Steven Atkinson – Geriatric Pharmacology: Maximizing Safety & Effectiveness

Outline

Aging and Pharmacodynamics

• Effects of Aging on Drug Therapy
• Variations in Drug Half-life and Clearance
• Drug Dosing in Chronic Kidney Disease
• Common Inappropriate & Over-prescribed Drugs
• Identifying Subtle Clues to Prevent an Adverse Drug Reaction

Drug-Drug Interactions

• The P450 System
• The Magic Drug Number in the Elderly
• The Top 10 Medications to Avoid
• The Top 10 Drug-drug Interactions
• Drugs Associated with Weight Loss

Strategies to Avoid Adverse Drug Events

• Identifying Subtle Clues to Prevent an Adverse Drug Reaction
• Individualizing a Monitoring Plan
• Mandatory Gradual Dose Reduction (GDR)
• The Garfinkel Method for Drug Discontinuation

The “BEERS Criteria”

• What are the Experts Saying?
• Follow the Criteria OR go with your Instincts?
• When Inappropriate Drugs are OK

STOPP and START

• New Recommendations
• Guidelines by Body System
• Putting it all Together – Still a Puzzle?

Controversial Vitamins & Herbal Supplements

• Is your Multivitamin killing you?
• After 19 years, the Research is in
• Advising your Patients Appropriately
• The Vitamins that Help & the Ones that Hurt

Psychopharmacology

• Selecting the Right Medication
• Challenges in LTC
• Black Box WARNINGS

Dementia, Depression & Delirium

• The 3 “Ds” in Geriatrics
• Drugs that Cause Cognitive Impairment

Prescribing Challenges & Solutions

• Cardiovascular
  • Digoxin, Amiodarone & the Risk of Orthostatsis
  • The New Anti-Hypertensive Guidelines
• Neurological
  • The Risk of “Sleepers”: Zolpidem, Eszopiclone, Zaleplon
• Endocrinology
  • “Doc I’ve got a Low ‘T'”
  • Eliminating Sliding Scales
• Gastrointestinal
  • Risks of Proton-pump-inhibitors (PPIs)
  • Best Antiemetic Choices
• Anticholinergics
  • Associated Psychosis
  • Increased Anxiety and Agitation
• Antithrombotics
  • Is Aspirin Still Recommended?
• Anti-Infectives
  • Antibiotic Stewardship
  • Drug Resistance Concerns
  • Major Contributors to Cdiff
• Pain Meds
  • Newest Guidelines for Opioid Discontinuance
  • Alternatives to Opioids