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Geriatric Medication-Related Problems Cheat Sheet (DRAFT) by [deleted]

This is a draft cheat sheet. It is a work in progress and is not finished yet.


An MRP, as defined by Hepler and Strand, is “an event or situation involving drug therapy that actually and potent­ially interferes with optimum outcome for a specific patient.” MRPs can be broken down into the following eight catego­ries:
Aging Well; Medica­tio­n-R­elated Problems in Geriatric Pharma­cology
By Brian Wolste­nholme, PharmD, CGP, FASCP

MRP Categories

1. Untreated condit­ions: The patient has a medical condition that requires drug therapy but is not receiving a drug for that condition.
2. Drug use without indica­tion: The patient is taking a medication for no medically valid condition or reason.
3. Improper drug select­ion: The patient’s medical condition is being treated with the wrong drug or a drug that is not the most approp­riate for the patient’s special needs.
4. Subthe­rap­eutic dosage: The patient has a medical problem that is being treated with too little of the correct medica­tion.
5. Overdo­sage: The patient has a medical problem that is being treated with too much of the correct medica­tion.
6. Adverse drug reacti­ons: The patient has a medical condition that is the result of an adverse drug reaction or adverse effect. In the case of older adults, adverse drug reactions contribute to already existing geriatric problems such as falls, urinary incont­inence, consti­pation, and weight loss.
7. Drug intera­cti­ons: The patient has a medical condition that is the result of a drug intera­cting negatively with another drug, food, or laboratory test.
8. Failure to receive medica­tion: The patient has a medical condition that is the result of not receiving a medication due to economic, psycho­log­ical, sociol­ogical, or pharma­ceu­tical reasons.

Questions to Consider Before Medication Order

When consid­ering a medication for a geriatric patient, consider the following questions,

1. Is there an indication for the drug?
2. Is the medication effective for the condition?
3. Is the dose correct?
4. Are the directions correct?
5. Are the directions practical?
6. Are there clinically signif­icant drug-drug intera­ctions?
7. Are there clinically signif­icant drug-d­isease intera­ctions?
8. Is there unnece­ssary duplic­ation with other drug(s)?
9. Is the duration of therapy accept­able?
10. Is the drug the least expensive altern­ative compared with others of equal utility?
Additional question:
11. Are the medica­tion, dose, frequency, and duration approp­riate for a geriatric patient?
Taken from the Medication Approp­riate Index

Special Consid­era­tions

Pharma­cok­inetic and pharma­cod­ynamic changes in an older patient necess­itate dosing consid­era­tions in this popula­tion. As renal function declines with age, creatinine clearance (CrCl) should be calculated for evaluating kidney function to adjust both dosing and frequency of medica­tions that are eliminated renally. Evaluation using serum creatinine alone without calcul­ating creatinine clearance is not suffic­ient.

The comple­xities of the medication regimen may also have an effect on the ability to achieve therap­eutic outcomes. Every medication added to the regimen not only increases the odds of drug intera­ctions and adverse events but also makes the regimen more difficult to follow.

Medication nonadh­erence rates range from 40% to 80% and account for up to 25% of all nursing home admissions and 11% of geriatric hospital admiss­ions. An estimated 125,000 older adults’ deaths can be attributed to medication noncom­pliance at a cost of $100 billion in the United States alone.1

Many medica­tions now have recomm­ended geriatric maximum doses, frequency, and duration of use while others are not recomm­ended for use in the elderly at all. The work of Mark Beers, MD, revolu­tio­nized geriatric medication use. Known as the Beers Criteria or Beers List, it names medica­tions that should potent­ially be avoided in elders or avoided in the presence of certain comorb­idi­ties. Medica­tions include some older antide­pre­ssants, such as amitri­pty­line; the allergy and sleep aid diphen­hyd­ramine; and long-a­cting benzod­iaz­epines, such as diazepam. Condit­ion­-sp­ecific consid­era­tions include benign prostatic hyperp­lasia and cognitive impair­ment.