Medication Management Summary
We hope you have added to your knowledge skills and attitudes about Medication Management in the Older ED Patient. It is important to understand the physiologic changes that occur in the aging body – especially in the hepatic, renal, cardiac, and neurologic systems—and how those changes affect prescribing. Keep in mind the high-risk classes of medications, both the low-benefit (NSAIDs, benzodiazepines, anti-cholinergics) and the high-benefit ones (warfarin, opioids, and hypoglycemics), and develop your own strategies for avoiding or using them safely. Have strategies for developing a complete medication review (review the “pill bag,” go over the Medication Administration Record, call the pharmacy) and for communicating clearly any changes to the patient (written instructions, feedback to the primary care-giver).
You may also want to review the modules on Atypical Presentations and Symptom Management and Falls which all have specific relevance to this topic.
Review the Learning Objectives before proceeding to the Knowledge Check.
At the end of this module you should be able to:
- Describe the physiologic changes associated with healthy aging that affect drug metabolism;
- Explain how physiologic changes affect prescribing in the older patient;
- Select appropriate drugs and dosages considering the patient’s acute and chronic diagnoses, other medications, and functional status,
- Recognize high-risk medication classes and how they can be safely used or avoided;
- Demonstrate an approach to polypharmacy including an awareness of drug-drug and drug-disease interactions;
- Demonstrate strategies for effective communication about medications.
Discussion: Medication Management Summary
Participate in the discusssion by posting a comment below
You must be logged in to post a comment
Will limit med changes and be sure to provide detailed instructions to Pt/fam. Update pcp
probably will limit the amount of discharge meds i give to only 2-3 days rather than a week or so
Definitely will consider these interactions when i prescribe medications next
Siempre tener en mente los cambios fisiológicos del paciente geriátrico además de más interacciones que se pueden llegar a presentar
dosing to weight/function vs. standard dosing for prescribing
Reconsider the physiology of our geriatric patients and how that affects what you should prescribe.
How the diff organs change with age and how tgat effects medications
consider physiological changes of ageing, review regular or PRN meds before prescribing any new meds, always way risk vs benefits before prescribing opioids, review bloods especially kidney and liver function test, coagulation profile.
Collateral History, Pharmacy review and checking with Regular GP will be also helpful.
always check drug-drug interactions, and in elderly patients ‘start low, go slow’
Drug drug interactions can be very dangerous
I have learned that a patient with many different kinds of medications are at risk for polypharmacy, and that this can manifest as bad side effects. I will pay attention to which medications my patients are on and take into consideration any new ones that will be added or ones that will be removed.
Be alert for polypharmacy, interactions
Importance of knowing all the medications a patient usually takes, how they take them and how my prescriptions are likely to interact. Importance of communicating medication changes to ensure patients understand what/why/how and risks of the change in medication.
Careful communication about changes to medication is important in all patients — but especially the older patient, potentially with some cognitive impairment, and multiple providers.
a better comprehension of drug-drug interactions in the elderly, the reasons why and the complaints they may present with.
I think I will definitely look for drug interactions if I am starting new medications for patients on warfarin. I will also try and avoid anti-cholinergics and benzos in the elderly in the ED. I will continue to do my triple checks upon d/c regarding new meds and ensuring its written down for patients, and that I also inform family members of changes.
In the ED currently, from a pain perspective, I do tend to use small doses of HM for pain in the elderly, vs NSAIDs or T#3.
How hyperaware I need to be when a patient is on Warfarin
start slow with meds, titrate accordingly
reconsider medciations, medication interactions (esp with warfarin) and better understand physiology
learned to be very thorough when prescribing to the elderly
have a full picture of the medications they are on that way it will prevent another er visit.
Certain changes in organ function during aging that should be taken into consideration when assessing patient presentation and medication lists.
I long for the days of an ER pharmacist that I no longer have. After this module, however, I will be quicker to reach for the phone to speak with a pharmacist regarding medication changes in elderly.
