What beers are left out of commercials?
We’ve all seen countless commercials for beers. It seems as if every brand has them, right? Wrong!
Ok, we admit that we’re mixing “beers” (as in “brewskis”) with the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults to make a point. The American Geriatrics Society’s (AGS) Beers Criteria is one of the most frequently cited reference tools to help healthcare providers improve medication safety for older adults. The guidelines enable informed prescribing to support improved safety and quality of care across providers, pharmacists, older-adult patients and their caregivers. Yet the latest information often isn’t broadly promoted and has a cost to access; thus, it can’t fulfill its broadest potential to help you serve your patients.
Originally published in 1991 by Dr. Mark H. Beers, et al., as guidelines on medication safety for nursing home residents, they’ve since become the central “go-to” reference for medication safety for all persons 65 and up. With people living longer and the proliferation of new medicines, today more than 90% of older Americans take at least one prescription and 66% of whom take three or more regularly.
But at RxLive®, it’s our goal to help all players in healthcare have the best and latest information conveniently at hand to improve outcomes, hence this blog.
Accessing the Beers Criteria
In a minute, we’ll share pertinent real-life cases that show the guidelines can be applied to make a difference. But first we’ll get right to how you can best access the criteria. Here’s the link to the AGS web. If you’re already a member, a free one-year digital subscription can be ordered online. Non-members can register, but there’s a cost for either the digital subscription or printed pocket cards, the latter coming in packets of 25. The full report on Wiley Online Library costs from $16.50 to $42, depending on whether you want read-only access or a full text and PDF download. A separate Wiley Library registration is required.
Case studies applying the latest guidelines
Here are two short cases that apply the newest guidelines in a practical manner.
65-year-old with osteoarthritis taking naproxen — Let’s look at TP, a patient with osteoarthritis who’s achieved functional pain management with naproxen 750mg once daily. AP has used this regimen successfully for the last 4 years but just celebrated his 65th birthday. He’s otherwise healthy and not taking any other medications. But with his age and prolonged use of naproxen (the same would be true with other non-steroidal anti-inflammatories), AP is at increased risk of gastrointestinal bleeding (GIB) and peptic ulcer disease (PUD).
Since he’s currently presenting without other risk factors, plus he’s newly 65 and otherwise healthy, there are a few things we’d likely suggest:
- Counseling on the signs and symptoms of GIB and PUD
- Counseling on the importance of taking the medication with food
- Consider adding a protective agent such as a proton pump inhibitor
- And, as always, a discussion with him about the risks, benefits and possible alternatives
In AP’s case, we’d pay close attention to the guidelines, keep them in consideration through his periodic office visits, encourage convenient medication-management check-ins via telehealth, and for now most likely maintain the regimen that’s currently working and not causing negative effects. However, we’ve found that a short drill-down through a telehealth consult with a clinical pharmacist might discover things he hasn’t thought to tell his doctor.
72-year-old with chronic UTIs, on nitrofurantoin — A second patient, PZ, suffers from chronic urinary tract infections. While she can’t remember the last time she went 3 consecutive months without a UTI, she currently presents symptom-free but with a new prescription for nitrofurantoin 50mg once daily at bedtime.
While the newest Beers Criteria soften the guidance on using nitrofurantoin with reduced creatine clearance (use for treatment is now considered safe with CrCl at or above 30 ml/min), using nitrofurantoin for UTI suppression is not suggested due to risk of permanent pulmonary fibrosis, liver toxicity, and peripheral neuropathy.
In this case, the Beers Criteria provide us a very clear path to seeking alternatives. This case also reminds us of the importance of careful stewardship of the overuse of antibiotics that can, over time, lose their effectiveness and can lead to “super-bugs” that become resistant. Also, testing local antibiograms can help determine which antibiotics and at what concentration levels may prove most effective. Remember…the goal is to improve sustainable clinical improvement while only using the minimum inhibitory concentration (MIC), the lowest concentration of the most-appropriate drug that shows no pathogen growth.
If some of this seems a bit overwhelming in your already-hectic work day and that of your existing care team, don’t forget: you’re not alone. All of this is right in the wheelhouse of skilled clinical pharmacists such as ours here at RxLive, who can act as natural extensions of your existing team. We’re here to help, anytime.
Also, we’d love to hear your thoughts on how you would handle these particular cases, and any comments on whether or not you’re using the Beers Criteria and how useful you feel the tool has been for you. Contact our team anytime at firstname.lastname@example.org.