Forty-nine people attended our June 12 program on Medication Use in Older Adults, presented by Nebila Kasse and Robert Hunt, who are pharmacy residents at Kaiser Permanente. For those who were unable to attend, or who would like to review the information presented, Ms. Kasse and Mr. Hunt have provided us their Powerpoint presentation. To download it, click this link: Download Medication Use in Older Adults Presentation.
Additionally, below are the notes taken at the presentation by our steadfast reporter, who prefers to remain anonymous:
While reviewing medications, a note is made of how many times they are taken, whether there may be duplicates, whether the dosage is appropriate for one's age, gender, condition; does it need to be taken with food?
The goal is to increase communication between doctor and patient.
Aging brings physiological changes ; there is less water in the body, more fat, less body mass. Absorption of the medications is altered and can be affected by particular diseases. There is also delayed gastric emptying; this affects the concentration of medications in the body.
Medications are metabolized in the liver, then travel to the kidneys. The liver does not work as well as one ages. Side effects increase. Same with the kidneys. Consequently, medications often need to be adjusted: one may have to take smaller doses, and less often. In particular, the following medications are affected: heart meds, antibiotics, antivirals, anti-gout, anti-ulcer prescriptions.
Adverse drug reactions: if one uses several pharmacies, there is a risk of duplication, consequently multi morbidity. If the patient experiences dementia, low body weight, vision/hearing impairment, regimen complexity, problems arise.
Higher risks for older patients: drowsiness, pain/fever, increase bleeding, kidney issues. Tylenol is often recommended as having few side effects; it does not cause bleeding.
Decongestants (Sudafed, for instance) can increase one's blood pressure. Coricidin is a better choice.
Anxiety medications can increase risks of falls, sleepiness. Estrogens (for hormone replacement) may cause blood clot formation.
Some medications are toxic to the kidney; baby aspirin is OK, in small amounts.
If taking herbal supplements, find out what they are exactly; avoid high doses. They can contain medications not indicated on the label; they can also interact with other medications. They are not regulated by the FDA. 'Natural' does not mean 'safe'...
A question is asked: Is Vitamin C a miracle drug? Answer: At high doses, it can cause kidney stones, diarrhea and generally does not provide proven benefits; 1,000 mg is too high.
In response to a diet question: A diet that includes lots of vegetables, salad in itself provides enough vitamin C; one should also eat some fruit, but not forget to add (necessary) protein in one's diet.
Heartburn medications can contain a high level of aluminum. AlkaSeltzerr has high levels of sodium; it is best to avoid it if one has kidney issues.
Re multivitamins, the speakers advise checking with your doctor so as not to damage your kidneys.
Drugs interact with each other; also with food, alcohol, over the counter medications. Warfarin, for instance interacts with green vegetables, grapefruit with several medications, alcohol, in particular with pain medications.
Alcohol prevents the metabolism of drugs.
For pain, Tylenol is a safe choice. Many people's first choice is often ibuprofen (also known as Aleve and Advil). However, ibuprofen may be harmful to the kidneys. Aspirin is good for one's heart, is a blood thinner.
In answer to another question: The current hip concept of 'cleansing' your kidneys this may dehydrate you also!
Hypertension control - Hypertension is also known as 'the silent killer'. A blood pressure of 150/90 is a good range if one is over 60; 140/90 for diabetics. One should measure it one to two hours after taking medications. Most people are on more than one blood pressure medication - these use different mechanisms to work.
Diabetes can affect one's vision, circulation, kidneys, limbs (amputation!), heart, may cause strokes. Important to try and keep it under control. One needs to check one's blood sugar (less than 130 normally, less than 180 after meals). HbA1c should be under 7%. Important to be aware of that measurement.
Heart failure is a common condition; becomes chronic (shortness of breath, cough, swelling of the legs, retaining of fluids). Beta blocker (metropolol) and water pills help control it. One needs to eliminate salt, take less than 2,000 mg/day; weigh oneself regularly.
COPD - shortness of breath, wheezing... One needs to rinse one's mouth after using the corticosteroid inhaler; avoid triggers; smoking needs to be stopped.
Administration of drugs: Some are taken on an empty stomach; some with food (small meal or large snack); check with your doctor on how to take the medications. Some are taken in the morning (thyroid pills), some in the evening (cholesterol meds).
Brands vs generic: Many medications are generic; they are much cheaper and help in particular if one is in the medicare 'doughnut hole'.
Disposal of medications - Do not put in the trash; police stations are a good resource; some may be flushed down the toilet; some mixed with coffee grounds or kitty litter. Needles/syringes need to be disposed of in special containers.
Medication tips: - know why you take the medications
- keep a list of them
- use pills boxes; some can be used for 7 days
- do not stop taking the medications unless advised by your doctor
- communicate any side effects about them with your physician
- do not run out of them; plan ahead and reorder
- some of them will be tapered off
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