I learned about physiological changes and how normal adult vitals may not be normal for the elderly. I will keep this in mind in the ER>
medication reconciliation is very important in the elderly
more caution in med prescribing
avoid certain medications, be conscious of drug interactions
Always be aware of medication interactions, particularly warfarin
I have learnt to recognize drugs with low benefit and height benefit; polypharmacy, iatrogenic drug reactions. To be more mindful of discharge with written prescriptions and involvement of ED pharmacist ,caregivers and family physicians to alter prescriptions for the elderly that would deem benficial for the patient.I learnt more about the physiology in the elderly.
Be more mindful at discharge for med rec. Advocate for ED Pharmacist
carefully look over charts before prescribing medications
review meds and include call to pharmacy or question family about if pt is taking them as prescribed
Reviewing of all medication for the elderly is very important. Be very careful when adding new drugs
review medication interactions carefully and if any question about reactions reach out to pharmacy. Ensure adequate communication with patient, caregiver/support person, and GP to ensure on same page with any medication changes and follow up necessary.
consider med interactions carefully (especially warfarin etc), start low and go slow
being very cautious , and starting low and going slow while calculating creatinine clearance for all old patients.
imporatance of calculating the cr clearance, principles of elimination, severity of interactions
Reviewing medications with both the patient and the primary caregiver is important. Making sure if there are any medication changes to send copies to PCP and nursing home staff. Education patient regarding side effects related to medications causing dizzy, constipating to help prevent complications and a return visit to the ER>
Review of all patients present medication before starting them on anything else or stopping or changing a drug. Also communication with the patient making sure they understand clearly what youre asking of them, if not communicate with caregiver. Whatever drug you are precribing make sure the benefits outweigh the risks.
Ensure to be careful when prescribing meds, and effectively communicate with the patient and care giver about what each drug is for, and if there have been any changes
Review medication list before prescribing a new medication. Consider polypharmacy as a cause of symptoms.
Additional medications to avoid prescribing
will be more considerate when prescribing drugs to elderly
info on liver metabolism was great. Also stresses just how easy it is to tip the balance in vulnerable patients. I like the phrase “already functioning near threshold”
medications should be used cautiously in older adults. changes in medications should be done cautiously.
the red ball
Since we have a pharmacist available 24/7, I will likely consult with him/her regarding medication changes in the elderly, especially in our large nursing home population.
IT IS VERY COMPLICATED TO CHANGE OR PRESCRIBE MEDICATIONS IN THIS POPULARION. THEREIS A “DOMINO” EFFECT WITH MEDICATIONS THAT IS HARD TO PREDICT.
NSAIDs can be dangerous in the elderly.
Encouraged me to become more aware of the medications prescribed to the elderly, ensuring they’re properly informed of all the effects and also to keep their primary care givers informed. It’s so important that the different points of contact for health as it relates to the patient work together.
importance of communication with patient, care giver, family, and primary physician.Consider aging changes in body systems and how it affect the medications metabolism.
Be careful when using the high risk medications.
Take the entire patient into account when prescribing medications
be more careful prescribing to geri pts
important to actively review meds and indications with pt or primary caregiver especially when making med changes
Make sure a patient’s medication list is up to date. Get pharmacy involved if needed. Triple check for drug interactions if prescribing any new medications. Send a copy of my note to patient’s PCP if prescribing any new medications.
always review meds carefully
it is important to consider changes in the aging patient that will affect choice of drug, dosage and interactions. Also, risk vs benefits when making choices of meds
always review medications
Thorough medication review
As a nurse I will question more items that are prescribed and always compare to what medications the patient is already taking. I will also always keep in mind the patients age and health conditions.
ask about meds and determine how they may affect the patient
One take away will be to consider more carefully medication dosing as it relates to the aging body and desired effect of the medication.
PD/PK of pharmacology in the elderly and differences in the ageing population
NSAID caution, more frequent consults to pharmacy in high risk geri patients!
Awareness of polypharmacy issues to alert to my medical colleagues.
