Pharmacotherapy: Safe Prescribing and Adverse Drug Events

  • Calvin H. Hirsch
  • Shyam Maharaj
  • James A. Bourgeois
Chapter

Abstract

Geriatric patients are likely to be treated with multiple medications for illnesses affecting many organ systems. The addition of psychotropic medication(s) to the regimens of patients already receiving many other medications must therefore be done only after consideration of the many factors that may affect safety and side-effects. These factors include side effects attributable to psychotropic medications themselves, drug-drug interactions, and considerations of age-related changes in drug absorption, pharmacokinetics, and pharmacodynamics. This chapter addresses the issues of polypharmacy in geriatric patients and the specific central nervous system and systemic side effects that need to be actively considered when prescribing psychotropic medications to treat various psychiatric illnesses. Because geriatric patients often have multiple clinicians prescribing medications for multiple illnesses, communication among clinicians and active use of pharmacy profiling are recommended to facilitate safe medication prescribing and monitoring.

Keywords

Older adults Geriatric psychiatry Psychotropic agents Psychopharmacology Geriatric psychopharmacology Drug metabolism Pharmacokinetics Pharmacodynamics Drug toxicity Drug-drug interactions Adverse drug events 

References

  1. 1.
    Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989–95.CrossRefPubMedGoogle Scholar
  2. 2.
    Payne RA. The epidemiology of polypharmacy. Clinical Med (London, England). 2016;16(5):465–9.CrossRefGoogle Scholar
  3. 3.
    Hanlon JT, Pieper CF, Hajjar ER, Sloane RJ, Lindblad CI, Ruby CM, et al. Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci. 2006;61(5):511–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Obreli Neto PR, Nobili A, de Lyra DP Jr, Pilger D, Guidoni CM, de Oliveira Baldoni A, et al. Incidence and predictors of adverse drug reactions caused by drug-drug interactions in elderly outpatients: a prospective cohort study. J Pharm Pharm Sci. 2012;15(2):332–43.Google Scholar
  5. 5.
    Marcum ZA, Amuan ME, Hanlon JT, Aspinall SL, Handler SM, Ruby CM, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012;60(1):34–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Parameswaran Nair N, Chalmers L, Peterson GM, Bereznicki BJ, Castelino RL, Bereznicki LR. Hospitalization in older patients due to adverse drug reactions -the need for a prediction tool. Clin Interv Aging. 2016;11:497–505.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hovstadius B, Hovstadius K, Astrand B, Petersson G. Increasing polypharmacy - an individual-based study of the Swedish population 2005-2008. BMC Clin Pharmacol. 2010;10:16.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gerlach LB, Olfson M, Kales HC, Maust DT. Opioids and other central nervous system-active polypharmacy in older adults in the United States. J Am Geriatr Soc. 2017;65(9):2052–6.Google Scholar
  9. 9.
    Novaes PH, da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G. The “iatrogenic triad”: polypharmacy, drug-drug interactions, and potentially inappropriate medications in older adults. Int J Clin Pharm. 2017;39(4):818–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Barnett ML, Song Z, Landon BE. Trends in physician referrals in the United States, 1999-2009. Arch Intern Med. 2012;172(2):163–70.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hirsch CH, Maharaj S, Bourgeois JA. The chief adverse effects of medications. In: Hategan A, Bourgeois JA, Hirsch CH, editors. On-call geriatric psychiatry: handbook of principles and practice. Cham: Springer Nature; 2016, pp. 161–83.Google Scholar
  12. 12.
    Wimmer BC, Cross AJ, Jokanovic N, Wiese MD, George J, Johnell K, et al. Clinical outcomes associated with medication regimen complexity in older people: a systematic review. J Am Geriatr Soc. 2017;65(4):747–53.CrossRefPubMedGoogle Scholar
  13. 13.
    Gertz BJ, Holland SD, Kline WF, Matuszewski BK, Freeman A, Quan H, et al. Studies of the oral bioavailability of alendronate. Clin Pharmacol Ther. 1995;58(3):288–98.CrossRefPubMedGoogle Scholar
  14. 14.
    Zijp IM, Korver O, Tijburg LB. Effect of tea and other dietary factors on iron absorption. Crit Rev Food Sci Nutr. 2000;40(5):371–98.CrossRefPubMedGoogle Scholar
