[Reblog] ‘Inherently dangerous’ drugs routinely prescribed to seniors: Report

Simple intervention helps doctors communicate better when prescribing medications (5 basic facts to convey)

English: medications (Photo credit: Wikipedia)

 

The EurkAlert article is here.

 

If the prescribing health care practitioner forgets, here they are

 

• the medication’s name
• its purpose
• the directions for its use
• the duration of use
• the potential side effects

 

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Study Questions Drug Expiration Policy

 

From the 8 October 2012 article at MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Published: October 08, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Prescription drugs retained their potency for as long as 40 years after expiration date, an analysis of 14 different compounds showed.

Overall 12 (86%) of the compounds tested at concentrations at least 90% of the labeled amount. Three compounds had concentrations that exceeded labeled amounts, and in two cases laboratory tests showed the compounds had less than 90% of the labeled concentration.

The findings add to existing evidence that prescription drugs retain their potency long after the expiration date, according to a research letter published online in Archives of Internal Medicine.

“The most important implication of our study involves the potential cost savings resulting from lengthier product expiration dating,” Lee Cantrell, PharmD, of the California Poison Control System in San Diego, and co-authors wrote. “Each dollar spent on SLEP [the Shelf-Life Extension Program] to demonstrate longer-than-labeled drug stability results in $13 to $94 saved on reacquisition costs…

…

The study involved eight medications comprising 15 different active ingredients, all in original, unopened containers. The medications were methaqualone, codeine, meprobamate, amphetamine, pentobarbital, secobarbital, and hydrocodone.

In addition to the primary ingredient, one or more of the eight medications included butalbital, aspirin, phenacetin, caffeine, phenobarbital, homatropine, chlorpheniramine, acetaminophen, and caffeine.

Ultimately, the authors evaluated medications representing 14 drug compounds. For each of the eight medications, the authors dissolved the contents of tablets/capsules, sonicated in methanol, reconstituted in analysis buffer, and analyzed with liquid chromatography time-of-flight mass spectrometry. Homatropine was the only drug not included in testing.

Of the 14 compounds analyzed, 12 retained the generally recognized minimum acceptable potency of 90% of labeled amount. The only two that did not meet the 90% minimum standard were aspirin (200 mg labeled, 2.28 mg by analysis; 226.8 mg labeled, 1.53 by analysis) and amphetamine (5.0 mg labeled, 2.2 mg by analysis; 15.0 mg labeled, 8.1 mg by analysis).

 

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American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Tablets and Patches of Clonidine, Comprimés et patch transdermique de clonidine (Photo credit: Wikipedia)

From the  April 2012 Full Text Report summary (with link to report)

Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults. PIMs now form an integral part of policy and practice and are incorporated into several quality measures. The specific aim of this project was to update the previous Beers Criteria using a comprehensive, systematic review and grading of the evidence on drug-related problems and adverse drug events (ADEs) in older adults. This was accomplished through the support of The American Geriatrics Society (AGS) and the work of an interdisciplinary panel of 11 experts in geriatric care and pharmacotherapy who applied a modi- fied Delphi method to the systematic review and grading to reach consensus on the updated 2012 AGS Beers Criteria. Fifty-three medications or medication classes encompass the final updated Criteria, which are divided into three categories: potentially inappropriate medications and classes to avoid in older adults, potentially inappropriate medications and classes to avoid in older adults with certain diseases and syndromes that the drugs listed can exacerbate, and finally medications to be used with caution in older adults. This update has much strength, including the use of an evidence-based approach using the Institute of Medicine standards and the development of a partnership to regularly update the Criteria. Thoughtful application of the Criteria will allow for (a) closer monitoring of drug use, (b) application of real-time e-prescribing and interventions to decrease ADEs in older adults, and (c) better patient outcomes.

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Your care is fragmented, here’s how to fix it

From the 4 April 2011 post by BARBARA BRONSON GRAY, RN at KevinMD.com

…The more complicated your problems, the more fragmented your care will be. The average Medicare patient sees two physicians and five specialists a year, (according to The Fragmentation of American Health Care: Cases and Solutions, edited by Einer Elhage). Those with a chronic illness see an average of 13 physicians a year. A Medicare patient with coronary artery disease sees ten physicians in six distinct practices annually. Indeed, the more physicians following someone after a heart attack, the lower the survival rates.

It’s important you know that there is no little Tinkerbell picking up your medical records and automatically delivering them to the physicians in your life who should know what’s happening with you. Consider yourself the the person most responsible to collect written updates, copies of test results and lists of new and changed medications and get them to all your other healthcare providers.

What can you do?

When you get a test result, procedure or have surgery, get the summary in writing, keep a copy, and send or bring copies to all your other healthcare providers. Attach a simple note: “Wanted to keep you up- to-date on my health status. Please put this in my chart.” If it’s an important healthcare issue, be sure to bring up the data or  problem at your next visit and mention that you sent a written summary for inclusion in your medical record.
Keep a list of all your medications and update it any time a healthcare provider adds or deletes a drug or changes a dosage. Bring a copy of that list to your medical appointments and to the emergency room if you end up there.
Don’t leave your dentist or your optometrist/ophthalmologist out of the loop. They need to know the details of your general health status. It will help them diagnose and treat any issues they may identify with you. Be sure they know if you have any infections, immune issues, heart problems, chronic conditions or are taking blood thinners or antibiotics, as well as other medications.
If you have a test or procedure and you do not hear the results soon afterwards, do not assume the results were normal. Call the healthcare provider who ordered the test and ask the office staff to email or send you a written copy of the test summary. Keep a copy in your own “medical updates” file. If the test was indeed OK, you still should have copy for reference at a later time, if needed.

