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Medication Management

Thomas Horton

  • Medication Reconciliation Upon Admission
  • Evaluating for Polypharmacy – Beer’s Criteria
  • Pharmacologic changes in the elderly
    • Pharmacokinetic (PK): Decreased hepatic and renal clearance. Reduction in first pass metabolism. Drug distribution changes due to decreased TBW and lean body mass resulting in relative increase in fat.
    • Pharmacodynamic (PD): Exaggerated responses to pharmacologic therapy (therapeutic and adverse effects).
  • Avoid Prescribing Defaults:
    • NSAIDs can lead to gastritis, which can lead to prescription of PPI
    • Diuretics can lead to urinary incontinence, which can lead to prescription of oxybutynin
    • HCTZ can lead to hyperuricemia which can lead to prescription of allopurinol
  • Discharge Tips for med adherence: provide pillboxes & arrange blister packs for meds
  • Recommended Tools: deprescribing.org (App available); medstopper.com