Review medications. Clear instructions.
discontinue meds, clear instructions
Importance of medication review
critical thinking about medication choices
Carefully review medications and add new medications carefully
will consider all interactions when prescribing new medications
thorough evaluation of medications
start low and go slow
Medication adjustment considerations.
review meds, drug/drug interactions, NSAID use/other high risk meds
lower doses, interactions, caution with NSAIDS, start low and slow, communication
Will definitely keep a closer eye on warfarin and interactions. As well as how other drugs interact. Our system flags interactions with certain medications but sometimes working in the ED we prescribed only a short course of the medications and always close the loop with the PCP for further mgt.
I learned more in depth “normal physiologic changes of aging” and how that affects the pharmokinetics/dynamics of medications we prescribe in the ER.
ask about meds and determine how they may affect the patient
medication selection is important
careful consideration with any new medications
More through review of medications in elderly, including home supplements, remedies, and recent changes in medication
I might consider adding yearly reviews of medications to my physical exam or chronic disease management visits so we are always reassessing the necessity of meds as pts age. I have a better understanding now of how fat vs water soluble med concentrations change in the aging population, and there were numerous drug-drug interactions mentioned in the module I was not previously aware of.
I learned a lot but specifically will attempt to avoid ranitidine for gastritis in those at risk for delirium.
Be very aware of drug drug interactions
Start low go slow will be n the back of my mind. Give clear instructions and directions
I will spend more time considering drug interactions.
to remember that normal CR does not mean no impairment in renal function… the little old lady consideration when giving meds. also the use of NSAIDs as alternative but not first choice. Be alert for Drug-drug interactions especially with coumadin
Review of potential drug interactions in elderly
Refresh of the Beers list and consideration of drug-drug interatctions
to me knowledge is power and this is the best website i have gone so far. It added my understanding of geriatric population and what to look and watch out for. I thank you so much for this website. My care and monitoring, assessment and evaluation, planning for this population changed my perspective totally for the best.
ranitidine antihistamine effect
I will be mindful that the “little old lady” with normal Cr or anyone over the age of 70 still likely has a significant reduction in renal function.
importance of drug interactions and monitoring for polypharmacy
drug interactions are critical to understand
You really need to look out for drug interactions with polypharmacy in the geriatric population
importance of differentiating between meds
I will add rantitidine and benadryl to my list of drug monitoring for the elderly.
I will consider the number of medications a patient is on when administering any new medication since the drugs will complete for liver enzymes. This can elevate serum concentrations of multiple medications.
more cautious with NSAIDs
Aprendí como tratar al paciente anciano , el uso de medicamentos de alto riesgo según los cambios fisiológicos ocurridos por la edad y las interacciones entre los medicamentos
learn about drugs that are inappropriate for older due to the physiological changes.
drugs that are high risks and low benefits and high risks and high benefits: the importance of communication with patients, and caregiver regarding medication changed especially polypharmacy and co-morbidity patients.
really liked the breakdown of thinking about it as body systems, then interactions
I learned about a lot of drugs I did not know about and some common interactions I was unaware of. when assessing patient’s medication lists I will be more attentive for these interactions now.
good refresher of many medications used for hypertension and pain management
Always try to minimized meds and doses when possible
Being mindful of starting any new medication. Completing a BPMH. Avoiding high risk drugs. Learning about various interactions.
Many new antihypertensive effects.
risk/benefit and interactions information was particularly helpful
assessing drug interactions, importance of knowing side effects of drugs, and what drugs to be cautious of
-Increased knowledge of the high risk medications and potential interactions of the elderly patient
-Increased knowledge of the beneficial medications for symptom mgmt in the elderly patient
-Increased awareness of the ways that physiological changes affect drug levels in the body
-Increased emphasis on medication review in the ED,involving pt and family
ALWAYS REVIEW ALL MEDS PATIENT ON.
Being mindful of high risk medications.
really take a look at their entire med list
High risk but high benefit med would watch for that
Always get the “updated” list from the patient’s pharmacy and check if the patient takes “over the counter” drugs before adding a new prescription
start low & slow w/ meds in the elderly
caution with polypharmacy
being aware of the interactions of medications and use the tools that are available to ensure not giving inappropriate medications
interactions with warfarin
Need to always consider drug-drug interaction when prescribing a new medication.
more careful medication review, caution in antibiotic prescribing and any new drug
careful review of medications and accurate coomunication to people involve in patient care
Increased care with medication list review in situations of polypharmacy.
