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Polypharmacother­apy in older age – drug interactions of the most frequently prescribed drugs in cardiology


Authors: H. Matějovská Kubešová;  K. Bielaková;  O. Výška;  S. Surková;  D. Prudius;  K. Greplová
Authors‘ workplace: Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno
Published in: Kardiol Rev Int Med 2018, 20(1): 22-28

Overview

The authors stress the specific characteristics of the older population –  increasing number of dis­eases and increasing number of medications used, higher risk of unwanted side effects and drug interactions. Higher number of medicaments usually means lower adherence by patients. This situation needs a simple and safe final medication scheme. If the ability of older patients to take the medications correctly decreases, it is necessary to provide them with assistance. The development of safety criteria is mentioned – starting with Beers criteria up to the currently-used STOPP-START criteria. The most frequently used medicaments are discussed –  angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, diuretics and statins. The final part of the article deals with the relationship between the loss of self-sufficiency and the resulting risks for the safety of pharmacother­apy. The article is completed with a table containing basic principles of drug prescription for elderly patients.

Key words:
polymorbidity –  polypharmacotherapy –  drug interactions –  undesired side effects –  adherence –  self-sufficiency –  cognitive decline


Sources

1. Wenger NK, Doherty CL, Gurwitz JH et al. Optimization of drug prescription and medication management in older adults with cardiovascular dis­ease. Drugs Ag­­ing 2017; 34(11): 803– 810. doi: 10.1007/ s40266-017-0494-2.

2. Vepřeková B. Respekt k autonomii geriatrického pa­cienta: kognitivní a mnestická kapacita. Dizertační práce. Brno: LF MU 2012.

3. Lozano I, Sanchez-Insa E, de Leiras SR. Acute coronary syndromes, gastrointestinal protection, and recom­mendations regard­­ing concomitant administration of proton-pump inhibitors (omeprazol/ esomeprazole) and clopidogrel. Am J Cardiol 2016; 117(3): 366– 368. doi: 10.1016/ j.amjcard.2015.11.007.

4. Rappaport R, Arinzon Z, Feldman J et al. The need for medication reconciliation increases with age. Isr Med As­soc J 2017; 19(10): 625– 630.

5. Bailey DG, Spence JD, Edgar B et al. Ethanol enhances the hemodynamic ef­fects of felodipine. Clin Invest Med 1989; 12(6): 357– 362.

6. Sica DA. Interaction of grapefruit juice and calcium chan­nel blockers. Am J Hypertens 2006; 19(7): 768– 773.

7. Beers MH, Ouslander JG, Rol­lingher I et al. Explicit criteria for determin­­ing inappropriate medication use in nurs­­ing home residents. Arch Intern Med 1991; 151(9): 1825– 1832.

8. Beers MH. Explicit criteria for determin­­ing potential­ly inappropriate medication use by the elderly: an update. Arch Intern Med 1997; 157(14): 1531– 1536.

9. Fick DM, Cooper JW, Wade WE et al. Updat­­ing the beers criteria for potential­ly inappropriate medication use in older adults. Arch Intern Med 2003; 163(22): 2716– 2724.

10. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potential­ly inap­propriate medication use in older adults. J Am Geriatr Soc 2012; 60(4): 616– 631. doi: 10.1111/ j.1532-5415.2012.03923.x

11. McLeod PJ, Huang AR, Tamblyn RM et al. Defin­­ing inappropriate practices in prescrib­­ing for elderly people: a national consensus panel. CMAJ 1997; 156(3): 385– 391.

12. Gal­lagher P, Ryan C, Byrne S et al. STOPP (Screeen­­ing Tool of Older Person’s Prescriptions) and START (Screen­­ing Tool to Alert doctors to Right Treatment). Int J Clin Pharmacol Ther 2008; 46(2): 72– 83.

13. Topinková E, Mádlová P, Fialová D et al. Nová evidence-based kritéria pro posouzení vhodnosti lékového režimu u seniorů. Kritéria STOPP (Screen­­ing Tool of Older Person’s Prescriptions) a START (Screen­­ing To ol to Alert doctors to Right Tre atment). Vnitř Lék 2008; 54(12): 1161– 1169.

14. Fialová D, Topinková E, Matějovská Kubešová H et al. Racionální farmakoterapie ve stáří: Expertní konsensus ČR 2012 v oblasti léčiv a lékových postupů potenciálně nevhodných u seniorů. Geriatrie a gerontologie 2013; 2(1): 5– 15.

15. O’Mahony D, O’Sul­livan D, Byrne et al. STOPP/ START criteria for potential­ly inappropriate prescrib­­ing in older people: version 2. Age Age­­ing 2015; 44(2): 213– 218. doi: 10.1093/ ageing/ afu145.

