Prescription medications that can increase the risk of falls for patients 65 and older
Related to the sedative effects of opioids is the risk of falls in the elderly. Sedative effects may also be related to postural hypotension.
The reason why people fall is multifactorial and includes sensory decline, reduced lower limb strength and the use of medications, such as opioids that can cause sedation or hypotension.
However pain itself such as pain associated with lower limb arthritis can also be a contributing factor of increased risk of falls in the elderly.
A Canadian study assessed the risk of fall‐related injuries in the general elderly population (aged ≥ 65 years old). It confirmed that opioids increase the risk of fall‐related injuries and the highest risk was associated with the use of codeine‐combination analgesics.
The higher risk associated with codeine‐based analgesics was possibly due to the high daily doses prescribed relative to other opioids evaluated.
Low‐potency opioids were also frequently prescribed in conjunction with other drugs with sedating side effects. It should be noted in this study the majority of fall‐related injuries were fractures at 55%.
For older people there is a risk with taking pain medications, but if they are in pain then that needs to be addressed. Risk of falls, constipation, nausea, vomiting and sedation, should not stop the appropriate use of opioids in the elderly. It is important that the people involved in the care of the elderly continuously monitor for development of side effects.
https://hellocaremail.com.au/side-effects-pain-medications-know-manage/
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Generic Name (Brand Name)
Alprazolam (Xanax)
Amitriptyline (Elavil)
Amobarbital (Amytal)
Amoxapine (Asendin)
Aripiprazole (Abilify)
Baclofen (Lioresal)
Bupropion (Wellbutrin, Wellbutrin SR)
Buspirone (Buspar)
Butabarbital
Carbamazepine (Tegretol, Tegretol XR, Carbatrol)
Chloral hydrate
Chlorazepate (Tranxene)
Chlordiazepoxide (Librium, Limbitrol, Librax)
Chlorpromazine (Thorazine)
Citalopram (Celexa)
Clidinium-chlordiazepoxide (Librax)
Clomipramine (Anafranil)
Clonazepam (Klonopin)
Clozapine (Clozaril)
Codeine (Tylenol with Codeine)
Desipramine (Norpramin)
Diazepam (Valium)
Digoxin (Lanoxin)
Disopyramide (Norpace)
Divalproex sodium (Depakote, Depakote ER)
Doxepin (Sinequan, Zonalon, Prudoxin)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Estazolam (Prosom)
Olanzapine (Zyprexa, Zyprexa Zydis)
Oxazepam (Serax)
Oxcarbazepine (Trileptal)
Oxycodone (Percocet)
Oxymorphone (Numorphan)
Paraldehyde (Paral)
Paroxetine (Paxil)
Pentobarbital (Nembutal)
Perphenazine (Trilafon)
Phenelzine (Nardil)
Phenobarbital
Phenytoin (Dilantin)
Pimozide (Orap)
Pregabalin (Lyrica)
Primidone (Mysoline)
Propoxyphene (Darvon, Darvocet)
Protriptyline (Vivactil)
Quazepam (Doral)
Ethosuximide (Zarontin)
Felbamate (Felbatol)
Fentanyl (Duragesic)
Fluoxetine (Prozac)
Fluphenazine (Permitil, Prolixin)
Flurazepam (Dalmane)
Fluvoxamine (Luvox)
Gabapentin (Neurontin)
Halazepam (Paxipam)
Haloperidol (Haldol)
Hydrocodone (Vicodin)
Hydromorphone (Dilaudid)
Imipramine (Tofranil)
Isocarboxazid (Marplan)
Levetiracetam (Keppra)
Levorphanol (Levo-Dromoran)
Lorazepam (Ativan)
Loxapine (Loxitane, Loxitane C)
Maprotiline (Ludiomil)
Mephobarbital
Meprobamate (Miltown, Equanil)
Mesoridazine (Serentil)
Methadone (Dolophine)
Methsuximide (Celontin)
Mirtazapine (Remeron)
Molindone (Moban)
Morphine (MS Contin)
Nefazodone (Serzone)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Secobarbital (Seconal)
Sertraline (Zoloft)
Temazepam (Restoril)
Thioridazine (Mellaril)
Thiothixene (Navane)
Tiagabine (Gabatril)
Topiramate (Topamax)
Tranylcypromine (Parnate)
Trazodone (Desyrel)
Triazolam (Halcion)
Trifluoroperazine (Stelazine)
Trimipramine (Surmontil)
Venlafaxine (Effexor, Effexor XR)
Ziprasidone (Geodon)
Zolpidem (Ambien)
Zonisamide (Zonegran)
A Pharmacist for regular Home Medicines Review
If you are using multiple medications, have difficulty managing your medication, or have been recently discharged from hospital or other care facility, or are having an adverse reaction to a medication. This involves your medical practitioner and pharmacist working together to review all the medicines you are taking, including prescription medicine, over-the-counter and complementary medicines.