  15. 15.
    Preskorn S, Ereshefsky L, Chiu YY, Poola N, Loebel A. Effect of food on the pharmacokinetics of lurasidone: results of two randomized, open-label, crossover studies. Hum Psychopharmacol. 2013;28(5):495–505.CrossRefPubMedGoogle Scholar
  16. 16.
    Nordstrom M, Melander A, Robertsson E, Steen B. Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients. Drug Nutr Interact. 1987;5(2):67–9.PubMedGoogle Scholar
  17. 17.
    Jung H, Peregrina AA, Rodriguez JM, Moreno-Esparza R. The influence of coffee with milk and tea with milk on the bioavailability of tetracycline. Biopharm Drug Dispos. 1997;18(5):459–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Chin TW, Loeb M, Fong IW. Effects of an acidic beverage (Coca-Cola) on absorption of ketoconazole. Antimicrob Agents Chemother. 1995;39(8):1671–5.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Eusebi LH, Rabitti S, Artesiani ML, Gelli D, Montagnani M, Zagari RM, et al. Proton pump inhibitors: risks of long-term use. J Gastroenterol Hepatol. 2017;32(7):1295–302.CrossRefPubMedGoogle Scholar
  20. 20.
    Panday K, Gona A, Humphrey MB. Medication-induced osteoporosis: screening and treatment strategies. Ther Adv Musculoskelet Dis. 2014;6(5):185–202.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lee JW, Morris JK, Wald NJ. Grapefruit juice and statins. Am J Med. 2016;129(1):26–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Timbo BB, Ross MP, McCarthy PV, Lin CT. Dietary supplements in a national survey: prevalence of use and reports of adverse events. J Am Diet Assoc. 2006;106(12):1966–74.CrossRefPubMedGoogle Scholar
  23. 23.
    Geller AI, Shehab N, Weidle NJ, Lovegrove MC, Wolpert BJ, Timbo BB, et al. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015;373(16):1531–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Di Minno A, Frigerio B, Spadarella G, Ravani A, Sansaro D, Amato M, et al. Old and new oral anticoagulants: food, herbal medicines and drug interactions. Blood Rev. 2017;31(4):193–203.CrossRefPubMedGoogle Scholar
  25. 25.
    Gardiner P, Phillips R, Shaughnessy AF. Herbal and dietary supplement--drug interactions in patients with chronic illnesses. Am Fam Physician. 2008;77(1):73–8.PubMedGoogle Scholar
  26. 26.
    Lund BC, Carnahan RM, Egge JA, Chrischilles EA, Kaboli PJ. Inappropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44(6):957–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Ni Chroinin D, Neto HM, Xiao D, Sandhu A, Brazel C, Farnham N, et al. Potentially inappropriate medications (PIMs) in older hospital in-patients: prevalence, contribution to hospital admission and documentation of rationale for continuation. Australas J Ageing. 2016;35(4):262–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Hyttinen V, Jyrkka J, Valtonen HA. Systematic review impact of potentially inappropriate medication on health care utilization and costs among older adults. Med Care. 2016;54(10):950–64.CrossRefPubMedGoogle Scholar
  29. 29.
    American Geriatrics Society 2015. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  30. 30.
    O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher PSTOPP. START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Ryan C, O'Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68(6):936–47.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Blanco-Reina E, Garcia-Merino MR, Ocana-Riola R, Aguilar-Cano L, Valdellos J, Bellido-Estevez I, et al. Assessing potentially inappropriate prescribing in community-dwelling older patients using the updated version of STOPP-START criteria: a comparison of profiles and prevalences with respect to the original version. PLoS One. 2016;11(12):e0167586.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hill-Taylor B, Walsh KA, Stewart S, Hayden J, Byrne S, Sketris IS. Effectiveness of the STOPP/START (screening tool of older Persons' potentially inappropriate prescriptions/screening tool to alert doctors to the right treatment) criteria: systematic review and meta-analysis of randomized controlled studies. J Clin Pharm Ther. 2016;41(2):158–69.CrossRefPubMedGoogle Scholar
  34. 34.
    GeriatricsCareOnline.org. GeriatricsCareOnline.org: American Geriatrics Society; 2017. Online store for Beers Criteria and mobile apps. Available from: https://geriatricscareonline.org/ProductAbstract/beers-pocket-card/PC001. Accessed 9 May 2017.
