Appropriate Prescribing The Challenging Patient: Older Patient with Multiple Co-Morbidities
What is an ADR?What is an ADE? • Adverse Drug Reaction (ADR) any undesirable or noxious drug effect at standard drug treatment doses • WHO;1996 Technical Report Series No. 425 • Adverse Drug Event (ADE) ADRs + errors in drug administration
Adverse Drug Reactions Side-effects Amplified drug effects Drug-drug interaction ADRs Drug-disease interaction Drug-nutrient interaction *not therapeutic failures *not ADWEs
ADR Risk Factors # of drugs ? aging pharm Adverse Drug Reaction # medical problems ? prior ADRs high risk drugs ? fragmented care
Cost of Polypharmacy risk drug interactions risk geri syndromes Polypharmacy risk inappropriate Rx functional status health care costs
Taxonomy of drug-related problems • Needed drug not given • Improper drug selection - “best” drug not used • Too little or too much • Failure to take ordered drug (non-adherence) • Adverse drug reactions • Drug-drug and drug-disease interaction • Drug use only for symptoms (other than palliation) or without indication Hepler & Strand. Am J Hosp Pharm. 1990;47:533.
CHAMP • Cost, Compliance • Hazardous interactions • Drug-drug; drug-disease; drug-aging • Aging pharmacology • Pharmacokinetics • Pharmacodynamics • Medications to avoid • Polypharmacy • >5 drugs, 50% chance of interaction • More meds than are required • Meds w/o clear indication
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