Senior Care Pharmacist最新文献

This case study examines how patients with Parkinson's disease (PD) may develop dopamine dysregulation syndrome (DDS), a condition characterized by the misuse of dopamine replacement therapy through excessive self-directed dosing beyond what is necessary to control motor symptoms. While carbidopa/levodopa remains the mainstay therapy for many adults with PD, some patients may choose Mucuna pruriens, a complementary medicine containing levodopa, to manage their motor symptoms. This case describes a patient with PD who presents with DDS following co-administration of self-directed Mucuna pruriens alongside extended-release (ER) and immediate-release (IR) carbidopa/levodopa. Recognizing the presentation and risk factors of DDS is crucial, as is educating and monitoring patients with PD to prevent misuse of both their prescribed dopamine replacement therapy and Mucuna pruriens supplements.

Background Oral therapy is widely used to treat many infections. However, there is less consensus regarding the use of oral antibiotics for serious infections. Objective This review aims to evaluate randomized controlled trials (RCTs) comparing intravenous and oral antibiotic treatments for osteomyelitis, endocarditis, and bacteremia, with a particular emphasis on data pertaining to older adults. Data Source A list of RCTs comparing intravenous and oral antibiotics for these types of infections was compiled through a search of PubMed and EMBASE. Data Synthesis A total of 19 RCTs were identified, including nine for osteomyelitis, three for endocarditis, six for bacteremia, and one addressing both osteomyelitis and bacteremia. All trials reported no significant difference between intravenous and oral antibiotic treatments. The inclusion of older adults varied across infection types. For osteomyelitis, only three of the ten RCTs had a mean patient age of 60 years or older. For endocarditis, two of the three RCTs had a mean patient age of 60 years or older. Lastly, for bacteremia, four of the seven RCTs had a mean patient age of 60 years or older. Discussion All retrieved RCTs support the use of fully or partially oral antibiotic regimens for osteomyelitis, endocarditis, and bacteremia. Although data support the use of oral antibiotics in older adults for all three infection types, the number of trials that included older adults varied. Conclusions Several RCTs support the use of fully or partially oral antibiotic regimens for osteomyelitis, endocarditis, and bacteremia. Oral agents may be reasonable options for older adults, depending on an individual's benefit-to-risk assessment.

In this case, a 67-year-old male experienced a progression of his Parkinson's disease symptoms following an inpatient hospitalization for pneumonia. He presents to the neurology clinic for follow-up, where the neurology ambulatory care pharmacist was consulted to assist with his case. The pharmacist identified a medication reconciliation discrepancy that resulted in an unintentional change in the dosing frequency of his carbidopa/levodopa. This, combined with the initiation of metoclopramide, a dopamine-receptor antagonist, led to a worsening of his Parkinson's symptoms. His carbidopa/levodopa dose was titrated back to the previous regimen, metoclopramide was discontinued, and his symptoms significantly improved. This case highlights the importance of best practices in medication reconciliation for patients with Parkinson's disease, the impact of drug-disease interactions, and emphasizes the critical role of ambulatory care pharmacists in geriatric patient care.

Background The patient is an 85-year-old resident of a skilled nursing facility (SNF) who sustained a hip fracture resulting from a fall. This injury required hip surgery and subsequent admission to a rehabilitation facility for a short-term stay. Her past medical history includes hypertension, type 2 diabetes mellitus, osteoporosis, and depression. Assessment The consultant pharmacist and physical therapist (PT) collaborate to assess the resident's functional abilities, mobility, gait, medications, and mentation using principles of Age-Friendly care. Screening for pain, mobility, frailty, and fall risk are performed to develop a comprehensive care plan for her rehabilitation. The speech-language pathologist (SLP) and occupational therapist (OT) assess and identify restrictions in range of motion, which are addressed through targeted exercises aimed at improving strength, stability, and cognitive function. The pharmacist evaluates the risks and benefits of each medication and, applying the Beers Criteria®, recommends deprescribing those with anticholinergic properties. Outcomes The pharmacist, PT, OT, and SLP components of the comprehensive care plan are implemented and monitored. The resident becomes stronger, more stable, cognitively alert, and better able to participate in her rehabilitation on a daily basis. Despite being frail and at high risk for falls upon admission, the resident undergoes rehabilitation through physical, occupational, and speech-language exercises that improve her gait, strength, and endurance, enhance stability during transitions, and reduce her fall risk. The pharmacist collaborates with the resident's physician to discontinue anticholinergic medications without compromising pain management or sleep quality. Instead of doxepin, a highly anticholinergic antidepressant, the resident is effectively transitioned to escitalopram, resulting in a stable mood. By optimizing her medications, the risk of cognitive decline is mitigated; the resident is able to think more clearly and exhibits less confusion. Conclusion Caring for residents with impaired function and mobility requires a comprehensive assessment and the application of the 4Ms: What Matters, Medication, Mobility, and Mentation. When pharmacists collaborate with other care providers during assessment and care planning, coordinated and successful outcomes can be achieved. Although the resident primarily presented with mobility issues, her case illustrates the interplay of all 4Ms and underscores the importance of a collaborative approach. This patient, whose main concern was mobility, required interventions to optimize medications and address mentation through the treatment of depression, all while maintaining a focus on what matters most to her as an individual.