFTs as another may have very different signs and symptoms. 

WiUcox SM, Hirumelstein DU, WooUiandler S. Inappropriate drug prescribing for the community-dweUing elderly. JAMA 1994 272 292-296. 

Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality A population-based study of the very old. Drugs Aging 2005 22 69-82. 

To pretend that fraud does not exist is to condone it. To take no action when fraud is suspected or when blatant evidence is seen is not acceptable. The most vulnerable potential victims are the patients whichever definition of fraud is used, the fact that patients have been exploited remains. This exploitation occurs when ethics committee authorization is not sought or is forged, denying patients the protection of review of the safety and ethics of the study. It occurs when safety data are not recorded or when patients are treated with inappropriate drugs. It occurs when drugs are licensed or withdrawn from the market using fraudulent data. It occurs when there are incorrect details on their patient notes. 

Lamy PP. Appropriate and inappropriate drug use. In Penta FB, ed. Pharmacy Practice for the Geriatric Patient. Alexandria, VA American Association of Colleges of Pharmacy, 1985 13.1-13.27. 

By the mid-1960s the problem of administering inappropriate drug doses to pediatric patients had been clearly documented. In 1959 reports of the gray baby syndrome in neonates were published documenting the toxicity of chloramphenicol when adult doses were miniaturized to infants without consideration of maturation differences. The resulting deaths occurred because neonates have immature glucuronyl transferase activity necessary for the biotransformation of chloramphenicol and therefore accumulation occurred. When chloramphenicol... 

Hanlon JT, Fillenbaum GG, Kuchibhatla M, et al. Impact of inappropriate drug use on mortaUty and decline in functional status in representative community dwelling elders. Med Care 2002 40 166-176. 

Fillenbaum GG, Hanlon JT, Dowd B, et al. Impact of inappropriate drug use defined by Beers criteria on health service use (abstract). Gerontologist 2001 41(suppl 1) 52. 

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