Be more aware of the physiologic changes that impact pharmacology
PK and PD changes
It is important to get an accurate medication list before changing or adding another medication. Age, medical conditions and the drugs they are already on will influence drug choices and dosages. Find out what over the counter medications the patient takes as well, non prescription drugs such as gravol and benadryl can be missed when an action plan is put into place. Give written instructions and what important side effects to watch for. Relay information to a primary care giver and family doctor.
list of high risk medications helpful
interconnectedness between medications
Pay more attention with polypharmacy
how drugs affect the body and how the body responds to different drugs
follow up when prescribing a med that can interact with anticoagulant medication
Always check medication interactions when giving a new medication and prepare patient and family for the changes to come. Also, benzodiazepines, gravol, antihistamines, anticholingerics are no good for elders
Carefully go over any medications changes with patient and caregiver. Try to avoid the high risk- low benefit medications.
learnt the importance of polypharmacy
Review of high-risk medications
Avoid high risk low benefit drugs
always look at possible drug interactions before prescribing in ED. Always get best possible medication history
review meds, pay attention to what we prescribe.
review medication lists
review med lists
Have a closer look at the meds list and be more diligent in prescribing INR follow-ups when prescribing a med that can interact with anticoagulant medication
Will be thoughtful in medication reviews and engage in discussions about the utility of multiple medications.
I will be more aware of the fragilities of the elderly person. I will adjust my doses more, not only for opioids. I will also keep in mind the High Risk, Low Benefits versus the High Risk, High Benefits.
I will be more cognizant of drug interactions. Try to achieve treating the elderly with less meds or less potent meds.
Things I learned:
Understanding physiologic changes like decreased liver enzymatic activity affecting metabolism of drugs.
Increased fat content with elderly patients so water soluble drugs have an increased level in the serum
Cotrimoxazole, ciprofloxacin and nitrofurantoin being detrimental in uti patients on warfarin.
Increased permeability of the blood brain barrier in the elderly.
poly-pharmacy and drug interactions
high risk/low reward, high risk/high reward section was very informative!
Helpful review of pharmacokinetics and pharmacodynamic changes in the elderly. This was a good reminder to ask the question – could this symptom be caused by medication – for every patient (especially the elderly).
in elderly, effects:
Decreased organ function
Learned to be more careful in medication changes or adding
Really highlights the importance to think twice before prescribing medications to the elderly. Is the medication warranted? Is there a better option? How can I minimize risks ?
Didnt realize codeine was such a bad option in this population. Will reconsider Rx’ing this.
Much more aware of medication “chasing” and not treating the s/e of one drug with another drug. Plus Septra and warfarin interaction
medication and how it affects the aging population
Less use of codeine in elderly patients. Septra being hepatic metabolized. Always cautious of patients on warfarin.
Caution with new meds added to warfarin. Avoid the high risk drugs if possible.
I will be more careful with adding new medications to patients who are on Warfarin.
Will certainly be more attentive to possible interactions and how it might be playing in patient’s overall presentation
Concept of metabolism as well as volume of distribution
better appreciation of physiology of elderly
better appreciation of seemingly benign drugs such as nitrofurantoin, ranitidine.
helpful conceptual presentatation of physiology of aging and pharmacology
Drug Interactions and physiology of old people
Checking for interactions
communication to all parties is essential
warfarin interacts with almost all drugs
high risk low benefit drugs and high risk high benefit drugs
avoidance of over-taxing the live with new meds. Avoiding NSAID use.
be more aware of drug interactions
Which medication to avoid in elderly
To weigh Risk and Benefit ratio
Painrelief medication safe in CKD
To weigh Risk and Benefit
Painrelief medication safe in CKD
Medications to avoid in elderly
very informative to practice
normal physiology of aging and metabolism
renal impairment based on CRE clearance (even if normal creatinine)- old little lady
There is so much to know about medications and then about the patient think a team approach would work best. Family and pt often answer the same question different once it has been asked a few time. Also working closely with pharmacist would be helpful. Pt need to stick to one PCP and pharmacy to avoid issues.