People taking nine or more medications have an 89 per cent higher risk of hospitalisation than those who take less than nine, the authors of a new study have said. Conducted by Monash University researchers and staff from Resthaven, the study set out to investigate whether there was an association between taking nine or more regular medications and admission to hospital.
The research team looked at residents’ time to first hospitalisation, the number of hospitalisations, and the number of days spent in hospital over a 12-month period. Tina Cooper (née Emery), executive manager of residential services at Resthaven, said the study has important implications for aged care and hospitals alike. She said: “The research adds to the increasing body of evidence that suggests reducing the number of unnecessary or low-benefit medications, referred to as deprescribing, may be a valuable way to reduce unwanted, expensive hospital stays.”
Prescription Drug Abuse Prevention
Prescription drug abuse prevention starts with you.
In pictures -
https://www.medicinenet.com/prescription_drug_abuse_pictures_slideshow/article.htm
Search your medications by brand name or active ingredient – A-Z
https://www.healthdirect.gov.au/medicines
A CMI leaflet gives you information on how to use your medicine safely and properly. For example, it tells you:
CMIs are available for:
NATIONAL HEALTH SERVICES DIRECTORY
The National Health Services Directory (NHSD) is the leading source of information about Australian health and related services. It is a joint initiative of all Australian governments, developed and delivered by Healthdirect Australia.
Pharmacist review, home checks part of medication strategy for people with dementia
By: Dallas Bastian in News, Top Stories August 4, 2017
Australian researchers are hoping to improve outcomes for people with dementia after they are discharged from hospital through a medication strategy that starts in the lead-up to discharge and continues into the home.
Associate professor Ashley Kable, from the University of Newcastle, said medication generally changes for people once they’ve been treated in hospital, which makes self-administration even harder for people with dementia, and added the responsibility often falls back on carers.
Kable said currently, home medication reviews can be requested by a general practitioner following a patient’s discharge from hospital, but are not always done. She said the safe medication strategy will include clinical pharmacist review of medications and communication with the carer, training in hospital to use medication dose administration aids and provision of a discharge medication plan and explanation.
The discharge summary will include a note for general practitioners to request a home medicines review. These will be conducted by community pharmacists who will aim to identify any prescribed medications that may be a risk for people with dementia, such as those that may cause confusion or result in falls, any potential drug interactions or contraindicated medications, any adjuvant medications being used in addition to prescribed medications that may be a risk, and any modifications to medications that may be required for a person with dementia.
SO, when your loved one is discharged from hospital, do make sure to go to your usual Pharmacist and ask for a Home Medicines Review. Many of the usual medications may have been changed, upped in dosage, or Brand altered in the hospital. YOU, need to know as the result can be most serious for your loved one. YOU, as a Carer, can do this. Alternatively, have a chat with your loved one's GP and have him write a note to your Pharmacist to do this.
How the pharmacist can simplify a dosing schedule during an Home Medicines Review:
• Reduce dosing frequency and recommend long-acting dosage forms where possible
• Recommend a higher strength to reduce the number of dosage units for a specific medicine where two tablets of the same medicine are taken at different times in a day
• Recommend a lower strength product where the person is cutting tablets in half or into quarters
• Consolidate dosing times to fit in with the patient’s lifestyle
• Recommend a combination product if suitable to reduce the number of medicines being used
• Recommend a suitable adherence aid for the patient with cognitive or dexterity issues
for a closer look:
https://www.veteransmates.net.au/documents/10184/38810/Nov_2016_GP_Insert.pdf/e9b3126e-bf0e-4238-bd74-8cdd617458d0
"With the focus on medicines and older Australians in these lists, we urge people to consider if they are on the right medicine, or whether they could be taking too many medicines and if you are due for a review. It’s always timely to check with your doctor or pharmacist to see if any medicines are unnecessary and if they could cause harm if taken together."
