Medication Appropriateness

Assuming that the patient is currently using her medications appropriately, how would you adjust this patient s medication ... 

Lithium and other mood-stabilizing drugs require baseline and routine laboratory monitoring to help determine medical appropriateness for initiation of therapy and monitoring of potential adverse effects. Guidelines for such monitoring are outlined in Table 36-6. 

There is a consensus amongst published recommendations for the management of C. difficile infection [19-21], The most important first step in the treatment is cessation of the precipitating agent, most commonly antibiotics, if this is deemed to be medically appropriate. In mild disease, this is often sufficient for full recovery. In more... 

There are other kinds of criteria that do not focus on specific medications but rather on the patient. One such example is Medication Appropriateness Index (MAI) with different questions as e.g. Is there an indication for the drug (Samsa et al. 1994). This instrument may be more useful when assessing pharmacotherapy for the individual patient. 

Medically Appropriate Use. This is not an issue in the assessment of alcohol or illicit drugs, but can be a consideration when there is suspicion of opiate analgesic or benzodiazepine abuse. Abuse of or dependence on these medications can lead to what is often derogatorily described as drug seeking behavior. The impli-... 

Moderate to severe vasomotor symptoms and/or moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause - Start at the lowest dose. Therapy may be given continuously with no interruption, or in cyclical regimens (eg, 25 days on followed by 5 days off) as is medically appropriate on an individualized basis. 

If rapid digitalization is considered medically appropriate, it may be achieved by administering a loading dose based upon projected peak digoxin body stores. Calculate maintenance dose as a percentage of the... 

Switching from other antipsychotics - The period of overlapping antipsychotic administration should be minimized. When switching patients with schizophrenia from depot antipsychotics, if medically appropriate, initiate quetiapine therapy in place of the next scheduled injection. Periodically reevaluate the need for continuing existing EPS medication. 

Special populations (oral) - The recommended initial dose is 0.5 mg twice daily in patients who are elderly, debilitated, have severe renal or hepatic impairment, are predisposed to hypotension, or in whom hypotension would pose a risk. Adjust dose at increments of no more than 0.5 mg twice daily. Give increases to dosages above 1.5 mg twice daily at intervals of at least 1 week. In some patients, slower titration may be medically appropriate. 

Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community... 

When you hand Mrs PJ her dispensed prescription, what information or help would you give her to ensure that she knows how to use her medications appropriately ... 

Educating the patient about his or her disease and the use of the anti-infective drug that is being prescribed is essential for effective therapy. The right drug with the right route of administration cannot be effective unless the patient uses or takes the medication appropriately. 

There have been many attempts to characterize and quantify the appropriateness of medications in the elderly. The first such scale was developed by Hanlon and is called the Medication Appropriateness Index. 

Shelton, P.S. Fritsch, M. Scott, M.A. Assessing medication appropriateness in the elderly a review of available measures. Drugs Aging 2000,16 (6), 437-450. 

Drug Formulary. System—an ongoing process whereby ti health care organization, through its physicians, pharmacists, and other health care professionals, establishes policies on the use of dmg products and therapies that are the most medically appropriate and cost-effective to best serve the health interests of a given population. ... 

Pharmaceutical care and disease management. The collaborative efforts of the interdisciplinary team of pharmacists and other health professionals help to ensure patients are utilizing medications appropriately. 

The appropriateness of each prescribed medication should be assessed using a variety of methods. " One standardized measure that has demonstrated reliability and validity is the Medication Appropriateness Index (MAI). The MAI consists of 10 questions that should be asked about each medication (Table 8-5). 

State of Colorado, Second Regular Session, Sixty-second General Assembly, A bill for an act concerning the policy of addressing the disease of obesity in a medically appropriate manner, www.state.co.us/gov dir/stateleg.htlm, February 2000. The bill did not pass. 

Get the person closer to the edge of bed or chair and ask him or her to lean forward when trying to stand (if medically appropriate). 

When it is medically appropriate, use a mechanical assist device to lift people from the floor. If assist devices are not readily available or appropriate, you may have to perform a manual lift. When placing slings, blankets, draw sheets, or cots under the person... 

---