ade overheads final
TRANSCRIPT
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Recognizing
Adverse Drug Events
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ADE Training Overhead 2
Module One: Medications andOlder Adults - Objectives
1. Describe use of medications b older adults.
2. Define t!es of drug interactions and
understand ho" the can occur.#. E$!lain "h it is im!ortant to %no" about druginteractions.
&. 'dentif age-related changes in the bod and
ho" the affect use of medications.(. Outline issues "ith medication use b older
adults) including the !ossibilit that drug effectsma not be identified.
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ADE Training Overhead #
Older Adults and Medications
* Older adults ma%e u! 1#+ of!o!ulation
* Account for:
, About #+ of !rescribedmedications
,About &+ of over-the-countermedications
* At least + ta%e at least one!rescri!tion medication
* 12+ use ten or more !er "ee%
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ADE Training Overhead &
/rescri!tion Drug 0!endingill 'ncrease
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ADE Training Overhead (
ho Ta%es the Most Medications
* omen
* 'ndividuals "ith
multi!le healthconditions
* 3rail elderl
* 4ursing homeresidents
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ADE Training Overhead 5
Medications Most 6ommonl 7sedin the 6ommunit
* Analgesics
* Diuretics* 6ardiovascular
* 0edative-h!notics
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ADE Training Overhead 8
Medications Most 6ommonl 7sedin the 4ursing 9ome
* Anti!schotics
* 0edative-h!notics
* Diuretics* Antih!ertensives
* Analgesics
* 6ardiovascular
* Antibiotics
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ADE Training Overhead
e Must Al"as As%:
* Do the !otential
benefits out"eighthe !otential ris%sfor this individual
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ADE Training Overhead
Drug 'nteractions
* Drug-drug interaction: effects of a drugare altered "hen ta%en at the same time"ith one or more other drugs. The drug
does not !erform as e$!ected.
, Example: as!irin and !rescri!tion blood
thinners such as 6oumadin
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ADE Training Overhead 1
Other Drug 'nteractions
* Drugs can interact"ith other things as"ell:
,A !hsicalcondition
, 3ood
,Alcohol
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ADE Training Overhead 11
Antacids (drugs for relief of
acid indigestion,heartburn, and/or sourstomach)
As% a doctor or !harmacist before use if ou
are: Allergic to mil% or mil% !roducts if the
!roduct contains more than ( gramslactose in a ma$imum dail dose
Ta%ing a !rescri!tion drugAs% a doctor before use if ou have: ;idne disease
Antihistamines (drugs thattemporarily relieve runnynose or reduce sneezing,itchy eyes or throat)
As% a doctor or !harmacist before use if ouare ta%ing:
0edatives or tranlaucoma or difficult in urination due to
an enlarged !rostate gland
?reathing !roblems) such as em!hsema)chronic bronchitis) or asthma
hen using this !roduct: Alcohol) sedatives) and tran
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ADE Training Overhead 12
9o" Do Drug 'nteractions Occur
* Ta%ing t"o drugs that affect the bod inthe same "a can ma%e the im!actstronger , an @additive effect
* 0ome drugs cancel each other out
* Drug ma affect the amount of asubstance in the bod "hich then affectsthe "a another drug is !rocessed
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ADE Training Overhead 1#
9o" Do Drug 'nteractions Occur
* An increase or decrease in an of thefollo"ing:
,Absor!tion, Distribution
, Metabolism
,Elimination
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ADE Training Overhead 1&
Absor!tion
* A change in blood flo" to theintestine
* Metabolism changes to thedrug b the intestine
* A change in the s!eed "ith"hich things move through theintestine B@motilitC
* More or less stomach acidit
* 6hanges in the intestinalbacteria
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ADE Training Overhead 1(
Metabolism and Elimination
An increase leads to a decrease
in en=me activit in drug concentration
and effect
A4D
A decrease leads to an increase
in en=me activit in drug concentration
and effect
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ADE Training Overhead 15
Drug 'nteractions 6an 9ave7nintended Effects
* Decreasing the intended effects of thedrug Bdrug is eliminated too fastC
O
* 'ncreasing the negative effects of the drugBcan lead to to$icitC