03 October 2017
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
The care of older people, whether living in the community or residential aged care facilities (RACFs), is often complex. The challenge is to provide appropriate care of the highest quality to these patients regardless of where they live. GPs are often required to collaborate with the patient’s broader multidisciplinary healthcare team, including RACF staff, carers, nurses, other specialist medical practitioners, and allied health professionals, in a way that focuses on the patient’s individual needs.
Medical care of older persons in residential aged care facilities, a Royal Australian College of General Practitioners (RACGP) publication commonly known as the Silver Book, is one of the RACGP’s flagship clinical resources. First developed more than 20 years ago as a brief manual of 17 pages, there have been four editions to date. While the resource doubled in size from the third to fourth editions, much of the content is now out of date or obsolete.
This fifth edition builds on the remarkable foundation set by the previous four editions, and is retitled the RACGP aged care clinical guide (Silver Book) to reflect the increasing prevalence of older people choosing to live their old age in the community, or remaining in the community for longer.
The fifth edition of the Silver Book will be significantly expanded from previous editions, both in scope and content, and will be released online in three interweaving parts:
Part A: Common clinical conditions in aged care (October 2019)
Part B: General approaches to aged care (early-to-mid 2020)
Part C: Organisational approaches to aged care (mid-to-late 2020)
The guide will be released online only to ensure regular updates can be undertaken and the information can remain up to date and relevant for GPs.
Related to the sedative effects of opioids is the risk of falls in the elderly. Sedative effects may also be related to postural hypotension.
The reason why people fall is multifactorial and includes sensory decline, reduced lower limb strength and the use of medications, such as opioids that can cause sedation or hypotension.
However pain itself such as pain associated with lower limb arthritis can also be a contributing factor of increased risk of falls in the elderly.
A Canadian study assessed the risk of fall‐related injuries in the general elderly population (aged ≥ 65 years old). It confirmed that opioids increase the risk of fall‐related injuries and the highest risk was associated with the use of codeine‐combination analgesics.
The higher risk associated with codeine‐based analgesics was possibly due to the high daily doses prescribed relative to other opioids evaluated.
Low‐potency opioids were also frequently prescribed in conjunction with other drugs with sedating side effects. It should be noted in this study the majority of fall‐related injuries were fractures at 55%.
For older people there is a risk with taking pain medications, but if they are in pain then that needs to be addressed. Risk of falls, constipation, nausea, vomiting and sedation, should not stop the appropriate use of opioids in the elderly. It is important that the people involved in the care of the elderly continuously monitor for development of side effects.
