Podcasts about beers criteria

This episode discusses the relevancy of the Beers Criteria in clinical practice, examining how recent changes impact medication safety and prescribing practices for older adults. Learn strategies for effective deprescribing and discover best practices for applying these criteria to improve patient outcomes. This essential episode equips healthcare professionals with the knowledge needed to navigate complex medication regimens and advocate for safer prescribing practices. HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTKristin Meyer, PharmD, BCGP, FASCPProfessor of Pharmacy PracticeDrake University College of Pharmacy and Health SciencesREFERENCEAmerican Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adultsPharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss recent updates to the Beers Criteria and their impact on medication safety for older adults.2. Describe evidence-based strategies to implement the Beers Criteria and manage complex medication regimens in clinical practice.0.05 CEU/0.5 HrUAN: 0107-0000-24-282-H01-PInitial release date: 10/28/2024Expiration date: 10/28/2025Additional CPE details can be found here.Looking for more? Check out our course on deprescribing in older adults: Less is More: A Patient-Centered Approach to Deprescribing for Older Adults1 hour  |  On DemandPolypharmacy in older adults leads to significant health risks and increased costs. Learn how to effectively engage in deprescribing, using patient-centered and evidence-based approaches to reduce unnecessary medications. Enroll in this course to enhance your skills in facilitating safer medication practices, become a leader in deprescribing, and improve patient outcomes!

This episode discusses the relevancy of the Beers Criteria in clinical practice, examining how recent changes impact medication safety and prescribing practices for older adults. Learn strategies for effective deprescribing and discover best practices for applying these criteria to improve patient outcomes. This essential episode equips healthcare professionals with the knowledge needed to navigate complex medication regimens and advocate for safer prescribing practices.HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTKristin Meyer, PharmD, BCGP, FASCPProfessor of Pharmacy PracticeDrake University College of Pharmacy and Health SciencesREFERENCEAmerican Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adultsPharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss recent updates to the Beers Criteria and their impact on medication safety for older adults.2. Describe evidence-based strategies to implement the Beers Criteria and manage complex medication regimens in clinical practice.0.05 CEU/0.5 HrUAN: 0107-0000-24-282-H01-PInitial release date: 10/28/2024Expiration date: 10/28/2025Additional CPE details can be found here.Looking for more? Check out our course on deprescribing in older adults:Less is More: A Patient-Centered Approach to Deprescribing for Older Adults1 hour  |  On DemandPolypharmacy in older adults leads to significant health risks and increased costs. Learn how to effectively engage in deprescribing, using patient-centered and evidence-based approaches to reduce unnecessary medications. Enroll in this course to enhance your skills in facilitating safer medication practices, become a leader in deprescribing, and improve patient outcomes!Follow CEimpact on Social Media:LinkedInInstagram

The American Geriatrics Society (AGS) Beers Criteria comprises medications older adults should either avoid or use cautiously. It aims to guide healthcare providers in safe prescription practices for those aged 65 and above.  Join us for an insightful discussion with Dr. Michael Steinman, a board member and expert in geriatric medicine, who was essential in updating these guidelines. We'll delve into areas of the Beers Criteria that commonly raise questions regarding patient care and medications contained in this list. Dr. Michael Steinman:  linkedin.com/in/mike-steinman-50ba117 Dr. Scott Stewart:  linkedin.com/in/scott-stewart-34973870   Dr. Tamara Ruggles:  linkedin.com/in/tamara-ruggles-491882251 US Deprescribing Research Network:  https://deprescribingresearch.org/ 2023 AGS Beers Criteria: https://sbgg.org.br/wp-content/uploads/2023/05/1-American-Geriatrics-Society-2023.pdf

In this episode, we discuss principles for medication use in the geriatric patient population and summarize the updated 2023 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Key Concepts The Beer's Criteria was originally developed by Dr. Mark Beers in 1991 to identify medications in which the risks may outweigh the benefits in nursing home patients. This list is now maintained by the American Geriatrics Society and includes a variety of drug safety information related to elderly patients including medications that are considered potentially inappropriate (Table 2 and 3), medications used with caution (Table 4), drug-drug interactions (Table 5), drugs with renal dose adjustments (Table 6), and drugs with anticholinergic properties (Table 7). The newest update prefers apixaban over other DOACs for VTE and atrial fibrillation in elderly patients. This is a very controversial recommendation given that other guidelines (e.g. from the ACC/AHA) have not published a similar preference of one DOAC over another. Many of the medications that are potentially inappropriate involve drugs that have anticholinergic properties and drugs that increase the risk of incoordination and falls. Other resources exist to guide drug therapy decisions in elderly patients. As an example, the STOPP/START criteria (published in the European Geriatric Medicine journal) outlines drugs to avoid but also drugs to consider in elderly patients. References By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J AM Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372. O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023 Aug;14(4):625-632. doi: 10.1007/s41999-023-00777-y.

On this podcast episode, I finish up my breakdown of the Beers Criteria. I cover the use of sliding-scale insulin and sulfonylureas in geriatric patients. Hypoglycemia is a major concern with both of these diabetes management strategies. PPIs show up on the Beers criteria list as they can increase the risk of C. diff, pneumonia, fractures, and GI malignancies. Metoclopramide has dopamine antagonist activity and can increase the risk of EPS and tardive dyskinesia.

In this podcast episode, I break down some of the most common medications that show up on the Beers criteria list. I discuss cardiovascular medications in this podcast episode, including rivaroxaban and warfarin, and why they show up on the Beers list. Alpha-blockers who up on the Beers list as these medications are inappropriate to use for the management of hypertension. The Beers criteria addresses the use of aspirin in primary prevention. I break down what the criteria state and why it should be avoided in general.

This 2023 revision of the American Geriatric Society's Beers Criteria for Potentially Inappropriate Medications (PIMs) in older adults includes major recommendations for the safe use of anticoagulants and for avoiding the initiation of aspirin for primary cardiovascular disease, oral and transdermal estrogens in postmenopausal women, sulfonylureas as first, second or add-on therapy for diabetes, and the use of highly anticholinergic medications. Additional areas that have been updated include how PIMs can exacerbate drug-disease and drug syndromes, important drug-drug interactions, and drugs that require alterations in dosing in renal impairment. Pharmacists should be cognizant of these changes to the AGS Beers Criteria so that they can use this tool to help optimize their older adults' medication regimens.  The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

On this episode of the Pain Pod, we discuss the intersection of pain management, our geriatric patient population, and the 2023 AGS Beers Criteria Update. Let's face it, if you're not geriatric (65yo or even more experienced), you hope to be one day! So, this episode is right up everyone's alley. A discussion of Centenarians (not the Roman soldier Centurions, rather those living to be at least 100yo)! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us 2023 AGS Beers Criteria (Article •https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372 JAGS • https://agsjournals.onlinelibrary.wiley.com/journal/15325415 AGS • https://www.americangeriatrics.org/  

