Elderly Patients (from Wikipedia)

Drugs to avoid in Elderly Patients

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, is a guideline for healthcare professionals' to help improve the safety of prescribing medications for older adults. It emphasizes deprescribingmedication which is unnecessary health care.

The criteria are used in geriatrics clinical care to monitor and improve the quality of healthcare. The criteria are also used in clinical care, training, research, and healthcare policy to develop performance measures and document outcomes. The "Beers Criteria" contains lists of medications that pose potential risks outweighing potential benefits for people 65 and older. By considering this information during routine care, practitioners may prevent harmful side effects, including those that could be life-threatening and other "adverse drug events". As more people reach geriatric status, the delivery of safe and effective healthcare in this special population has become increasingly important.

The Beers Criteria is meant to serve as a guide for clinicians and is not a substitute for professional judgment in prescribing decisions for an individual patient. Evidence from both the recent Budnitz study, which addresses emergency hospitalizations for ADEs in older Americans, and the STOPP/START criteria (Screening Tool in Older Persons for Potentially Inappropriate Prescriptions and Screening Tool to Alert Doctors to the Right Treatment)  should be used in a complementary manner with the Beers Criteria to guide clinicians about safe prescribing in older adults.

Polypharmacy

Polypharmacy is the use of multiple medications by a patient, generally older adults (those aged over 65 years). More specifically, it is often defined as the use of four or more regular medications. It sometimes alternatively refers to purportedly excessive or unnecessary prescriptions.  The term polypharmacy lacks a universally consistent definition. Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes.

Although polypharmacy can be appropriate, it is more often inappropriate  Concerns about polypharmacy include increased adverse drug reactions, drug-drug interactions, prescribing cascade, and higher costs. Polypharmacy is often associated with a decreased quality of life, decreased mobility and cognition.

It is well accepted in pharmacology that it is impossible to accurately predict the side effects or clinical effects of a combination of drugs without studying that particular combination of drugs in test subjects. Knowledge of the pharmacologic profiles of the individual drugs in question does not assure accurate prediction of the side effects of combinations of those drugs.

Whether or not the advantages of polypharmacy (over monotherapy) outweigh the disadvantages or risks depends upon the particular combination and diagnosis involved in any given case. The use of multiple drugs, even in fairly straightforward illnesses, is not an indicator of poor treatment. A perfectly legitimate treatment regimen could include, for example, the following: a statin, an ACEI inhibitor, a beta-blocker, aspirin, paracetamol, and an antidepressant in the first year after a myocardial infarction.

Blockbuster Drugs
 
A blockbuster drug is a drug generating more than $1 billion of revenue for the pharmaceutical company that sells it each year. Cimetidine was the first drug ever to reach more than $1 billion a year in sales, thus making it the first blockbuster drug.

A report from URCH Publishing estimated that about one third of the pharma market by value is accounted for by blockbusters. About 125 products are blockbusters. The top seller currently is Lipitor, a cholesterol-lowering medication marketed by Pfizer with sales of $12.5 billion. In 2009 there were a total of seven new blockbuster drugs, with combined sales of $9.8 billion. Beyond this purely arbitrary financial consideration,

"In the pharmaceutical industry, a blockbuster drug is one that achieves acceptance by prescribing physicians as a therapeutic standard for, most commonly, a highly prevalent chronic (rather than acute) condition. Patients often take the medicines for long periods."  The birth control pill Enovid was the first modern drug taken by those not ill for a highly prevalent chronic condition. The focus on highly profitable drugs for chronic conditions and resulting de-emphasis of one-time acute treatment drugs has led to occasional shortages of antibiotics or vaccines, such as the influenza vaccine shortage in the United States.

Leading blockbuster drugs as of 2011
Drug Trade name Type Indication Company Sales ($billion/year)*

Atorvastatin Lipitor Small molecule Hypercholesterolemia Pfizer 12.5
Clopidogrel Plavix Small molecule Atherosclerosis Bristol-Myers Squibb Sanofi 9.1
Fluticasone/salmeterol Advair Small molecule Asthma GlaxoSmithKline 8.7
Esomeprazole Nexium Small molecule Gastroesophageal reflux disease AstraZeneca 8.3
Rosuvastatin Crestor Small molecule Hypercholesterolemia AstraZeneca 7.4
Quetiapine Seroquel Small molecule Bipolar disorder Schizophrenia Major Depressive Disorder AstraZeneca 7.2 Adalimumab Humira Biologic Rheumatoid Arthritis AbbVie 6.6
Etanercept Enbrel Biologic Rheumatoid Arthritis Amgen Pfizer 6.5
Infliximab Remicade Biologic Crohn's Disease Rheumatoid Arthritis Johnson & Johnson 6.4 O
lanzapine Zyprexa Small molecule Schizophrenia Eli Lilly 6.2 *

Sales are for the 12 months preceding June 30, 2011.

Compliance

In medicine, compliance (also adherence, capacitance or Concordance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both the patient and the health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance, although the high cost of prescription medication also plays a major role.

Compliance is commonly confused with concordance. Concordance is the process by which a patient and clinician make decisions together about treatment.

Worldwide, non-compliance is a major obstacle to the effective delivery of health care. Estimates from the World Health Organization (2003) indicate that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations. In particular, low rates of adherence to therapies for asthma, diabetes, and hypertension are thought to contribute substantially to the human and economic burden of those conditions.Compliance rates may be overestimated in the medical literature, as compliance is often high in the setting of a formal clinical trial but drops off in a "real-world" setting.

Major barriers to compliance are thought to include the complexity of modern medication regimens, poor "health literacy" and lack of comprehension of treatment benefits, the occurrence of undiscussed side effects, the cost of prescription medicine, and poor communication or lack of trust between the patient and his or her health-care provider. Efforts to improve compliance have been aimed at simplifying medication packaging, providing effective medication reminders, improving patient education, and limiting the number of medications prescribed simultaneously.


Elderly Patients Related Websites


AGS 2012 Beers Criteria - American Geriatrics Society

Beers Criteria Public Translation - American Geriatrics S

Beers Criteria - American Geriatrics Society

Beers revised: Drugs not to use in older adults | American ...

Beers Criteria (Medication List) 

Drugs to avoid in Elderly Patient per Beer Criteria