Important to understand patient and drugs they are on and new ones added
Great overview of the physiologic effects of aging and what clinicians should be mindful of when prescribing, de-prescribing, and adjusting medications in the older adult.
always check for drug-interactions, think about de-prescribing, communicate effectively, and several clinical pearls to be reminded of
Comprehensive mode ranging from physiological changes of ageing to medication management of elderly. The pharmacokinetics and pharmacodynamics of drugs. Always review the medication management plan on every visit with drug interactions. always be vigilant in prescribing medication to elderly.
better understanding of hepatics issues with the elderly
Learned how changes in aging on the brain, cardiovascular, gi, renal, liver impact on different classes of drugs and trigger drug to drug interactions, particularly re: pharmacokinetic and pharmacodynamic implications in elderly and in some case gender
i learn alot with this module
Appreciation for the profound effects on elderly physiology even with minor adjustments of medication and importance of involving external persons regarding adjustments/ variations in prescribing rather than simply informing the patient only who may or may not comprehend the instructions
always stop and consider any medication changes especially in elderly. be clear with communication of these changes
Great review of pharmokinetics/ dynamics in geriatric population. Very applicable cases. I will be much more aware of use of benzo’s, codiene, and gravol/ H1’s/ benadryl in these patients. I will also be more aware of modified CrCl in elderly and using modified dosages.
This reinforces of my practice of having a very high threshold to start any new medications in elderly pts in the ED. There are conflicting information out there about the use of NSAIDs as a single low dose in the ED to avoid opioids in pts in which acetaminophen is not enough. I currently avoid all NSAIDs in elderly pts but I have had internists tell me to consider single doses for pain control.
i will be more careful with medication adjustments or prescribing in the elderly
I will exercise much more vigilance in the medication review of a geriatric patient presenting with altered mental status. I will also recognize the functional decline of body systems, i.e. renal, cardiac, etc. when deciding which medications to prescribe in a given setting.
how aging processes affect physiology and thus pharmokinetics and pharmodynamics are improtant to understand when prescribing.
Pay more attention to medication reconciliation sheets, collaborate more with pharmacists
1) Changes in body fat/protein/water composition affecting pharmacokinetics of drugs
2) Reduced hepatic & renal clearance of drugs
3) Zantac is an anticholinergic!
4) Better communication strategies for medication changes
Pay close attention to the use of anticholinergic mess in older population
Resources very helpful; will be careful with the usage of NSAIDS. Excellent module.
resources were helpful, need a good resource for drug/drug interaction
I will closely watch for warfarin on med lists and screen for D-D interactions more systematically.
I have learned that we lose aCH as we age, which explains why anti-cholinesterase increase risk of delirium
Being more careful about medication adjustments and additions. Especially with warfarin.
It is important to recognize polypharmacy and adverse effects of drugs. Communication of changes is paramount.
its important to recognize how much teaching is important in the ed
hydromorphone for IV analgesia better than morphine
I will remember the low water/high fat situation associated with aging and how it affects water soluble/ fat soluble drugs. I will pay particular attention to how the patient describes her medications- i.e blue pill/ round pill etc.
Carefully weigh the benefits/risks of adding vs discontinuing medications in the elderly.
To proceed carefully when prescribing medications for the elderly, use all resources at my disposal re:drug interaction checkers, the pharmacy etc to ensure safe medication use. To communicate clearly to my elderly patients potential side effects of medications and the possibility of drug interactions in relation to aging. I am really glad I came across this online as I have really learnt a lot of pearls that I can apply.
BAN use in the eldely – Benzos, Anti-cholinergics, and NSAIDs
I have learned about drug interactions and what drugs to stay away from in the elderly population
I will be more vigilant in review of patients’ medicaitons and especially try to advocate for alternative drug options when the high risk low benefit meds are being considered in ED or patient has been started on by the GP.
I will also be more on alert for the small older ladies, who may have normal Cre clearance yet whose elimination is likely not so great – thanks for that reminder!