On this episode of the Pain Pod, we discuss the intersection of pain management, our geriatric patient population, and the 2023 AGS Beers Criteria Update. Let's face it, if you're not geriatric (65yo or even more experienced), you hope to be one day! So, this episode is right up everyone's alley. A discussion of Centenarians (not the Roman soldier Centurions, rather those living to be at least 100yo)! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us 2023 AGS Beers Criteria (Article •https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372 JAGS • https://agsjournals.onlinelibrary.wiley.com/journal/15325415 AGS • https://www.americangeriatrics.org/  

Hot off the press is a brand spanking new updated 2023 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.  The Beers Criteria is one of the most frequently cited reference tools in geriatrics, detailing potentially inappropriate medications to prescribe to older people. We've invited two members who helped update the criteria including Todd Semla and Mike Steinman.   We discuss a little history of the Beers criteria, including the original Beers Criteria that was published by the late Dr. Mark Beers, and how it has evolved over the last three decades.  We also discuss specifics about how to use and not use the Beers Criteria, how medications are selected for inclusion in the criteria, and specifics about certain medications. And of course, take a deep dive by downloading the JAGS paper on the updated Beers Criteria or any of the great links from AGS including the: 2023 AGS Beers Criteria App  Beers pocket card  

Drs. Rachel Meyers and David Hoff address how to use the KIDs List to help with issue of potentially inappropriate medications and excipients in pediatric patients.   Guest speakers: Rachel Meyers, PharmD, BCPS, BCPPS, FPPA Pediatric Clinical Pharmacist Rutgers University, Cooperman Barnabas Medical Center, Ernest Mario School of Pharmacy   David Hoff, PharmD, BCPPS, FCCP, FPPA Pharmacy Director, Acute Care Children's Minnesota   Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence   Show Notes: [02:13-03:45] What is the KIDs List? [03:46-05:43] Why the KIDs List is needed [05:44-09:26] Putting the KIDs List together [09:27-11:54] Comparing the KIDs List to Beers Criteria and STOPP/START [11:55-13:25] Ways clinicians can use KIDs List [13:26-16:49] Ways clinicians should not use the KIDs List [16:50-17:39] Future plans for the KIDs list [17:40-20:16] Unique projects of changes that have come from the KIDs List [20:17-21:38] How frontline pharmacy staff can leverage use of the list   Links | Resources: Journal of Pediatric Pharmacology and Therapeutics https://meridian.allenpress.com/DocumentLibrary/PPAG/KIDS-List.pdf   Subscribe Today! Apple Podcasts Amazon Podcasts Google Podcasts Spotify Stitcher Android RSS Feed  

Over the past five years, more than 20 million Americans aged 65 and over had elective surgery. This number is expected to grow to more than 27 million by 2030. While elective surgery can be life-changing and even life-saving, it's not without its risks. There are many things to consider before elective surgery – from the cost of the procedure to who will provide caregiving afterwards during recovery. In addition to the normal conversations, exams, and tests that will be run to clear an older adult for surgery, there are ten additional things older adults and their families should know before heading into the Operating Room. Most surgical offices will require thorough lab work, along with heart, lung, and kidney function tests; but if you are over 65 years old or the loved one of someone who's going to have the elective surgery, be sure you—and those the surgical team — know the following because many of these have been linked to a higher risk of death or complications after an older adult has surgery. These recommendations are based on the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society Developed Best Practice Guidelines recommend the following: Key points covered in this episode:  ✔️ #1: Know The Person's Pre-Surgery Cognitive Ability Though you may be an older adult, have been feeling great recently, and even played golf the day before surgery, things can take a turn for the worse post-operation. You can end up looking pretty sick to providers who don't know you—and due to pervasive ageism, health care professionals can unfortunately make an assumption that you have a cognitive impairment (when you don't!) You want to be sure that your surgical team knows what the person's cognitive ability was before the surgery ~ because you should return to baseline with your thinking.  ✔️ #2: Depressed Or Not? Depression has been associated with a higher likelihood of dying after surgery and more days in the hospital after surgery. It is essential that the surgical team understands what the person's emotional state was before surgery. Older adults may not want to talk about it, but if a loved one is going in for surgery, please ask: “Have you been feeling down or depressed lately?” ✔️ #3: Any Alcohol Or Substance Abuse/ Dependence Issues? While a glass of wine with dinner or a beer while watching the game may be part of your routine, there may also be some signs that alcohol use is more along the lines of alcohol dependency or abuse.  There are four questions that are asked, and we call it the CAGE questionnaire: C: Have you ever felt the need to Cut down on your drinking? A: Have you ever felt Annoyed by people criticizing your drinking? G: Have you ever felt Guilty about your drinking? E: Have you ever had an Eye-opener (a drink first thing in the morning) to steady your nerves or get rid of a hangover? Substance abuse isn't only about alcohol. It can includes taking other drugs. In either case, alcohol and substance misuse also puts the person at a higher risk for complications after surgery ✔️ #4: Know Your Risk Of Post-Surgery Delirium And How To Recognize It In A Loved One Delirium is a change in mental status, and people can fluctuate in and out of it. They may be confused at times and then clearheaded at other times in the same day. Being 70 or older and taking multiple medications increase a person's risk for delirium.  Before elective surgery, it is essential to let your loved one's surgical team know about any medications they are taking and if they have had issues with delirium in the past. The bottom line after surgery: If you have any feeling that your loved one “just isn't right”, mention it to their medical team because it needs to be investigated. ✔️ #5: Know Functional Status And History/ Risk Of Falls Can the person get dressed? Take a bath? Get out of a chair or the bed by themselves? Prepare own meals and/or do their own shopping ? Have you fallen in the past year? The answers to these questions give the surgical team a good idea of what level of care the person was prior to surgery and can discuss self-care goals post-surgery. The risk of falling also needs to be discussed. A history of falls or any current balance issues puts someone at a higher risk for complications after surgery. The surgical team can also administer the Timed Get UP and Go Test (TUG): This is when the older adult is asked to stand up from a chair, walk 5 or 6 feet, turn around and walk back to the chair, and sit down. Taking longer than 15 seconds to do this indicates an increased risk of falls. ✔️ #6: Is The Person Malnourished? Older adults can lose weight for many reasons: changes in taste, dentition issues, and inability to cook for themselves. But whatever the reason, malnutrition puts someone at a higher risk for complications after surgery. The best way to assess this is by asking if they had an unintentional weight loss of more than 10 pounds last year. A laboratory test of albumin and pre-albumin levels or calculating the Body Mass Index (BMI) based on Height and weight. It determines if a person is overweight or underweight, which can result in negative surgical outcomes.  ✔️ #7: What Is The Person's Frailty Score? One indicator of frailty is an unintentional weight loss of more than 10 pounds in the past year.  Another frailty indicator is decreased grip strength, which is the inability to open a jar of peanut butter or hold a cooking utensil.  Slow gait speed (walking) is another indicator. Self-reported poor energy or low endurance may also be seen. Or you may notice that they don't expend much energy during the week. So this is someone who may be doing a lot of sitting, and if they are up and walking, it will be slow. ✔️ #8: Take A Medication List With Diagnoses I recommend the Brown Bag Approach: bringing all medications in a brown paper bag to each appointment. This allows the clinician or surgical team to go through everything and ensure that each one is still indicated.  Put all ALL medications - vitamins, over-the-counter, and prescriptions -into a ‘Brown Bag' and take them all in to be reviewed with your provider. You should know the reason for taking each medication - the diagnosis it is treating. This allows the clinician to understand what other health problems the person may have and if any of those could interact with surgery or anesthesia.  Talk with your provider because any nonessential medications should be discontinued before surgery; know what medications can be taken on the day of surgery or be continued after surgery. It would also be best to review your medication list against the Beers Criteria and be sure every medication has a supporting diagnosis. Otherwise, work with your provider to discontinue it.  The bottom line: The more information the surgical team has, the better they can assess and plan for the surgery ✔️ #9: Treatment Goals And Expectations If a person thinks they will have a surgery to cure their pain and they don't get that result—that will be disappointing. So it's essential to manage expectations by getting a clear explanation of the goal(s) of surgery. The goal may be to decrease the pain but not necessarily get rid of it. It's also important to set realistic goals for post-operative function Be sure to have a discussion about the patient's preferences and expectations – and if there will be a need for rehabilitation after surgery, where is the preferred facility for that to take place, or can it be done at home? ✔️ #10: Take Paperwork: Who Will Be Involved In Care Take copies of any and all legal paperwork that you may need – this includes the person's advanced directive (code status: full code vs. no code) and who their designated decision-makers are in case they are needed – such as their healthcare power of attorney. Copies of these should also be in the person's medical record. If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  ------------------------------------------------------------------------ About Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 which led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