If you or someone you love ends up in the hospital, your role of communicator will be even more vital. Often multiple consulting physicians — specialists — are called by the admitting physician to weigh in on issues and questions that develop while you’re in the hospital. They don’t always talk to each other or even realize who has changed or added a medication, who has ordered a test, or what results are in. The more you communicate the better. If you are being asked to go back for a test you already had or if you have questions about what is happening, don’t assume someone at the “nurses’ station” has it all managed. Ask questions and be sure you understand what tests you’re getting and why. If you are being discharged from the hospital ask for the results of any tests or procedures you had in the hospital.

Related Resources

• How to create a pill card (US Agency for Healthcare and Research)
• Creating a Health Journal (American Academy of Family Physicians)
• Personal Health Records (MedlinePlus) has links to overviews, basics, news, “how to”, and more)
• Consumers and Patients (US Agency for Healthcare Research and Quality) contains information in areas as staying healthy, choosing quality care, getting safer care, and comparing medical treatments

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American Medical Association (AMA) News: Quantifying adverse drug events: Med mishaps send millions back for care (with Feb 2012

amednews: Quantifying adverse drug events: Med mishaps send millions back for care :: June 13, 2011 … American Medical News

Yes, this is old too..but interesting.

Quantifying adverse drug events: Med mishaps send millions back for care

 

Reviewing drug lists and making sure patients understand how to take their medicines are two keys to preventing problems.

By KEVIN B. O’REILLY, amednews staff. Posted June 13, 2011.

Every year, adverse drug events send more adult patients to American physician offices and emergency departments than do pneumonia or strep throat.

The trips add up to an estimated 4.5 million annual outpatient visits related to medication problems, with seniors and patients taking more than six medications the most likely to show up in doctors’ offices.

The findings — the first published attempt to estimate the nationwide impact of adverse drug events in the ambulatory setting — come after an April report by the Agency for Healthcare Research and Quality that said 1.9 million hospitalizations annually are due to medication side effects or errors. Nearly three-quarters of the 4.5 million adverse drug event-related visits were to physician offices, said the study, published online May 10 in Health Services Research. About 400,000 of these 4.5 million patients are subsequently hospitalized.

…….

“This shows we have to do a better job of looking at medications as the culprits of a lot of the medical problems that are coming in,” she said.

4.5 million ambulatory visits each year are related to adverse drug events.

In total, one-half of 1% of all ambulatory visits are related to adverse drug events, the study said. That may not seem like a lot, but the 4.5 million annual adult outpatient visits for medication problems exceed the numbers for conditions such as strep throat (4.4 million) and pneumonia (4.2 million), said Urmimala Sarkar, MD, MPH, lead author of the study.

“Those are things that we think of as common problems,” said Dr. Sarkar, assistant professor of medicine in residence at the University of California, San Francisco School of Medicine’s Division of General Internal Medicine. “We should think of this as a common problem too.”

Patients 65 and older were more than twice as likely as middle-age patients and nearly three times likelier than patients between 25 and 44 to experience adverse drug events serious enough to send them to a doctor or an ED, the study said. After adjusting for age, gender, insurance status and other factors, patients taking six drugs or more had the highest odds of experiencing adverse drug events…..

WEBLINKS

“Adverse Drug Events in U.S. Adult Ambulatory Medical Care,” Health Services Research, published online May 10 (www.ncbi.nlm.nih.gov/pubmed/21554271)

“Medication-Related Adverse Outcomes in U.S. Hospitals and Emergency Departments, 2008,” Healthcare Cost and Utilization Project Statistical Brief #109, Agency for Healthcare Research and Quality, April (www.hcup-us.ahrq.gov/reports/statbriefs/sb109.pdf)

Preventing Medication Errors, Institute of Medicine, 2007 (www.nap.edu/catalog.php?record_id=11623)

Institute for Safe Medication Practices Medication Errors Reporting Program (www.fda.gov/safety/medwatch/howtoreport/ucm085568.htm)

Food and Drug Administration on how to report serious adverse drug events to the agency (www.fda.gov/safety/medwatch/howtoreport/ucm085568.htm)

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Communicating Health Risk Is A Risky Task For FDA

 

Image via Wikipedia

Communicating Health Risk Is A Risky Task For FDA

From the 23 January Medical News Today article

The impact of efforts by the U.S. Food and Drug Administration to notify the general public and health care providers about unanticipated risks from approved medications has been “varied and unpredictable,” according to a systematic review of published studies about FDA warnings and alerts over the last 20 years.

Although some communication efforts had a strong and immediate effect, many had little or no impact on drug use or health behaviors and several had unintended consequences, researchers report in the journal Medical Care. …

…The FDA has several standard tools to disseminate new evidence about drug safety. These include “Dear Healthcare Provider” letters to prescribers*, “public health advisories” and “Safety Alerts” targeting the general public, and “black box warnings”** added to a label when a drug’s risks may be particularly severe or affect a large population. Despite numerous studies examining single alerts, advisories and label changes, no prior study has systematically examined the effect of these risk communications….

[Article summarizes the effectiveness of 4 categories of communication]

…Part of the problem, the authors emphasize, is the challenge of communicating complex risk messages to a large, diverse audience. “The most effective communications were the simplest, those that were specific, where alternatives were available, and where the messaging was reinforced over time,” said Stacie Dusetzina, PhD, lead author from Harvard Medical School.

 

Read the entire Medical News Today article

*No direct links to “Dear Healthcare Provider” letters at http://www.fda.gov/Drugs/ResourcesForYou/HealthProfessionals/default.htm
However, individual letters can be found through using search engines, as a recent one for the drug Promacta

**Recent black box warnings are listed at Drug Safety Communications . If a drug has a black box warning, it will be part of its label. Drug information by name of drug is located at Drugs@FDA.

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