  35. 35.
    West T, Pruchnicki MC, Porter K, Emptage R. Evaluation of anticholinergic burden of medications in older adults. J Am Pharm Assoc JAPhA. 2013;53(5):496–504.CrossRefGoogle Scholar
  36. 36.
    Beuscart JB, Dupont C, Defebvre MM, Puisieux F. Potentially inappropriate medications (PIMs) and anticholinergic levels in the elderly: a population based study in a French region. Arch Gerontol Geriatr. 2014;59(3):630–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015;15:31.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Chatterjee S, Bali V, Carnahan RM, Johnson ML, Chen H, Aparasu RR. Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression. Am J Geriatr Psychiatry. 2016;24(6):485–95.Google Scholar
  39. 39.
    Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401–7.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Jeon WJ, Dean B, Scarr E, Gibbons A. The role of muscarinic receptors in the pathophysiology of mood disorders: a potential novel treatment? Curr Neuropharmacol. 2015;13(6):739–49.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Chatterjee S, Bali V, Carnahan RM, Chen H, Johnson ML, Aparasu RR. Anticholinergic medication use and risk of fracture in elderly adults with depression. J Am Geriatr Soc. 2016;64(7):1492–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46(12):1481–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Lampela P, Lavikainen P, Garcia-Horsman JA, Bell JS, Huupponen R, Hartikainen S. Anticholinergic drug use, serum anticholinergic activity, and adverse drug events among older people: a population-based study. Drugs Aging. 2013;30(5):321–30.CrossRefPubMedGoogle Scholar
  44. 44.
    Magin PJ, Morgan S, Tapley A, McCowan C, Parkinson L, Henderson KM, et al. Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines' levels of anticholinergic activity and clinical indications. J Clin Pharm Ther. 2016;41(5):486–92.CrossRefPubMedGoogle Scholar
  45. 45.
    Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508–13.CrossRefPubMedGoogle Scholar
  46. 46.
    Bloch F, Thibaud M, Dugue B, Breque C, Rigaud AS, Kemoun G. Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J Aging Health. 2011;23(2):329–46.CrossRefPubMedGoogle Scholar
  47. 47.
    Gebara MA, Lipsey KL, Karp JF, Nash MC, Iaboni A, Lenze EJ. Cause or effect? Selective serotonin reuptake inhibitors and falls in older adults: a systematic review. Am J Geriatr Psychiatry. 2015;23(10):1016–28.Google Scholar
  48. 48.
    Iaboni A, Flint AJ. The complex interplay of depression and falls in older adults: a clinical review. Am J Geriatric Psychiatry. 2013;21(5):484–92.Google Scholar
  49. 49.
    Lenze EJ, Rogers JC, Martire LM, Mulsant BH, Rollman BL, Dew MA, et al. The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. Am J Geriatr Psychiatry. 2001;9(2):113–35.Google Scholar
  50. 50.
    Marcum ZA, Perera S, Thorpe JM, Switzer GE, Castle NG, Strotmeyer ES, et al. Antidepressant use and recurrent falls in community-dwelling older adults: findings from the health ABC study. Ann Pharmacother. 2016;50(7):525–33.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    American Geriatrics Society. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  52. 52.
    Erickson SC, Le L, Zakharyan A, Stockl KM, Harada AS, Borson S, et al. New-onset treatment-dependent diabetes mellitus and hyperlipidemia associated with atypical antipsychotic use in older adults without schizophrenia or bipolar disorder. J Am Geriatr Soc. 2012;60(3):474–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Ramaswamy K, Masand PS, Nasrallah HA. Do certain atypical antipsychotics increase the risk of diabetes? A critical review of 17 pharmacoepidemiologic studies. Ann Clin Psychiatry. 2006;18(3):183–94.CrossRefPubMedGoogle Scholar
  54. 54.
    Lipscombe LL, Levesque LE, Gruneir A, Fischer HD, Juurlink DN, Gill SS, et al. Antipsychotic drugs and the risk of hyperglycemia in older adults without diabetes: a population-based observational study. Am J Geriatr Psychiatry. 2011;19(12):1026–33.Google Scholar
  55. 55.
    Bishara A, Phan SV, Young HN, Liao TV. Glucose disturbances and atypical antipsychotic use in the intensive care unit. J Pharm Pract. 2015;72:438–45. 9Google Scholar
  56. 56.