The 4M's Framework: MEDICATION with Ayo Bankole PhD, RN and Tahira I. Lodhi MD   "Do the Brown Bag with your pharmacist too; because there are drug-drug interactions, drug-food interactions, and drug-supplement interactions to be aware of. Make sure that you're very clear about everything you are taking"    — Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN  _________________________________________________________________________________________________   We all hear about the increasing rates of health care services and how costly prescription medications can be, especially for older adults. But these costs can grow higher if you don't take the prescription correctly. The figures are especially troubling for older adults. Roughly 23% of nursing home admissions are attributed to an older individual's failure to self-manage their prescribed drugs at home. About 21% of drug-related health problems are induced by patients, whether by mistake or failing to stick to their prescription regimens. Also, while having their medicines, up to 58 % of older adults commit some fundamental mistake, with 26% committing errors. These statistics are alarming, and that is the primary reason why Medication is such a critical part of the 4M's Framework and part the Age-Friendly Systems are highly encouraged in nursing homes and health care systems. In today's episode, we are joined by Drs. Ayo Bankole PhD, RN, and Tahira I. Lodhi, MD. Join us as we engage in meaningful discussions about one component of the 4M's Framework: Medication and learn how to make sure that your medications are age-friendly.    Part One of 'The 4M's Framework: MEDICATION'.   Overview of Medication as an Essential Component of the 4M's Framework    In implementing the 4M's Framework to achieve an age-friendly healthcare system, we want to ensure that Medication does not interfere with the other M's, which are: What Matters, Mentation and Mobility across care settings. To do that, we should have a clear definition of the terms associated with the medication. Two of these terms are polypharmacy and medication reconciliation.  What is Polypharmacy?   Tahira I. Lodhi MD explained that polypharmacy is too many medications in simple terms. She also said that when you see a patient with a medication that does not have a corresponding diagnosis documented, that's also polypharmacy by one definition.    "Whichever situation you are in, whether you are by the bedside in the hospital, in outpatient or long-term care settings, be very aware of the definitions of polypharmacy and be ready to address them." -Tahira I. Lodhi, MD (03:21-03:35)   What is Medication Reconciliation?   Ayo Bankole, PhD, RN, expounded that medication reconciliation involves reviewing the medications a patient is taking and comparing them to the medicines on file. Medication reconciliation ensures no discrepancies, such as medication duplication, missing prescriptions, and inappropriate medications.     Patient Education: Things to Look for or to Report to a Provider   Use a Medication Administration Sheet   When you get that medication list from the hospital or your provider, it often comes in a list. This can be overwhelming, so using a “real time” document can help reduce medication errors - particularly if there is more than one person trying to help the older adult. Write down your medications in the order you would need to take them in a day, rather than trying to use the list in the format typically given to patients. And write  [Can we link this form? https://drive.google.com/drive/u/1/folders/11CoEC6kj3bRw7k4yFHdjgTxIS8WqqYVD] Crystal - we created this document for EP21, but doesn’t seem to be included in the brand article?  Keep a Medication List   With that, Ayo Bankole PhD, RN suggests keeping a medication list. Your medication list should include the following; Any medications you're taking, and this includes vitamins and supplements or herbal supplements. The medication list is not only the medicines that are prescribed by a physician or a nurse practitioner. It also includes other medications that might be over-the-counter supplements that your patient might be taking. Include the name of the medications you are taking, the dose, and where the medicine is used. Include the name of the prescribing doctor  Have phone numbers of your pharmacist or your doctors on the list as well.    Teach the “Brown Bag” Review   Aside from keeping medication lists, Tahira I. Lodhi MD also suggests teaching patients the Brown Bag review. She pointed out that doing the Brown Bag Review leads your patient to gather all the medications, put them in the bag, and bring them on every visit. Once they are in the clinic, either your medical assistant or you take out those medications, put them on a table where the patient can see them.    The review brings you and your patient on the same page about what medications they are taking, what supplements they are taking, etc. This is an excellent opportunity to know whether your patient is aware of why they're taking this medicine, what doses they're taking. Furthermore, Brown Bag Review is a unique tool a provider can use to avoid polypharmacy in their patients.    What To Look For Or Report To Providers?   For patients experiencing polypharmacy, monitoring for any side effects and signs and symptoms is essential.  The following are the signs to look out for and should be reported to providers ASAP; Loss of appetite Diarrhea Fatigue  Weakness Change in mental status Confusion Hallucinations  Changing mood and behavior   Part Two of 'The 4M's Framework: MEDICATION'.   Medication Assessment   For the second part of the interview, Drs. Lodhi and Bankole mentioned Medication Assessments. They shared that there are assessments or tools students or practicing providers can use when prescribing medications to older adults. These criteria are validated tools and are widely used. Two of them are Beer's criteria and the STOPP and START criteria.   Beer's Criteria  Beer's Criteria for medications is a medication list that is put out by the American Geriatric Society. This is a list of potentially inappropriate medications for older adults. These medications carry different side effects, potential complications, and medication interactions, which account for many adverse drug reactions in the more aging adult population.  "I would tell students to be careful about Beer's criteria. The list of medications doesn't mean they are contraindicated. It means they are to be used very carefully, to be prescribed very carefully."- Tahira I. Lodhi MD(14:02-14:19) STOPP and START Criteria STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) are more commonly used in Europe and was developed by the European Consensus Group. Still, it could also be used by providers and practitioners in the United States.  The STOPP criteria are similar to the specifications of medications that could be stopped or suggest medicines for discontinuation. On the other hand, the START part is the right treatment. Those are the recommended treatments for older adults, including the pneumonia vaccine and those recommended treatments for the more aging adult population.  Interventions and Best Practices After you've done a medication reconciliation and reviewed the Beers Criteria, Dr. Lodhi shared some of the best practices that providers can use.   Deprescribing (both dose reduction and medication discontinuation)   First, she advised that you should look at the medications the patient is taking. Make sure there is no polypharmacy. Then, be ready to adjust the dose on every visit. Assess how they are doing in terms of the medication. For example, with antihypertensive, look at the patient's self-monitoring of blood pressure. If it's consistently on the low side or there are signs of orthostatic hypotension, decrease the dose and at the same time have a plan of how you're going to follow in the future.     Pharmacy Consult   Secondly, Dr. Lodhi stressed out that your pharmacist is your friend and never hesitate to call them. She says, "Your pharmacists oversee your patient's prescriptions. They regularly make their recommendations because it's regular monitoring and quality control in long-term care settings." So make sure you reach out to your pharmacist frequently.   Re-evaluate on each visit with every provider   Lastly, Dr. Lodhi emphasized that every provider should guarantee that the medications are used as prescribed. Moreover, providers should also ensure that they'll go back to the patient's chart whenever they're asked to refill a prescription. They should always double-check for schedules and indications when to continue medications.  About Tahira I. Lodhi MD  I graduated from medical school in 1999. My Family Medicine training was at Virginia Commonwealth University and Geriatrics fellowship training at George Washington University.  My interest is Geriatrics primary care practice and teaching. Since graduating from Fellowship in Geriatrics in 2011, I have had medical students, residents and fellows join me in traditional and non-traditional settings, including hospital, clinic and classrooms but also assisted living, post-acute and long term care settings. I am also interested in workflow improvement through deploying available technology. My goal is to help my patients get simplified, patient-centered care, while collaborating with an interdisciplinary team.  About Ayo Okanlawon Bankole Ph.D, RN Ayo Okanlawon Bankole Ph.D, RN is a clinical assistant professor at GW Nursing. She is also one of the faculty members affiliated with the George Washington University/Medstar Washington Hospital Center academic partnership and scholarship program, W-squared. Dr. Bankole has practiced as a nurse in multiple areas within the acute care and community care setting. She is also committed to nursing education and she has been teaching nursing students since 2013 (in both part-time adjunct and full time appointments). Dr. Bankole's overall research goal is to contribute to research that improves health outcomes and wellbeing for older adults with complex healthcare needs. Her specific research interest are: aging, chronic disease self-management, theoretical approaches to chronic disease self-management and multi-morbidity.  About Melissa Batchelor, PhD, RN, FNP,  FGSA, FAAN I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor, where I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at https://melissabphd.com/. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234383/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573668/

