Prescription elderly

Lubricant laxatives work by coating the stool, which allows it to be expelled more easily. The oily film covering the stool also keeps the stool from losing its water to intestinal reabsorption processes. Mineral oil (liquid petrolatum) is a non-prescription heavy oil that should be used with caution, if at all, since it may be aspirated into the lungs and cause lipoid pneumonia. This is of particular concern in the young or the elderly. 

Obtain a thorough history of prescription, non-prescription, and natural drug product use. Is the patient taking any medications that could contribute to cognitive changes in the elderly ... 

The common causes of thyrotoxicosis are shown in Table 41-6.29,30 Thyrotoxicosis can be related to the presence or absence of excess hormone production (hyperthyroidism). Graves disease is the most common cause of hyperthyroidism. Thyrotoxicosis in the elderly is more likely due to toxic thyroid nodules or multinodular goiter than to Graves disease. Excessive intake of thyroid hormone may be due to overtreatment with prescribed therapy. Surreptitious use of thyroid hormones also may occur, especially in health professionals or as a self-remedy for obesity. Thyroid hormones can be obtained easily without a prescription from health food stores or Internet sources. 

Rowgowski, J., L.A. Lillard and R. Kington (1997), The financial burden of prescription drug use among elderly persons , Gerontologist, 37, 475-82. 

If patients are on PPI and nutritional deficiencies occur, the indication and further prescription should be reconsidered, in particular in the elderly... 

A few studies have examined the impacts of Medicaid and non-Medicaid copayments on drug utilization and health care costs. In a 1993 study, Reeder et al. noted an 11% decrease in prescription use after South Carolina established a 50-cent per prescription copayment. This increase was significantly greater than in Tennessee, a comparison state with no copayments (Reeder et al., 1993). Another study using survey data from the 1992 Medicare Beneficiary Survey found that elderly and disabled Medicaid beneficiaries who live in states with prescription drug copayments have lower prescription drug utilization than their counterparts in states without copayment, and three-fourths of the difference was directly attributed to copayment policies. The study predicted that Medicaid copayments... 

A large and growing number of older people across the world suffer from schizophrenia. Recommendations for their treatment are largely based on data extrapolated from studies of the use of antipsychotic medications in younger populations. In addition most manufacturers of such medications recommend prescription of reduced doses to the elderly. The evidence base for these assumptions is unclear and raises obvious questions regarding the appropriateness of such prescribing practice. 

Nomura K, Nakao M, Sato M et al. (2007) The long-term prescription of benzodiazepines, psychotropic agents, to the elderly at a university hospital in Japan. Tohoku J Exp Med 212(3) 239-246... 

Kragh A (2004) [Two out of three persons living in nursing homes for the elderly are treated with at least ten different drugs. A survey of drug prescriptions in the northeastern part of Skane]. Lakartidningen 101(11) 994—996... 

In 1971, when the prescription charge was 0.20, the proportion of prescriptions that were exempted was 52% of the total of these, 32% were for the elderly (men over 65 and women over 60) and 20% were for non-age related reasons. In 1995, 89% of prescriptions were exempt from charge, 45% on grounds of age, which means that 44 % of prescriptions were exempt from charge for non-age related reasons. 

Requests for confirmation of treatment despite apparent lack of effectiveness may be expression of the fact that the patient has already tried to stop the drug but became subjectively worse due to withdrawal rather than the re-emergence of the original symptoms. On the other hand requests for repeat prescription may also indicate a dependence in a therapeutic relationship, the patient needing support and contact. The prescription of a drug is then merely a vehicle which the patient finds acceptable as a reason for approaching the doctor. This may be particularly true for elderly, lonely patients. 

Anticholinergics and antihistamines chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril and Atarax), cyproheptadine (Periactin), promethazine (Phenergan), dexchlorpheniramine (Polaramine) All nonprescription and many prescription antihistamines may have potent anticholinergic properties. Nonanticholinergic antihistamines are preferred in elderly patients when treating allergic reactions. High... 

Cooper IK, Love DW, Raffoul PR Intentional prescription nonadherence (noncompliance) by the elderly. I Am Geriatr Soc 1982 30 329-333. 

Modafinil is a Schedule IV medication and does not require a triplicate prescription. Its mechanism of action is unclear but is thought to differ from those of conventional stimulants. Modafinil is metabolized by the liver and excreted by the kidneys. Its half-life is approximately 15 hours. It is available in 100- and 200-mg tablets. The typical daily dose is 200 00 mg every morning this dose should be reduced in elderly or hepatically impaired patients. 

Sodium phosphate is available as a nonprescription liquid formulation and by prescription as a tablet formulation. When taking these agents, it is very important that patients maintain adequate hydration by taking increased oral liquids to compensate for fecal fluid loss. Sodium phosphate frequently causes hyperphosphatemia, hypocalcemia, hypernatremia, and hypokalemia. Although these electrolyte abnormalities are clinically insignificant in most patients, they may lead to cardiac arrhythmias or acute renal failure due to tubular deposition of calcium phosphate (nephrocalcinosis). Sodium phosphate preparations should not be used in patients who are frail or elderly, have renal insufficiency, have significant cardiac disease, or are unable to maintain adequate hydration during bowel preparation. 

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