Senior Care Pharmacist最新文献

The first combination inhaled corticosteroid and short-acting beta₂ agonist (ICS-SABA) was approved by the Food and Drug Administration (FDA) in 2023 for as-needed treatment or prevention of bronchoconstriction and to reduce the risk of asthma exacerbations in patients 18 years of age and older. The recently approved product contains an ICS-albuterol combination. The 2024 Global Initiative for Asthma (GINA) guidelines recommend as-needed ICS-formoterol as the preferred asthma reliever therapy; however, a GINA alternative recommendation is the use of ICS whenever an as-needed (SABA) is used. There is no difference in as-needed asthma treatment recommended by the GINA guidelines in older adults, and there has been minimal study in older adults. Because of limited guidance on the use of the ICS-SABA reliever inhaler in older adults, the purpose of this review is to evaluate the DENALI and MANDALA studies and the potential role of ICS-SABA in older adults. The mean ages in both studies were 50 years. The MANDALA primary outcome result was a statistically significant lower risk of severe exacerbations in the ICS-SABA reliever group compared with the as-needed albuterol (ALB) group at 24 weeks. In the MANDALA older adults subgroup analysis, there was not a statistically significant difference in the ICS-SABA reliever group compared with the as-needed ALB-alone group but the results favored ICS-SABA. The DENALI primary outcome results were a greater change from baseline in forced expiratory volume in the first second (FEV1) area under the curve averaged over 12 weeks with albuterol/budesonide (ALB-BUD) 180/160 ug compared with budesonide alone and placebo and a greater change from baseline in trough FEV1 with ALB-BUD 180/160 ug and 180/80 ug than ALB-alone and placebo. Because of minimal adverse effects in both trials and the benefits in preventing asthma exacerbations reported in the MANDALA trial, it is important to assess and recommend that older adults with asthma receive inhaled corticosteroid with their reliever asthma inhaler.

Background Antibiotic lengths of therapy (LOT) vary widely, based on infection type, antibiotic regimen, and patient characteristics. Longer LOT are associated with increased risk of antibiotic resistance, adverse effects, and health care costs. There are increasing data supporting shorter LOT for many infections based on randomized, controlled trials (RCTs). Objective To evaluate RCTs supporting shorter antibiotic LOT for common infections, with an emphasis on applying the data to older adults. Data Sources A list of RCTs that evaluated shorter LOT for common infections was first gathered from the website of Brad Spellberg, MD, at https://www.bradspellberg.com/shorter-is-better. The list was then verified through a PubMed search using the terms for each infection and LOT. Data Synthesis Of the 28 identified RCTs, 27 supported shorter antibiotic LOT. These trials were categorized by disease states: complicated urinary tract infections including pyelonephritis (n = 9), community-acquired pneumonia (n = 6), hospital-acquired pneumonia/ ventilator-associated pneumonia (n = 3), skin and soft tissue infections (n = 4), complicated intra-abdominal infections (n = 2), and gram-negative bacteremia (n = 3). The single incongruent trial was conducted on male patients with complicated urinary tract infections, and the results could be explained by a lower than usual dose of antibiotic utilized in the study. Discussion Many RCTs have demonstrated the safety and efficacy of shorter antibiotic LOT for the disease states included in this review. Several of these trials enrolled older adults. Conclusion There are sufficient data to support using shorter antibiotic LOT in older patients. Implementing this strategy can help pharmacists and other health care professionals optimize antibiotic use in older adults.

These case studies review the treatment of patients with overactive bladder (OAB), a chronic condition presenting with urinary urgency, often occurring with frequency and nocturia, which may or may not be associated with urinary incontinence. Patients with OAB can have multiple clinical factors to consider when selecting the optimal therapy, and this treatment series provides examples of approaches to balance treatment selection with other comorbidities and patient expectations.

This article will serve as a quick historical summary of the notorious process of vetting, nominating, and confirming Cabinet members, with a particular emphasis on how it is playing out for President-elect Trump.

Objective: This review summarizes recent case reports where the consumption of dietary supplements by older adults may have caused an adverse event. Data Sources: In December 2023, PubMed was surveyed for case reports published from 2000 onwards, using two medical subject heading (MeSH) terms, "aged" and "dietary supplements," where the latter was combined with the MeSH subheadings "adverse effects," "poisoning," or "toxicity." Major clinical trials for dietary supplements were identified at ClinicalTrials.gov, an online database of clinical research studies, or in PubMed, and screened for information on adverse effects. Data Synthesis: The described search strategy yielded 820 publications, including 122 case reports, which were then manually screened for relevant and informative case reports involving dietary supplements and people 65 years of age or older. Consequently, 41 publications were selected describing 46 individual case reports. Etiologies of adverse events included interactions of dietary supplements with prescribed medication, ingestion of higher-than-intended or instructed supplement doses, intake of the same supplement from multiple sources, and supplement contamination. Prominent adverse events encompassed hypercalcemia (vitamin D), thyroid test interference (vitamin B7), neuropathy (vitamin B6), oxalate nephropathy (vitamin C), and interactions with warfarin therapy (vitamins E and K, and omega-3 fatty acids). Conclusion: Health care practitioners are advised to consider dietary supplements as contributors to adverse clinical symptom presentations, while patients are encouraged to provide current records of their prescribed medications and dietary supplements to their health care providers. This is particularly important for older adults where both medication intake and supplement consumption are high.

Editor Emeritus Chris Alderman reflects on his past five years in his role with The Senior Care Pharmacist. This editorial is his farewell address to the readers as new editors in chief take the helm.