Host Amie Taggart Blaszczyk, Pharm.D., BCGP, BCPS, FASCP interviews Dr. Creaque V Charles about their article in the February 2020 issue of The Senior Care Pharmacist, Highlights From the 2019 AGS Beers Criteria® Updates. The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations. 

Episode 25: Autism [Music to start: Grieg’s Morning Mood (https://www.youtube.com/watch?v=-rh8gMvzPw0) The sun rises over the San Joaquin Valley, California, today is August 28, 2020. The Journal of the American Board of Family Medicine recently published the characteristics of primary care physicians (PCPs) associated with prescribing potentially inappropriate medication (PIM) for elderly patients. Medicare data from more than 100,000 PCPs was analyzed. The sample included specialists in family medicine, internal medicine, geriatrics and general practice. PCPs more likely to prescribe PIMs were on average older, male, DO, practicing in the South, and have a smaller Medicare patient panel. The study also found that PIM rates have been decreasing over time (1). So, don’t forget to review your Beers Criteria (2) when prescribing meds to your elderly patients. Cancer and VTE normally means low molecular weight heparin, LMWH aka Lovenox®, right? But direct oral anticoagulants (DOACs) are being used more frequently in patients with acute venous thromboembolism (VTE) and active cancer. Studies comparing their safety and efficacy with LMWH are limited. In a recent, randomized trial of 1170 patients with cancer and VTE, the DOAC apixaban resulted in similar rates of recurrent VTE when compared with the LMWH dalteparin (Fragmin®) (5.6 versus 7.9 percent) without any impact on major bleeding events. Apixaban is now considered a suitable alternative to LMWH for treatment of VTE in patients with active cancer (3). So, good point for Eliquis®.  [Music mixes with country Chris Haugen - Cattleshire - Country & Folk https://www.youtube.com/watch?v=WiYqHkH4Tnc&list=PLYo1YtVKirP-LAZ3AjpIiJNW9KIe1MJLw&index=7]Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere.The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. [Music continues and fades…] ____________________________[MUSIC]“By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest.” –Confucius Spanish refrains don’t make sense, but here I have one to see if it makes sense: “Nobody learns on someone else’s brain”. It means, you learn better by experience. Dear residents, how do you want to learn wisdom? By reflection, by imitation or by experience?  Question number 1: Who are you?  This is Steven Saito. I am a former Navy doctor, having spent 6.5 years in the service primarily working out of a branch clinic having taken on a variety of additional duties including prior department head and senior medical officer. I am also a recent graduate from RBFM and have come back as faculty Tag line: I’m here to give you your weekly suppository of information. Relax and let it in.  Question number 2: What did you learn this week?  What I actually encountered was a need for follow up from podcast #9 vaccine hesitancy.  There were follow on questions for autisms and what we can be doing as primary care providers. I’m going to start with some basics of autism. Diagnostic Criteria The current DSM criteria states that a child must have persistent deficits in 3 areas of social communication/interaction and at least 2 of 4 types of restricted/repetitive behaviors.  It’s important to understand these criteria as not every child who has difficulty with eye contact falls on the spectrum. A: Areas of social communication and interactionDeficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.B: Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).C: Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).D: Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.E: These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.Hey. Hey you.  The poor resident and or medical student that just sat through a bunch of raw criteria.  I’m sorry. A real quick aside, we have already covered some of the basics of epidemiology in a prior podcast (that’s Podcast #9 which dealt with vaccine hesitancy) Let me expand that discussion a little bit, we know that boys are about 4x as likely as girls to have it, there does seem to be a genetic component as noted in twin studies.  As far as impact it falls somewhere around 1 in 40 and 1 in 500 people.  There may be environmental factors that act as a second hit, but again see our prior podcast- studies have shown time and again no significant correlation between vaccines and autism.    There are some things which have been shown to cause a greater relative risk such as older parents, chromosomal abnormalities (such as fragile X), and certain medications taken during the prenatal period (such as valproic acid)Symptoms can present prior to 18 months, but they are most typically fully noted at 18 to 24 months when symptoms exceed the capacities of the patient. Let’s talk about something that you might need to wake up for.  Wake up. Wake up. Wake up.  The role of Primary Care is not necessarily to make the diagnosis.  Comprehensive evaluation by appropriate tools is still best left to specialists who are well trained in the field.  Most commonly developmental pediatricians, pediatric psychologist/psychiatrists, or pediatric neurologist.  However, it is very important that we recognize the signs and symptoms of autism and that we perform appropriate screening.   So, what constitutes appropriate screening? For children who appear neurotypical in whom parents are not concerned, routine screening should be implemented at ages 18 and 24 months using any of the standardized tools. The M-CHAT R/ F is validated as a first tier screening.  It is available in multiple languages through their official website.  Importantly for the primary care provider it can be completed in under 5 minutes and at least for the initial questionnaire can be completed by the parent before the visit eg either in the waiting room if given while awaiting or if the appropriate underlying electronic health record / email service is in place, the questionnaire can be given online prior to the visit.  For F component of the M-CHAT R/F is a structured set of follow up questions that should be done prior to referral.  For example, the first question: “If you point at something across the room, does (your child) look at it?”    Prompts the question, what does your child typically do?  There is a list of 7 items that are typical examples.  A child might still pass for example if he were to point at the object.  A greater concern might be when the child ignores the parent or looks at the finger instead of the object. Please note that there are other standardized questionnaires for example the Autism Spectrum Screening Questionnaire.  Most still require additional studies or are potentially better at finding other issues (such as general intellectual disability)  Resources for parentsIf the child is less than 3 years old, the Early Childhood Technical Assistance Center may be of use (especially if I am talking to people outside of my local jurisdiction)  Their website located at ectacenter.org has a contact list for coordinators that may be connect parents with services.Locally, we have the Kern Regional Center    For those 3 and older, you can contact the local public school system even for those not currently enrolled in school.For those of us in California, the Lanterman Act is very important.  The Lanterman act is the California law that gives people with developmental disabilities the right to the services and supports they need to live a more independent and normal life.  In particular, your patient may be eligible for Medi-Cal even if they might otherwise not be eligible, and they may be entitled top additional services.  Furthermore, it allows them to access for additional services through the Regional Center.  As an example, their diagnosis may entitle the family to Respite services. Now that we have identified the patient with autism, what are some of the ways that we can improve their care in our primary care.First remember that these children still need routine primary care preventive services and screening.  Anticipatory guidance may need to adapted to include some additional safety recommendations for example discussing elopement  Those with autism may have some difficulty with change, and so unfamiliar settings eg things that are not done everyday and per routine, may be more difficult.  If the patient is already in ABA therapy they may already be getting social stories or a visual board to orient the child as to expectations.  