The breakdown of high risk / low benefit and high risk / high benefit very helpful giving me a better understanding and will use it when reviewing Pt. meds.
consider drug interactions, consider pt’s response to meds given their age
be more aware of the affects that medications have on elderly patients more so than younger patients.
consider drug interactions, consider pt’s response to meds given their age
Need to consider drug interactions and dosages, follow more closely
start low, go slow
Cr clearance calculation is an invaluable tool
caution is the word of the day
A careful and thorough review of rx. hx.
A careful review of RX should be mandatory for elderly with polypharmacy.
I will be carefuller when prescribing drugs.
careful in what you prescribe
starting with and adjusting new or multiple pharmacy slowly, titrate accordingly
age drastically changes the effects drugs can have.
I’ve learned how much I don’t know about drug interactions! I’ve also learned that I cannot rely on my memory alone, so I will use internet resources, my pharmacy and other apps to check for drug-drug interactions when seeing older patients, particularly those with polypharmacy.
too be very cautious while prescribing medications in elderly and to inform caregiver, the patient and the family physician of the new prescription and give them a summary of all the medications.. obtain proper medication history
How to be vigilant when prescribing medications to elder people, with taking into account the good communication, multiple care giver , pharmacokinetics and pharmacodynamics.
Fantastic information on medication interactions
how important the assessment of patients medications can impact a diagnosis and proper treatment
The relearning of the effects on the elderly with the use of Gravol was like turning on a swith. I knew that but in reflection had observed this in practice.
Will take greater consideration on side effect profile when prescribing new medications, as well as drug to drug interactions especially patients on anticoagulant therapy such as warfarin who are at increased risk of bleeding.
careful when prescribing drugs and take a lot of care whit the older physiology changes
increased awareness of drug interactions and physiology of aging
Medical history has greater orientation to the problems of the elderly
Cool knowledge and awareness is the amount of medicamebtos consuming seniors
mejorar la historia clinica y estudiar las interacciones medicamentosas
A much more extensive evaluation of the different drug interactions.
Better understand the changes associated with aging and the effect these changes have on medication administration
no matter how small the med dose, one should always think about potential side effects when dealing with elderly,
All about melds and elderly people
Really think twice about prescribing any new drugs to an elderly patient. Even drugs I thought were benign like Keflex can have important implications.
opiods/NSaids put elderly at risk
be aware of narcotics for elderly
communicate needs for blister packs and thoroughly explain prescriptions to pts
didn’t know nitrofurantin is poorly tolerated by elderly; won’t prescribe T#3s anymore to elderly;I also thought ranitidine is pretty benign-thanks for reminding me that it’s an antihistamine,..can contribute to confusion in elderly
Looking at drug interactions more closely and renal function in the elderly.
Learned about the relationship between age related organ changes and pharmacology
I am motivated to get most older people on the least amount of meds as possible.
hope to see less use of coumadin in the future and more use of novel oral anticoagulants with fewer drug interactions
I will make a review and involve the pharmacist in multi medication patients.
it is important to review prescribed, OTC and any supplements the patient maybe on. Supplements can have a major effect as well.
take great care adding any meds to a patient already on warfarin
I will carefully review meds. for those patients taking Warfarin.
Watch for drug-drug interactions.
Like to know what to be more aware of/high risk!
More careful prescribing
will check thoroughly their drugs including OTC and their creat-clearance
Excellent module. Will always double check when perscribing med in ED and ensure to involve family and family doc
I won’t treat the elderly
Will increase education/monitoring regarding expected a/e with necessary drugs
Great summary of drugs to avoid because they aren’t that effective in the elderly and the one’s you can’t avoid; keeping in mind the pitfalls.
I’m going to watching more closely when meds changes are made- and the patient is on warfarin.
A good reminder to watch out for interactions and maintain good communication!
Excellent module. Very practical.
Better understanding of the physiology of aging and how it effects the metabolism and effects of common medications
Will be more careful for adding new drugs to the treatment in elderly.
Will be more cautious regarding use of NSAIDS!
I’d watch out for drugs like NSAIDs/T3s in the elderly.
Will reconsider prescribing medications like digoxin, opioids…