    Coupland C, Dhiman P, Morriss R, Arthur A, Barton G, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ (Clinical research ed). 2011;d4551:343.Google Scholar
  57. 57.
    De Picker L, Van Den Eede F, Dumont G, Moorkens G, Sabbe BG. Antidepressants and the risk of hyponatremia: a class-by-class review of literature. Psychosomatics. 2014;55(6):536–47.CrossRefPubMedGoogle Scholar
  58. 58.
    Bhuvaneswar CG, Baldessarini RJ, Harsh VL, Alpert JE. Adverse endocrine and metabolic effects of psychotropic drugs: selective clinical review. CNS Drugs. 2009;23(12):1003–21.CrossRefPubMedGoogle Scholar
  59. 59.
    Liamis G, Milionis H, Elisaf MA. Review of drug-induced hyponatremia. Am J Kidney Dis. 2008;52(1):144–53.Google Scholar
  60. 60.
    Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):723–33.CrossRefPubMedGoogle Scholar
  61. 61.
    Szalat A, Mazeh H, Freund HR. Lithium-associated hyperparathyroidism: report of four cases and review of the literature. Eur J Endocrinol. 2009;160(2):317–23.CrossRefPubMedGoogle Scholar
  62. 62.
    Niethammer M, Ford B. Permanent lithium-induced cerebellar toxicity: three cases and review of literature. Mov Disord. 2007;22(4):570–3.Google Scholar
  63. 63.
    Juurlink DN, Mamdani MM, Kopp A, Rochon PA, Shulman KI, Redelmeier DA. Drug-induced lithium toxicity in the elderly: a population-based study. J Am Geriatr Soc. 2004;52(5):794–8.CrossRefPubMedGoogle Scholar
  64. 64.
    Perry PJ, Wilborn CA. Serotonin syndrome vs neuroleptic malignant syndrome: a contrast of causes, diagnoses, and management. Ann Clin Psychiatry. 2012;24(2):155–62.PubMedGoogle Scholar
  65. 65.
    de Abajo FJ. Effects of selective serotonin reuptake inhibitors on platelet function: mechanisms, clinical outcomes and implications for use in elderly patients. Drugs Aging. 2011;28(5):345–67.CrossRefPubMedGoogle Scholar
  66. 66.
    Abadie D, Rousseau V, Logerot S, Cottin J, Montastruc JL, Montastruc F. Serotonin syndrome: analysis of cases registered in the French Pharmacovigilance database. J Clin Psychopharmacol. 2015;35(4):382–8.PubMedGoogle Scholar
  67. 67.
    Jhun P, Bright A, Herbert M. Serotonin syndrome and opioids--what's the deal? Ann Emerg Med. 2015;65(4):434–5.CrossRefPubMedGoogle Scholar
  68. 68.
    Douros A, Grabowksi K, Stahlmann R. Drug-drug interactions and safety of linezolid, tedizolid, and other oxazolidinones. Expert Opin Drug Metab Toxicol. 2015;11(12):1–11.CrossRefGoogle Scholar
  69. 69.
    Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112–20.CrossRefPubMedGoogle Scholar
  70. 70.
    Deardorff OG, Khan T, Kulkarni G, Doisy R, Loehr C. Serotonin syndrome: prophylactic treatment with Cyproheptadine. Prim Care Companion CNS Disord. 2016;18(4).  https://doi.org/10.4088/PCC.16br01966.
  71. 71.
    Takeuchi H, Suzuki T, Remington G, Uchida H. Antipsychotic polypharmacy and corrected QT interval: a systematic review. Can J Psychiatry. 2015;60(5):215–22.Google Scholar
  72. 72.
    Vieweg WV, Wood MA, Fernandez A, Beatty-Brooks M, Hasnain M, Pandurangi AK. Proarrhythmic risk with antipsychotic and antidepressant drugs: implications in the elderly. Drugs Aging. 2009;26(12):997–1012.CrossRefPubMedGoogle Scholar
  73. 73.
    Waring WS. Clinical use of antidepressant therapy and associated cardiovascular risk. Drug Healthc Patient Saf. 2012;4:93–101.Google Scholar
  74. 74.
    Jiang HY, Chen HZ, Hu XJ, Yu ZH, Yang W, Deng M, et al. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2015;13(1):42–50.e3Google Scholar
  75. 75.
    Shin D, Oh YH, Eom CS, Park SM. Use of selective serotonin reuptake inhibitors and risk of stroke: a systematic review and meta-analysis. J Neurol. 2014;261(4):686–95.CrossRefPubMedGoogle Scholar
  76. 76.
    Adams EN, Marks A, Lizer MH. Carbamazepine-induced hyperammonemia. Am J Health Syst Pharm. 2009;66(16):1468–70.CrossRefPubMedGoogle Scholar
  77. 77.
    Wu YF. Recurrent hyperammonemia associated with olanzapine. J Clin Psychopharmacol. 2017;37(3):366–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Calvin H. Hirsch
    • 1
  • Shyam Maharaj
    • 2
  • James A. Bourgeois
    • 3
  1. 1.Division of General MedicineUniversity of California Davis Medical CenterSacramentoUSA
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.Baylor Scott and White Department of PsychiatryTexas A&M University College of MedicineTempleUSA

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