Allow additional time if possible (or manipulate your schedule to have easier / shorter appointments adjacent to this visit) to give more time to allow the patient to adapt.     Question number 3: Why is that knowledge important for you and your patients?   Question number 4: How did you get that knowledge? (learning habits)  As a general rule, I refer to multiple online sources like UpToDate to read articles and get suggestions for primary source citation. eg check the bibliography from UTD to see there sources and see if you agree with their evidence for your evidence-based medicine and primary sources.   However, for this talk I wanted to get some additional sources to discuss.  My usual go to locations for additional broad information is to first start with important medical institutions including the Center for Disease Control, World Health Organization, and AAFP. Question number 5: Where did that knowledge come from? (cite source)  I used a variety of references.  Primarily I used  UpToDate, but I also used the DSM, as well as information from the Center for Disease Control and the World Health Organization Rights Under the Lanterman Act https://www.disabilityrightsca.org/publications/rula-rights-under-the-lanterman-act-complete-manual Date of access 8/18/2020 Caldwell, Nicole. Going to the Doctor http://www.positivelyautism.com/downloads/DoctorVisit_Story.pdf “Autism” Center for Disease Control, https://www.cdc.gov/ncbddd/autism/index.html  Date of access 8/18/2020American Psychiatric Association. Autism spectrum disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p.50World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. www.who.int/classifications/icd/en/bluebook.pdf (Accessed on March 28, 2018).Augustyn, Marilyn MD. “Autism spectrum disorder: Terminology, epidemiology, and pathogenesis” UpToDate, https://www.uptodate.com/contents/autism-spectrum-disorder-terminology-epidemiology-and-pathogenesis Date of access 8/18/2020Weissman, Laura MD “Autism spectrum disorder in children and adolescents: Pharmacologic interverventions” UpToDate https://www.uptodate.com/contents/autism-spectrum-disorder-in-children-and-adolescents-pharmacologic-interventions  Date of access 8/18/2020Augustyn, Marilyn MD and von Hahn, L Erik MD. “Autism spectrum disorder: Clinical Features” UpToDate, https://www.uptodate.com/contents/autism-spectrum-disorder-clinical-features   Date of access 8/18/2020Augustyn, Marilyn MD. “Autism spectrum disorder in children and adolescents: Overview of management” UpToDate, https://www.uptodate.com/contents/autism-spectrum-disorder-in-children-and-adolescents-overview-of-managementDate of access 8/18/2020 Handleman, J.S., Harris, S., eds. Preschool Education Programs for Children with Autism (2nd ed). Austin, TX: Pro-Ed. 2000.National Research Council. Educating Children with Autism. Washington, DC: National Academy Press, 2001.  ____________________________[Music] Speaking Medical: Anosognosia by Cameron Anderson, MS4When someone rejects a diagnosis of mental illness, it’s tempting to say that he's “in denial.” But someone with acute mental illness may not be thinking clearly enough to consciously choose denial. They may instead be experiencing “lack of insight” or “lack of awareness.” The formal medical term for this condition is anosognosia, from the Greek meaning “to not know a disease.”As humans, we are consistently updating our reality and perception. Think about it this way: when you get a sunburn because you spent your weekend at the beach you expect yourself to look red when you look in the mirror. You have updated your perception of what your reality is. You now expect to appear more red. This update requires a functioning frontal lobe of the brain. When that is not working properly you can lose your ability to update what is real. Everyone else can tell you received a sunburn but you are unable to recognize you have one. In essence, this is anosognosia.This lack of insight into the disease is fairly common in those with schizophrenia and bipolar disorder. When a person is in this state they become very difficult to treat because they believe their perceptions of reality are what we should be experiencing. These people frequently will stop taking their medications because in their mind there is no reason to continue them because there is no disease.People with anosognosia often fluctuate with how aware they are of their disease. This can also cause a strain on their support system and relationships with friends and families. Since our perceptions feel accurate, we conclude that our loved ones are lying or making a mistake. If family and friends insist they're right, the person with an illness may get frustrated or angry, or begin to avoid them. When maintaining a relationship with a person with anosognosia, it is important to realize that their perception of reality is as real to them as our reality is to us.  Remember the word anosognosia.____________________________[Music]  Espanish Por Favor: Cansancioby Dr Claudia CarranzaHi this is Dr Carranza on our section Espanish Por Favor. This week’s word is cansancio. Cansancio means tiredness or fatigue. The verb “cansar” comes from the Latin word “campsare” which means to deviate or bend from a path or trajectory. Interestingly, back in the day cansancio began to be used to describe taking a break from a trip, taking a break due to exhaustion, or to rest because you’re tired. Patients can come to you with the complaint: “Doctor, tengo cansancio” or “Doctor, estoy cansado” which means: “Doctor, I am tired” or “I feel tired”. Cansancio is a very common complaint in clinic but it’s not very specific. So, the question “¿Se siente cansado?” “Are you feeling tired?” normally is answered with a yes, more so if you are a resident. Feeling tired may be physiologic, but feeling tired continually, with no relief after rest, and with no identifiable cause can lead you to start an investigation. Ask if this cansancio is new or chronic, think of differentials such as thyroid disease, anemia, sleep apnea, acute viral illness and continue with your work up. Now you know the Spanish word of the week, cansancio. ___________________________[Music]For your Sanity: Medical Jokesby Dr RAVA[SURAJ, PLEASE EDIT]I used all my sick days, so I called in dead.Statistically, 9 out of 10 injections are in vein.PMS jokes aren't funny; period.He was wheeled into the operating room, and then had a change of heart.I don't find health-related puns funny anymore since I started suffering from an irony deficiency (5). [Music to end: Jeremy Blake - Stardrive - Rock | Bright ]Now we conclude our episode number 25 “Autism with Saito”. Dr Saito explained the key features of Autism Spectrum Disorder and reminded us to screen at 18 and 24 months by using M-CHAT. Health care of patients with ASD requires a multidisciplinary team, and you can be part of that team. For some reason, we decided to expand on the word anosognosia (explained in episode 14). Cameron explained that anosognosia (UH NO SO NOGSIA) may fluctuate in intensity causing difficulty in relationships with family and friends. Dr Carranza gave us a good explanation about cansancio, which means tiredness, a good word to describe how we feel after a busy shift like today. Tomorrow the sun will rise again over the San Joaquin Valley and we’ll continue to learn and grow.This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere.If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. _____________________Our podcast team is Hector Arreaza, Lisa Manzanares, Steven Saito, Roberto Velazquez, Audio edition: Suraj Amrutia. See you soon! _____________________References:Avanthi Jayaweera, Yoonkyung Chung and Yalda Jabbarpour, The Journal of the American Board of Family Medicine July 2020, 33 (4) 561-568; DOI: https://doi.org/10.3122/jabfm.2020.04.190310American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults By the 2019 American Geriatrics Society Beers Criteria, Update Expert Panel, https://qioprogram.org/sites/default/files/2019BeersCriteria_JAGS.pdfAgnelli G, Becattini C, Meyer G, et al. Apixaban for the Treatment of Venous Thromboembolism Associated with Cancer. N Engl J Med 2020. 382:1599-1607. https://www.nejm.org/doi/full/10.1056/NEJMoa1915103Stokes, Andrew, PhD; Dielle J. Lundberg, MPH; Bethany Sheridan, PhD; et al, Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US, April 2, 2020, JAMA Netw Open. 2020;3(4):e202012. doi: 10.1001/jamanetworkopen.2020.2012, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763785https://aimseducation.edu/blog/medical-puns-jokes-and-one-liners

