A common reason for older people to present to the ED is adverse effects of their medication. A scrupulous medication history will often uncover an etiology for the presenting symptoms. Some strategies for obtaining a complete medication history – beyond asking the patient – are listed on the right. Click on a suggestion to learn more.
- Cause symptoms which mimic disease (eg. over-the-counter dimenhydrinate or diphenhydramine causing confusion);
- Interact with other drugs to cause symptoms (eg. new antibiotic causing decreased warfarin metabolism causing increased INR causing slow GI bleed causing anemia causing weakness);
- Interact with diseases to cause symptoms (eg. prednisone for the PMR causing the NIDDM to be less controlled with hyperglycemia and hyponatremia causing confusion)
To learn more on this topic, visit the Medication Management module.
Do you have access to a centralized drug registry? For example, many health care systems with pharmacare allow access to a registry that provides EDs with a complete list of prescriptions filled in the past year, the prescriber, and the phone number of the pharmacy.
Can you call the pharmacy of the confused patient to confirm any new additions or changes? (The “weak” patient may have just yesterday picked up a long-acting opioid for chronic pain.)
Can you review the MAR (Medication Administration Record) from the nursing home searching for recent additions, changes, deletions. (A new nurse who has started giving the “prn” lorazepam on a regular basis may explain the newly confused patient.)
Brown Bag Biopsy
Can you do a “brown bag biopsy” — do a microscopic examination of ALL the medications in that big bag and ask the patient how/why she is taking each one. Often some surprises lurk in the bottom of that bag! The now agitated person who has started taking non-prescription diphenhydramine or dimenhydrinate to help her sleep. Or that the “multiple falls” patient who mis-read “take 1/2 tabs” as “take 2 tabs” of hydrochlorothiazide or metoprolol.
Can you ask about over-the-counter medications, supplements, vitamins? The OTC calcium may explain why the oral ciprofloxacin is having no effect on the urinary tract infection
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look at all medications thouroughly and whether they are being taken appropriately
Polypharmacy can cause a huge problem if not managed well. This can sometimes be prevented by proactive pharmacist and doctors.
did realize cipro was effected by calcium
good to note
for every 5 meds 1 major side effect
I do think it is important to ask the patient how they are taking them. Often they are taking them wrong. Good example with the 1/2
like the Brown Bag Biopsy idea.
Lack knowledge of their medications:
“I take a little blue pill for my heart”. “I don’t know what I take, it’s in your computer”
all drugs interact with each other and often decreases the potency of others so we must have an idea of the list of medication taking and why. I like the brown bag idea as i often use it
like brown bag biopsy!
brown bag biopsies can certainly have their surprises…
need to ask about over the counter meds and supplements
Es necesario utilizar todos nuestros medios para obtener información de los medicamentos que ingiere el adulto ,la frecuencia y si es automedicación
brown bag biopsy is interesting/should be practiced more
so many meds
accurate med rec=hardest thing in geri-em
Brown bag biopsy is always done in our Er
like the Brown bag biopsy
Good points. Also remember to ask about supplements and natural health products that patients take on their own without advice from doctor or pharmacist.
need BPMH on elderly patients presenting to ED
this is a common problem for older adult clients with polymorbidity.
We are fortunate to have a central prescription database in B.C.
drug registry would be nice and helpful, full home med list is important
Good to know these new drugs
All drugs interact with each other as well as diet.
Computerization of pharmacies has help considerably in keeping track of polypharmacy’s. We still do follow ups with pharmacists and nursing homes.
Love it, brown bag biopsy….
Review of all medications-regular and over the counter.
Cutting down on polypharmacy.
Good information for ED JMOs
Didn’t realize Cipro negated by OTC Calcium. Wow!
didn’t know about cipro and calcium, learned something new 🙂
Points to ponder.
beware of polypharmacy and its effects
need an app
muchos farmacia es un problema
think the polifarmacy
es muy frecuente que la polifarmacia afecte a estos pacientes
la polifarmacia es un gran problema
Dangerous Brown Bag Biopsy!!!!
Polypharmacy and iatrogenic issues are huge
To much drugs
lots o drugs
meds may look like each other ,bearing in mind the seniors visual problems he or she may mistakenly take the wrong meds.
and sometimes pills that were prescribed years ago for something else are still used from time to time
I always specifically ask about ASA most patients often forget to mention it.
brown bag bx sounds great
brown bag biopsy is a good idea. also calling the pharmacist
good reminder to ask about over the counter medications! Also punch in all the drugs on lexicomp and look for any interactions!
I now see the majority of my patients by home visit. I am often quite surprised at the percentage of patients taking a completely different cocktail than they were prescribed on discharge.
If appropriate I get the patient or family to dissect what’s in the bag for me to see how much they understand, one biopsy revealed the patient thought her warfarin was actually bisoprolol and vice versa
Great! A classic example of the value of looking closely at what’s actually happening — not just “see list.”
like the Brown Bag Biopsy idea.