{"id":249,"date":"2015-12-02T17:26:49","date_gmt":"2015-12-02T17:26:49","guid":{"rendered":"http:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/?p=249"},"modified":"2016-12-14T19:58:37","modified_gmt":"2016-12-14T19:58:37","slug":"managing-melange-medications","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/2015\/12\/02\/managing-melange-medications\/","title":{"rendered":"A Melange of Medications"},"content":{"rendered":"
\"Charity

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Charity Maniates, MSPA, MPH, PA-C practices geriatric medicine in Maine.<\/p>\n

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It\u2019s unavoidable — treating the frail, confused, 80 year-old patient with congestive heart failure, atrial fibrillation, type 2 diabetes mellitus and chronic kidney disease in your office, emergency department, or hospital ward. In geriatrics, often acute presentations are the result of harmful medical interactions, resulting in falls, toxicity, delirium, or acute kidney injury.<\/p>\n

Over time, many medications are prescribed with good intentions but are not reevaluated or stopped. The result is a melange of medication lists and prescriptions stashed in an older adult\u2019s kitchen cupboard, used either inappropriately or accidentally. The arduous task of clarifying medications requires detective skills — especially when you\u2019ve been given a handwritten scrap of paper listing twenty medications, many crossed out and rewritten with questionable doses.<\/p>\n

\"pills151556425med\"<\/a>As a physician assistant or nurse practitioner, we are often the first to assess and initiate workup, order diagnostic tests, and tailor treatment plans for older adults. We can help to identify potentially harmful medication interactions, dose antibiotics for renal function, or consider alternative medications to reduce falls, delirium or worsening dementia. With all that is required of clinicians, delving into the pages of pharmacopoeia for guidance is simply daunting. <\/p>\n

The Beers Criteria, first published in 2012, is a comprehensive list of potentially harmful medications for older adults extensively researched and published in the Journal of the American Geriatrics Society. The aim of the 2015 Beers Criteria is to create heightened awareness of potentially harmful medications to stimulate clinicians to weigh the risks and benefits of starting a mediation or to consider an alternative. Recognizing common drugs that carry potential for mishap — including first-generation antihistamines, tricyclics, peripheral alpha 1 blockers, sulfonylureas, and oral NSAIDs — is a good step in reducing polypharmacy. Below are a few medications highlighted in the \u201cAmerican Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults\u201d review, published in November\u2019s Journal of the American Geriatrics Society <\/i>1<\/sup>: <\/p>\n