Lecture SummaryIn this podcast I talk about my experiences with adverse drug reactions working as a Hospitalist. I then provide a brief summary of the 2019 American Geriatric Society Beers Criteria. "Beers List" reviews medications which are potentially inappropriate to use in elderly patients.Key Points- At least 10% of the patients I admit to the hospital are the direct result of the medications they have been prescribed.- Bleeding, falls, altered mentation, kidney and electrolyte problems, and overdose are the most common adverse reactions I see in my practice- The American Geriatric Society publishes a Beers Criteria, every 3 years, to highlight medications that are potentially harmful in elderly patients (> 65 years)- Avoid mixing multiple medications with strong anticholinergic properties.- Read this paper if you treat elderly patients!- I often break these guidelines in my practice, but I try to be aware of potential problems so I can identify adverse reactions quickly and remove culprit medications.ReferencesBeers Criteria/List. American Geriatric Society. 2019 addition

On today's episode, we finish part 2 from last week - diving into STOPP vs Beers criteria and how to change your practice to tackle polypharmacy, inappropriate medications, and do it efficiently and/or/maybe well.

Senior Care Pharmacy Podcast host Amie Taggart Blaszczyk, Pharm.D., BCGP, BCPS, FASCP interviews Dr. Creaque V Charles about their article in the February 2020 issue of The Senior Care Pharmacist, Highlights From the 2019 AGS Beers Criteria® Updates. The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations. SenioRx Radio See omnystudio.com/listener for privacy information.

Senior Care Pharmacy Podcast host Amie Taggart Blaszczyk, Pharm.D., BCGP, BCPS, FASCP interviews Dr. Creaque V Charles about their article in the February 2020 issue of The Senior Care Pharmacist, Highlights From the 2019 AGS Beers Criteria® Updates. The AGS Beers Criteria® is intended to improve and optimize the care of the geriatric population. It serves as a guide to minimize older adults' exposure to PIMs whenever possible. As with previously published updates to the AGS Beers Criteria®, the 2019 update outlines the following: recommendations, rationale, and quality of the recommendations, as well as the strength of the recommendations. SenioRx Radio

This podcast focuses on new and noteworthy recommendations from the 2019 Beers Criteria update, as well as how to best apply these suggestions in clinical practice for thoughtful geriatric medication management.Christina Tran, PharmDPGY-2 Ambulatory Care Pharmacy ResidentWilliam S. Middleton Memorial Veterans Hospital

Dr. K discusses risky medications and the 2019 Beers Criteria in more details, with a focus on which drugs are most important for older adults to be aware of. She also shares 5 ways you can be proactive, and her favorite resources to help deprescribe risky medications The post 090 More on Avoiding Risky Medications & on Using the 2019 AGS Beers Criteria appeared first on Better Health While Aging.