https://hellocaremail.com.au/side-effects-pain-medications-know-manage/
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Generic Name (Brand Name)
Alprazolam (Xanax)
Amitriptyline (Elavil)
Amobarbital (Amytal)
Amoxapine (Asendin)
Aripiprazole (Abilify)
Baclofen (Lioresal)
Bupropion (Wellbutrin, Wellbutrin SR)
Buspirone (Buspar)
Butabarbital
Carbamazepine (Tegretol, Tegretol XR, Carbatrol)
Chloral hydrate
Chlorazepate (Tranxene)
Chlordiazepoxide (Librium, Limbitrol, Librax)
Chlorpromazine (Thorazine)
Citalopram (Celexa)
Clidinium-chlordiazepoxide (Librax)
Clomipramine (Anafranil)
Clonazepam (Klonopin)
Clozapine (Clozaril)
Codeine (Tylenol with Codeine)
Desipramine (Norpramin)
Diazepam (Valium)
Digoxin (Lanoxin)
Disopyramide (Norpace)
Divalproex sodium (Depakote, Depakote ER)
Doxepin (Sinequan, Zonalon, Prudoxin)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Estazolam (Prosom)
Olanzapine (Zyprexa, Zyprexa Zydis)
Oxazepam (Serax)
Oxcarbazepine (Trileptal)
Oxycodone (Percocet)
Oxymorphone (Numorphan)
Paraldehyde (Paral)
Paroxetine (Paxil)
Pentobarbital (Nembutal)
Perphenazine (Trilafon)
Phenelzine (Nardil)
Phenobarbital
Phenytoin (Dilantin)
Pimozide (Orap)
Pregabalin (Lyrica)
Primidone (Mysoline)
Propoxyphene (Darvon, Darvocet)
Protriptyline (Vivactil)
Quazepam (Doral)
Ethosuximide (Zarontin)
Felbamate (Felbatol)
Fentanyl (Duragesic)
Fluoxetine (Prozac)
Fluphenazine (Permitil, Prolixin)
Flurazepam (Dalmane)
Fluvoxamine (Luvox)
Gabapentin (Neurontin)
Halazepam (Paxipam)
Haloperidol (Haldol)
Hydrocodone (Vicodin)
Hydromorphone (Dilaudid)
Imipramine (Tofranil)
Isocarboxazid (Marplan)
Levetiracetam (Keppra)
Levorphanol (Levo-Dromoran)
Lorazepam (Ativan)
Loxapine (Loxitane, Loxitane C)
Maprotiline (Ludiomil)
Mephobarbital
Meprobamate (Miltown, Equanil)
Mesoridazine (Serentil)
Methadone (Dolophine)
Methsuximide (Celontin)
Mirtazapine (Remeron)
Molindone (Moban)
Morphine (MS Contin)
Nefazodone (Serzone)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Secobarbital (Seconal)
Sertraline (Zoloft)
Temazepam (Restoril)
Thioridazine (Mellaril)
Thiothixene (Navane)
Tiagabine (Gabatril)
Topiramate (Topamax)
Tranylcypromine (Parnate)
Trazodone (Desyrel)
Triazolam (Halcion)
Trifluoroperazine (Stelazine)
Trimipramine (Surmontil)
Venlafaxine (Effexor, Effexor XR)
Ziprasidone (Geodon)
Zolpidem (Ambien)
Zonisamide (Zonegran)
A Pharmacist for regular Home Medicines Review
If you are using multiple medications, have difficulty managing your medication, or have been recently discharged from hospital or other care facility, or are having an adverse reaction to a medication. This involves your medical practitioner and pharmacist working together to review all the medicines you are taking, including prescription medicine, over-the-counter and complementary medicines.
People taking nine or more medications have an 89 per cent higher risk of hospitalisation than those who take less than nine, the authors of a new study have said. Conducted by Monash University researchers and staff from Resthaven, the study set out to investigate whether there was an association between taking nine or more regular medications and admission to hospital.
The research team looked at residents’ time to first hospitalisation, the number of hospitalisations, and the number of days spent in hospital over a 12-month period. Tina Cooper (née Emery), executive manager of residential services at Resthaven, said the study has important implications for aged care and hospitals alike. She said: “The research adds to the increasing body of evidence that suggests reducing the number of unnecessary or low-benefit medications, referred to as deprescribing, may be a valuable way to reduce unwanted, expensive hospital stays.”
Prescription Drug Abuse Prevention
Prescription drug abuse prevention starts with you.
- Only take prescriptions medications as directed by your doctor.
- Never give your prescription medications to anyone else.
- Never take a medication that has been prescribed for someone else.
- Talk to children and teens about the dangers of abusing prescription drugs and safeguard medications in your home.
- Ask your pharmacy if they participate in take-back programs to safely dispose of unwanted and expired medications.
- Be aware too of the impact of those 'normal' medications.
In pictures -
https://www.medicinenet.com/prescription_drug_abuse_pictures_slideshow/article.htm
Search your medications by brand name or active ingredient – A-Z
https://www.healthdirect.gov.au/medicines
A CMI leaflet gives you information on how to use your medicine safely and properly. For example, it tells you:
- how to take the medicine
- why it may have been prescribed for you
- potential side effects
- other medicines it may interact with.
CMIs are available for:
- all prescription medicines
- all pharmacist-only medicines
- some non-prescription medicines.