16. Foppiani L, Cascio C, Lo Pinto G. Iodine-induced hyperthyroidism as combination of dif­ferent etiologies: an overlooked entity in the elderly. Ag­­ing Clin Exp Res 2016; 28(5): 1023– 1027. doi: 10.1007/ s40520-015-0483-4.

17. Taylor BA, Lorson L, White CM et al. A random­ized trial of coenzyme Q10 in patients with confirmed statin myopathy. Atherosclerosis 2015; 238(2): 329– 335. doi: 10.1016/ j.atherosclerosis.2014.12.016.

18. Konopa J, Bul­lo B, Rutkowski B. Life threaten­­ing drug-induced hyperkaliemia –  case report. Pol Arch Med Wewm 2006; 115(3): 238– 242.

19. Woolcott JC, Richardson KJ, Wiens MO. Meta-analy­sis of the impact of 9 medication clas­ses on fal­ls in elderly persons. Arch Intern Med 2009; 169(21): 1952– 1960. doi: 10.1001/ archinternmed.2009.357.

20. Galinier M, Emeriau JP. Prescrib­­ing beta block­ers in elderly patients with heart failure. Pres­se Med 2008; 37 (6 Pt 2): 1047– 1054. doi: 10.1016/ j.lpm.2008.02.011.

21. Cleland JG, Coletta AP, Torabi A et al. Clinical trials update from the European Society of Cardiology Heart Failure meet­­ing 2009: CHANCE, B-Convinced, CHAT, CIBIS-ELD, and Signal-HF. Eur J Heart Fail 2009; 11(8): 802– 805. doi: 10.1093/ eurjhf/ hfp102.

22. Wikstrand J, Wedel H, Castagno D et al. The large-scale placebo-control­led beta-blocker studies in systolic heart failure revisited: results from CIBIS-II, COPERNICUS and SENIORS-SHF compared with stratified subsets from MERIT-HF. J Intern Med 2014; 275(2): 134– 143. doi: 10.1111/ joim.12141.

23. Edelmann F, Musial-Bright L, Gelbrich G et al. Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD Trial. JACC Heart Fail 2016; 4(2): 140– 149. doi: 10.1016/ j.jchf.2015.10.008.

24. Axmon A, Ahlström G, Höglund P. Prevalence and treatment of diabetes mel­litus and hypertension among older adults with intel­lectual disability in comparison with the general population. BMC Geriatr 2017; 17(1): 272. doi: 10.1186/ s12877-017-0658-2.

25. van Middelaar T, van Vught LA, van Charante EP et al. Lower dementia risk with dif­ferent clas­ses of antihypertensive medication in older patients. J Hypertens 2017; 35(10): 2095– 2101. doi: 10.1097/ HJH.0000000000001411.

26. Rouch L, Cestac P, Hanon O el al. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized control­led trials and meta-analyses, with discus­sion of potential mechanisms. CNS Drugs 2015; 29(2): 113– 130. doi: 10.1007/ s40263-015-0230-6.

27. Kalvach Z, Zadák Z, Jirák R et al. Geriatrie a gerontologie. Praha: Grada Publish­­ing 2004.

28. Woodward M, Gonski P, Gros­smann M et al. Dia­g­­-nosis and management of hyponatraemia in the older patient. Intern Med J 2018; 48 (Suppl 1): 5– 12. doi: 10.1111/ imj.13682.

29. Spinar J, Parenica J, Vitovec J et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry. Crit Care 2011; 15(6): R291. doi: 10.1186/ cc10584.

30. Llobet Vila L, Manresa Domínguez JM, Carmona Segado JM. Fac­­ing a dilem­ma in elderly complex and vulnerable patients: to stop or not to stop prevention? Aten Primaria 2017; pii: S0212-6567(17)30174-9. doi: 10.1016/ j.aprim.2017.05.016.

31. Kriegbaum M, Lau SR. Medication non-adherence and uncertainty: Information-seek­­ing and proces­s­­ing in the Danish LIFESTAT survey. Res Social Adm Pharm 2017; pii: S1551-7411(17)30571-5. doi: 10.1016/ j.sapharm.2017.09.002.

32. Riaz H, Krasuski RA. Should physicians be encouraged to use generic names and to prescribe generic drugs? Am J Cardiol 2016; 117(11): 1851– 1852. doi: 10.1016/ j.amjcard.2016.03.023.

33. Hen­nein R, Hwang SJ, Au R et al. Bar­riers to medication adherence and links to cardiovascular dis­ease risk factor control: the Framingham Heart Study. Intern Med J 2017. doi: 10.1111/ imj.13687.

34. Stacey E. Hot topics in General Practice. Oxford: BIOS Scientific Publishers 1996.

Labels
Angiology Paediatric cardiology Vascular surgery Internal medicine Cardiac surgery Cardiology

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