More senior citizens take benzos than any other age group. And yet, they are also the group most at-risk for complications. What are the effects of this dangerous combination? And what can be done to buck the overprescribing trend? In today's episode, we look at the stats, the warnings, and the consequences of benzodiazepine and Z-drug use in the elderly. We also shine the spotlight on the website benzo.org.uk, share a story from Grand Junction, Colorado, and discuss anti-depressants and sleepless nights. https://www.easinganxiety.com/post/the-dangers-of-benzodiazepine-use-in-the-elderly-bfp015Video ID: BFP015 Chapters 00:00 Introduction06:41 Mailbag12:02 Benzo News14:45 Benzo Spotlight18:30 Benzo Story25:40 Feature: Benzos and the Elderly44:03 Moment of Peace  Resources The following resource links are provided as a courtesy to our listeners. They do not constitute an endorsement by Easing Anxiety of the resource or any recommendations or advice provided therein. INTRODUCTION “The Lost Years: A Father, A Son, Benzos, and Aging” by D E Foster BENZO NEWS “Benzos added to fentanyl causing hard-to-revive overdose problems” by Karen Graham in Digital Journal“Benzodiazepines intake may increase miscarriage risk” by Medha Baranwal in Speciality Medical Dialogues“‘Hello, It's Me:' Loneliness in Benzo Withdrawal” by D E Foster in Benzo Free “The world's happiest people have a beautifully simple way to tackle loneliness” by Jenny Anderson in QZ.comPodcast Episode #14 — “Finding Faith, Hope, and Acceptance in Benzo Withdrawal: A Conversation with Jennifer Leigh, PsyD”“My Fifth-Year Anniversary” by Holly Hardman on As Prescribed Blog“7 Effective Thought-Stopping Techniques for Anxiety” by Melissa Stanger on Thrive Global“Anxiety ‘epidemic' brewing on college campuses, researchers find” by Will Kane on Berkeley News BENZO SPOTLIGHT Benzo.org.uk FEATURE: Benzos and the Elderly “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.”Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual) by C. Heather Ashton“Benzodiazepine Use and Risk of Alzheimer's Disease: Case-Control Study.” BMJCommonwealth of Pennsylvania. Prescribing Guidelines for Pennsylvania: Safe Prescribing Benzodiazepines for Acute Treatment of Anxiety & Insomnia.“Physicians' perspectives on prescribing benzodiazepines for older adults: a qualitative study.” Journal of General Internal MedicineBenzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal by D E Foster “Yes, Benzos Are Bad for You” by Dr. Frances Allen“Factors Associated With Long-term Benzodiazepine Use Among Older Adults.” JAMA Intern Med.“No End in Sight: Benzodiazepine Use in Older Adults in the United States.” Journal of the American Geriatrics Society“Benzodiazepine Use in the United States.” JAMA Psychiatry“The Benzodiazepine–Dementia Disorders Link: Current State of Knowledge.” CNS Drugs“Risk of Death Associated with New Benzodiazepine Use Among Persons with Alzheimer's Disease — a Matched Cohort Study.” International Journal of Geriatric Psychiatry“Benzodiazepine Dependence and Withdrawal in Elderly Patients.” The American Journal of Psychiatry“The New Old Age: A Quiet Drug Problem Among the Elderly.” by Paul Span in The New York Times.“Once prescribed, 25% of elderly become dependent on benzodiazepines: JAMA.” by Hina Zahid in Speciality Medical Dialogues. FORMAL REFERENCESAmerican Geriatrics Society (AGS). “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Beers Criteria Update Expert Panel (2015). Accessed April 9, 2018. http://www.sigot.org/allegato_docs/1057_Beers-Criteria.pdf.Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual.Billioti de Gage, Sophie, Yola Moride, Thierry Ducruet, Tobias Kurth, Hélène Verdoux, Marie Tournier, Antoine Pariente and Bernard Bégaud. “Benzodiazepine Use and Risk of Alzheimer's Disease: Case-Control Study.” BMJ 349(g5205)(2014). Accessed January 30, 2017. doi:10.1136/bmj.g5205.Commonwealth of Pennsylvania. Prescribing Guidelines for Pennsylvania: Safe Prescribing Benzodiazepines for Acute Treatment of Anxiety & Insomnia. Updated May 15, 2017. Accessed April 7, 2018. https://www.health.pa.gov/topics/Documents/Opioids/PA%20Guidelines%20on%20Benzo%20Prescribing.pdfCook, J.M., R. Marshall, C. Masci, and J.C. Coyne. “Physicians' perspectives on prescribing benzodiazepines for older adults: a qualitative study.” Journal of General Internal Medicine 2007 Mar;22(3):303-7. Accessed April 22, 2019. https://www.ncbi.nlm.nih.gov/pubmed/17356959Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. http://www.benzofree.org/book.Frances, Allen. “Yes, Benzos Are Bad for You.” Pro Talk: A Rehabs.com Community, June 10, 2016. Accessed October 13, 2016. https://www.rehabs.com/pro-talk-articles/yes-benzos-are-bad-for-you.Gerlach LB, Maust DT, Leong SH, Mavandadi S, Oslin DW. “Factors Associated With Long-term Benzodiazepine Use Among Older Adults.” JAMA Intern Med. 2018;178(11):1560–1562. doi:10.1001/jamainternmed.2018.2413Maust, Donovan T., Helen C. Kales, Ilse R. Wiechers, Frederic C. Blow, Mark Olfson. “No End in Sight: Benzodiazepine Use in Older Adults in the United States.” Journal of the American Geriatrics Society 64(12)(December 2016):2546-53. Accessed February 17, 2017. doi:10.1111/jgs.14379.Olfson, M., M. King and M. Schoenbaum. “Benzodiazepine Use in the United States.” JAMA Psychiatry 72(2)(February 2015):136-42. Accessed March 7, 2017. doi:10.1001/jamapsychiatry.2014.1763.Pariente, Antoine, Sophie Billioti de Gage, Nicholas Moore and Bernard Bégaud. “The Benzodiazepine–Dementia Disorders Link: Current State of Knowledge.” CNS Drugs 30(1)(January 2016):1-7. Accessed December 12, 2016. doi:10.1007/s40263-015-0305-4.Saarelainen, Laura, Anna-Maija Tolppanen, Marjaana Koponen, Antti Tanskanen, Jari Tiihonen, Sripa Hartikainen and Heidi Taipale. “Risk of Death Associated with New Benzodiazepine Use Among Persons with Alzheimer's Disease — a Matched Cohort Study.” International Journal of Geriatric Psychiatry (November 15, 2017). Accessed April 8, 2018. doi:10.1002/gps.4821.Schweitzer, Edward, George Case, and Karl Rickels. “Benzodiazepine Dependence and Withdrawal in Elderly Patients.” The American Journal of Psychiatry; Washington 146(4)(April 1989):529-31. Accessed April 22, 2019. https://search.proquest.com/openview/8061f199e2c28c42650c88feb8a394cf/1.pdf?pq-origsite=gscholar&cbl=40661.Span, Paula. “The New Old Age: A Quiet Drug Problem Among the Elderly.” The New York Times. March 16, 2018. Accessed April 22, 2019. https://www.nytimes.com/2018/03/16/health/elderly-drugs-addiction.html.Zahid, Hina. “Once prescribed, 25% of elderly become dependent on benzodiazepines: JAMA.” Speciality Medical Dialogues. September 13, 2018. Accessed April 22, 2019. https://speciality.medicaldialogues.in/once-prescribed-25-of-elderly-become-dependent-on-benzodiazepines-jama/.  Introduction In today's intro, I rambled on a bit, as I often do, about the elderly, a blog post I wrote about my dad, but most of all about loss. The loss so many of us feel from those years were trapped on the drugs.  Mailbag This is where we share questions and comments which were discussed: COMMENT: You could attract more listeners if you included anti-depressants in your content. This comment was from Sara in Memphis, Tennessee. She suggested that I could draw more listeners if I included anti-depressants in the content. I agreed and suggested I would try and be more inclusive, but that our primary focus will still be on benzos. QUESTION: I would love for you to do a “bedtime” podcast.This question was from Karla in Chino Hills, California. She suggested I do a “bedtime” version of the podcast for people to listen to when they have insomnia. This was a great idea and I asked for suggestions of what it would entail.  Benzo News We discussed a variety of stories around the benzo community in this section today.  Benzo Spotlight Today's spotlight was on the website benzo.org.uk. This is the home to the Ashton Manual and thousands of links related to benzos, studies, articles and other information.  Benzo Stories Today's story was from Jill in Grand Junction, Colorado.  Feature Today's featured topic: The Effects of Benzodiazepines and Z-drugs on the Elderly The senior population around the world is an at-risk group, especially when it comes to the effects of certain drugs like benzos. Unfortunately, they are also the most likely to take these drugs. In today's feature, I shared several statistics, studies, and articles about the dangers of the overprescribing of these drugs in the elderly population.  The PodcastThe Benzo Free Podcast provides information, support, and community to those who struggle with the long-term effects of anxiety medications such as benzodiazepines (Xanax, Ativan, Klonopin, Valium) and Z-drugs (Ambien, Lunesta, Sonata). WEBSITE: https://www.easinganxiety.comMAILING LIST: https://www.easinganxiety.com/subscribe YOUTUBE: https://www.youtube.com/@easinganx DISCLAIMERAll content provided by Easing Anxiety is for general informational purposes only and should never be considered medical advice. Any health-related information provided is not a substitute for medical advice and should not be used to diagnose or treat health problems, or to prescribe any medical devices or other remedies. Never disregard medical advice or delay in seeking it. Please visit our website for our complete disclaimer at https://www.easinganxiety.com/disclaimer. CREDITSMusic provided / licensed by Storyblocks Audio — https://www.storyblocks.com Benzo Free Theme — Title: “Walk in the Park” — Artist: Neil Cross PRODUCTIONEasing Anxiety is produced by…Denim Mountain Presshttps://www.denimmountainpress.com ©2022 Denim Mountain Press – All Rights Reserved

