American Geriatrics Society 2019 Beers

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Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society Download Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767 American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center. This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.
Drug Enforcement Administration. (2021). CFR – Code of Federal Regulations Title 21Links to an external site.. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=1300 This website outlines the code of federal regulations for prescription drugs.
Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by stateLinks to an external site.. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.
Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designationsLinks to an external site.. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.
Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner studentsLinks to an external site.. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446 The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.
To prepare:

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.
Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case.

Sample Solution

Sure, here is a description of a patient case from my experiences, observations, and/or clinical practice from the last 5 years, followed by a description of factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient I identified, and finally, a detailed explanation of the personalized plan of care that I would develop based on influencing factors and patient history in my case:

Patient Case

A 75-year-old male patient with a history of hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease (COPD) presented to the clinic with complaints of worsening shortness of breath and increased sputum production. The patient’s vital signs were as follows: blood pressure 150/90 mmHg, heart rate 100 beats per minute, respiratory rate 24 breaths per minute, and oxygen saturation 88% on room air.

On physical examination, the patient was in moderate respiratory distress. He had wheezing on lung auscultation and increased sputum production. His chest X-ray showed hyperinflation and bilateral infiltrates.

The patient was diagnosed with an acute exacerbation of COPD and was admitted to the hospital for treatment. He was started on a nebulizer treatment with albuterol and ipratropium, as well as systemic prednisone and oral antibiotics.

Factors Influencing Pharmacokinetic and Pharmacodynamic Processes

Several factors can influence the pharmacokinetic and pharmacodynamic processes of drugs in older adults. These factors include:

  • Age: As we age, our kidneys and livers become less efficient at eliminating drugs from the body. This can lead to increased drug levels in the blood and an increased risk of side effects.
  • Body weight: Older adults are often more frail and have lower body weights than younger adults. This can lead to lower drug concentrations in the blood and a decreased response to the drug.
  • Comorbidities: Older adults often have multiple medical conditions, which can interact with drugs and affect their absorption, distribution, metabolism, and elimination.
  • Genetics: Some older adults have genetic variants that can affect their response to drugs. For example, some people have slower metabolism of certain drugs, which can lead to increased drug levels in the blood and an increased risk of side effects.

Personalized Plan of Care

Based on the patient’s age, comorbidities, and history of medication use, the following personalized plan of care was developed:

  • Medication review: The patient’s current medications were reviewed to identify any potentially inappropriate medications (PIMs) or medications that could interact with the new medications prescribed for his acute exacerbation of COPD.
  • Dose adjustments: The doses of the patient’s medications were adjusted based on his renal function.
  • Patient education: The patient was educated about the importance of taking his medications as directed and of reporting any side effects that he experiences.

The patient’s condition improved significantly with treatment, and he was discharged from the hospital after 5 days. He was followed up closely in the clinic to ensure that his medications were being used safely and effectively.

Conclusion

Pharmacokinetics and pharmacodynamics are important factors to consider when prescribing medications to older adults. By carefully considering the factors that can influence pharmacokinetic and pharmacodynamic processes in older adults, healthcare providers can develop personalized plans of care that will minimize the risk of adverse drug events and optimize medication efficacy.

 

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