NATIONAL HEALTH SERVICES DIRECTORY
The National Health Services Directory (NHSD) is the leading source of information about Australian health and related services. It is a joint initiative of all Australian governments, developed and delivered by Healthdirect Australia.
Pharmacist review, home checks part of medication strategy for people with dementia
By: Dallas Bastian in News, Top Stories August 4, 2017
Australian researchers are hoping to improve outcomes for people with dementia after they are discharged from hospital through a medication strategy that starts in the lead-up to discharge and continues into the home.
Associate professor Ashley Kable, from the University of Newcastle, said medication generally changes for people once they’ve been treated in hospital, which makes self-administration even harder for people with dementia, and added the responsibility often falls back on carers.
Kable said currently, home medication reviews can be requested by a general practitioner following a patient’s discharge from hospital, but are not always done. She said the safe medication strategy will include clinical pharmacist review of medications and communication with the carer, training in hospital to use medication dose administration aids and provision of a discharge medication plan and explanation.
The discharge summary will include a note for general practitioners to request a home medicines review. These will be conducted by community pharmacists who will aim to identify any prescribed medications that may be a risk for people with dementia, such as those that may cause confusion or result in falls, any potential drug interactions or contraindicated medications, any adjuvant medications being used in addition to prescribed medications that may be a risk, and any modifications to medications that may be required for a person with dementia.
SO, when your loved one is discharged from hospital, do make sure to go to your usual Pharmacist and ask for a Home Medicines Review. Many of the usual medications may have been changed, upped in dosage, or Brand altered in the hospital. YOU, need to know as the result can be most serious for your loved one. YOU, as a Carer, can do this. Alternatively, have a chat with your loved one's GP and have him write a note to your Pharmacist to do this.
How the pharmacist can simplify a dosing schedule during an Home Medicines Review:
• Reduce dosing frequency and recommend long-acting dosage forms where possible
• Recommend a higher strength to reduce the number of dosage units for a specific medicine where two tablets of the same medicine are taken at different times in a day
• Recommend a lower strength product where the person is cutting tablets in half or into quarters
• Consolidate dosing times to fit in with the patient’s lifestyle
• Recommend a combination product if suitable to reduce the number of medicines being used
• Recommend a suitable adherence aid for the patient with cognitive or dexterity issues
for a closer look:
https://www.veteransmates.net.au/documents/10184/38810/Nov_2016_GP_Insert.pdf/e9b3126e-bf0e-4238-bd74-8cdd617458d0
"With the focus on medicines and older Australians in these lists, we urge people to consider if they are on the right medicine, or whether they could be taking too many medicines and if you are due for a review. It’s always timely to check with your doctor or pharmacist to see if any medicines are unnecessary and if they could cause harm if taken together."
03 October 2017
- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
The care of older people, whether living in the community or residential aged care facilities (RACFs), is often complex. The challenge is to provide appropriate care of the highest quality to these patients regardless of where they live. GPs are often required to collaborate with the patient’s broader multidisciplinary healthcare team, including RACF staff, carers, nurses, other specialist medical practitioners, and allied health professionals, in a way that focuses on the patient’s individual needs.
Medical care of older persons in residential aged care facilities, a Royal Australian College of General Practitioners (RACGP) publication commonly known as the Silver Book, is one of the RACGP’s flagship clinical resources. First developed more than 20 years ago as a brief manual of 17 pages, there have been four editions to date. While the resource doubled in size from the third to fourth editions, much of the content is now out of date or obsolete.
This fifth edition builds on the remarkable foundation set by the previous four editions, and is retitled the RACGP aged care clinical guide (Silver Book) to reflect the increasing prevalence of older people choosing to live their old age in the community, or remaining in the community for longer.
The fifth edition of the Silver Book will be significantly expanded from previous editions, both in scope and content, and will be released online in three interweaving parts:
Part A: Common clinical conditions in aged care (October 2019)
Part B: General approaches to aged care (early-to-mid 2020)
Part C: Organisational approaches to aged care (mid-to-late 2020)
The guide will be released online only to ensure regular updates can be undertaken and the information can remain up to date and relevant for GPs.