Dr. K talks with Dr. Michael Steinman about risky medications in older adults and how to ensure safer prescribing. They also discuss the 2019 update to the Beers Criteria list of potentially inappropriate medications for older adults, which Dr. Steinman helped author. The post 088 Interview: Avoiding Inappropriate Prescribing in Aging & What to Know About the Beers Criteria appeared first on Better Health While Aging.

Avoid common pitfalls, recognize prescribing cascades, and deprescribe like a champ with tips from Clinical Pharmacist, Dr. Sean M. Jeffery, Clinical Professor of Pharmacy at the University of Connecticut School of Pharmacy, and Chair of the Polypharmacy Special Interest Group for the American Geriatrics society. We discuss how to create better medication lists, tools and tips for deprescribing, how to counsel patients on polypharmacy, and safe use of medication in the elderly. Special thanks to the American Geriatrics Society for setting up this interview. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 01:12 Listener feedback 01:56 Picks of the week 06:28 Topic intro and guest bio 07:49 Getting to know our guest 13:05 Defining polypharmacy and related terms 16:30 Clinical Case of polypharmacy 20:34 Making better medication lists 25:01 Clinical Case from Kashlak Memorial 28:40 Beers Criteria 35:41 Statins in frail, elderly patients 38:00 Treating insomnia in the elderly 44:15 Dosing of meds in patients with CKD 45:50 Tool for analysis of drug-drug interactions 48:10 Take home points from Dr. Jeffery 50:00 Outro Tags: polypharmacy, deprescribing, prescribing, cascade, pharmacist, drug, therapy, medications, side, effects, adverse, reaction, beers, criteria, interaction, disease, anticholinergic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student  

You'll see renewed focus on appropriate med use in patients 65 and older...due to new Beers Criteria from the American Geriatrics Society. Continue to think of these guidelines as a "warning light" to be cautious with certain meds...NOT a "stop sign" to always avoid them. PPIs are new to the list. Discourage using PPIs for over 8 weeks without a good reason, such as chronic oral steroid use. Explain PPIs are linked to a higher risk of C. difficile, fractures, pneumonia, etc. Help patients taper off a PPI if needed. Advise lowering the dose, then taking it every OTHER day for a week or more before stopping. "Z drugs" (zolpidem, zaleplon, eszopiclone) are a concern now when used for ANY duration...not just over 90 days. Potential harms...such as delirium, falls, and fractures...seem to outweigh any benefit. Keep in mind not to turn to benzos...they're still on the list and aren't safer for sleep. Instead, emphasize nondrug strategies. Or consider suggesting low doses of trazodone or doxepin...or ramelteon. Nitrofurantoin used to be discouraged for UTIs if CrCl < 60 mL/min. But now feel comfortable suggesting it short-term if CrCl ≥ 30 mL/min...since new evidence supports its safety and efficacy in these patients. Digoxin should now be saved for atrial fib or heart failure patients only when other options aren't enough...since it may increase mortality. If digoxin must be used, recommend a max of 0.125 mg/day. Warfarin with amiodarone, anticholinergic combos, and other interactions can be riskier in seniors. Suggest avoiding if possible. Direct oral anticoagulants (dabigatran, etc), famotidine, gabapentin, and others may cause more side effects in renal impairment. Advise reducing the med's dose or avoiding it...based on renal function. Expect the Star Ratings high-risk med list to catch up eventually.

In this episode, Dr. Christopher Cannon discusses decisions about stopping dual antiplatelet therapy in patients with intracoronary stents (starts at 01:21); Dr. Tom Gildea discusses novel bronchoscopic interventions on the horizon for patients with severe emphysema (starts at 11:45); and Dr. Paula Rochon discusses the updated Beers criteria to guide appropriate use of pharmacotherapy in older adults (starts at 22:52). Dr. Nancy Sokol hosts.