ITEMS IN FPM WITH MESH TERM:
ABSTRACT: Chronic kidney disease affects renal drug elimination and other pharmacokinetic processes involved in drug disposition (e.g., absorption, drug distribution, nonrenal clearance [metabolism]). Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes. Dosages of drugs cleared renally should be adjusted according to creatinine clearance or glomerular filtration rate and should be calculated using online or electronic calculators. Recommended methods for maintenance dosing adjustments are dose reductions, lengthening the dosing interval, or both. Physicians should be familiar with commonly used medications that require dosage adjustments. Resources are available to assist in dosing decisions for patients with chronic kidney disease.
ABSTRACT: Adverse drug events are common in older patients, particularly in those taking at least five medications, but such events are predictable and often preventable. A rational approach to prescribing in older adults integrates physiologic changes of aging with knowledge of pharmacology. Focusing on specific outcomes, such as the prompt recognition of adverse drug events, allows the family physician to approach prescribing cautiously and confidently. Physicians need to find ways to streamline the medical regimen, such as periodically reviewing all medications in relation to the Beers criteria and avoiding new prescriptions to counteract adverse drug reactions. The incorporation of computerized alerts and a multidisciplinary approach can reduce adverse drug events.
When Medical Errors Hit Home - Balancing Act
Maintaining a Medication List in the Chart - Improving Patient Care
ABSTRACT: A systematic approach advocated by the World Health Organization can help minimize poor-quality and erroneous prescribing. This six-step approach to prescribing suggests that the physician should (1) evaluate and dearly define the patient's problem; (2) specify the therapeutic objective; (3) select the appropriate drug therapy; (4) initiate therapy with appropriate details and consider nonpharmacologic therapies; (5) give information, instructions, and warnings; and (6) evaluate therapy regularly (e.g., monitor treatment results, consider discontinuation of the drug). The authors add two additional steps: (7) consider drug cost when prescribing; and (8) use computers and other tools to reduce prescribing errors. These eight steps, along with ongoing self-directed learning, compose a systematic approach to prescribing that is efficient and practical for the family physician. Using prescribing software and having access to electronic drug references on a desktop or handheld computer can also improve the legibility and accuracy of prescriptions and help physicians avoid errors.
ABSTRACT: Adverse drug events occur in 15 percent or more of older patients presenting to offices, hospitals, and extended care facilities. These events are potentially preventable up to 50 percent of the time. Common serious manifestations include falls, orthostatic hypotension, heart failure, and delirium. The most common causes of death are gastrointestinal or intracranial bleeding and renal failure. Antithrombotic and antidiabetic medications, diuretics, and nonsteroidal anti-inflammatory drugs cause most of the preventable hospital admissions due to adverse drug events. Strategies to reduce the risk of adverse drug events include discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications. The Beers, STOPP (screening tool of older persons’ potentially inappropriate prescriptions), and START (screening tool to alert doctors to right treatment) criteria can help identify medications causing adverse drug events. Not all potentially inappropriate medications can be avoided. Clinicians should involve patients in shared decision making and individualize prescribing decisions based on medical, functional, and social conditions; quality of life; and prognosis.