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ADE Training Overhead 18
E$am!les of Drug-drug 'nteractions
Patientstaking: Who endedup inhospitalwith:
Were: To havetaken thisdrug in pastweek:
>lburide 9!oglcemia 5 times moreli%el
6o-trimo$a=ole
Digo$in Digo$in to$icit 12 times
more li%el
6larithromcin
BA6ECinhibitor
9!er%alemia 2 timesmore li%el
/otassium-s!aring diuretic
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ADE Training Overhead 1
Age-elated 6hanges:Effects on Medications
* Total bod "ater decreases increased serumconcentration of "ater-soluble drugs
* 6hange in bod "eight influences a!!ro!riatedosage and ho" long it stas in bod:, More bod fat !rolonged half-life
, ess lean bod mass increased drug concentration
* Digestive sstem changes affect the s!eed of
drugs getting into bloodstream
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ADE Training Overhead 1
Age-elated 6hanges:Effects on Medications
* 0lo"er circulation ma dela drugs gettingto liver and %idnes
* 0lo" do"n of liver and %idnes affectstime it ta%es for medication to brea% do"nand leave bod
*ess absor!tion from transdermal !atches* Drug @rece!tor sites ma be different inolder adults
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ADE Training Overhead 2
9o" ?od and Medications 'nteract
* /harmaco%inetics , "hat the boddoes to the medication
Babsor!tion)etc.C
* /harmacodnamics , "hat themedication does to the bod
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ADE Training Overhead 21
@Anticholinergic Effects
* Dr mouth
* Dr s%in
* 6onsti!ation* 7rinar retention
* Ata$ia
* 6an also bring on dementiaFdelirium
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ADE Training Overhead 22
Other 'ssues ith Medication 7seand Older Adults
* A!!ro!riateness
* Multi!le medicalconditions
* Multi!le !hsicians* /ol!harmac
* 7nderuse
* 6ost
* 4oncom!liance
* ac% of research
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ADE Training Overhead 2#
0ignals of /ossible Medication/roblem
* 3alls
*estlessness* 6onfusion
* oss of memor
* 6onsti!ation
* 0lee! disorders
* eight loss
* ?o"el changes
* 'ncontinence
* Di==iness
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ADE Training Overhead 2&
evie" of 'ssues
* 6hronic health conditions are commonamong older !eo!le.
* There are !hsical changes that come"ith aging that affect ho" the medicationsare !rocessed b the bod.
* Drug effects a!!ear un!redictabl andma be assumed to be another health!roblem or @just old age.
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ADE Training Overhead 2(
The Main /oints
* Medications are not to be given ortaken lightly especially by olderpeople!
* "t is harder #or older bodies toprocess and $etabolize $edications!
* "t is all too easy to $istake a
$edication proble$ #or anotherhealth proble$%
* &ene#its vs! risks
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ADE Training Overhead 25
Module T"o:Adverse Drug Events - Objectives
1. Define @adverse drug event) both !reventableand non-!reventable) and give e$am!les.
2. 7nderstand the difference bet"een an adversedrug event and side effects.
#. 0tate "h it is im!ortant to %no" about adversedrug events) ho" common the are) and ho"dangerous the can be.
&. Discuss drug allergies) "hat causes them) and
identif common sm!toms.(. ;no" the term @ana!hla$is.5. /rovide at least three e$am!les of strategies to
!revent adverse drug events.
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ADE Training Overhead 28
Definitions
* 0ide effect: an action of a drug other thanthe one for "hich it is being used.
* Adverse drug event BADEC: injur resulting
from the medical use of a drug., /reventable ADE: those that result from a
medication error in !rescribing) dis!ensing)administering) or monitoring
, 4on!reventable ADE G Adverse drug reaction.An injur resulting from the medical use of adrug "here no error is involved
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ADE Training Overhead 2
0ide Effects vs. ADEs
Ta%e medication
0m!toms , 0ide effects
'njuries , Adverse drug events
/reventable:Adverse drug event
4ot ,!reventable:Adverse drug reaction
Error
Hes 4o
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ADE Training Overhead 2
h Do e 4eed to;no" About ADEs
* Most common t!e of adverse event in hos!ital
* About 1F# of drug-related hos!itali=ations and Idrug-related deaths occur in !eo!le over age 5
* # to 1+ of all hos!ital admissions for older!atients are due to ADEs
* e!orted incidence higher for older adults, 2 to 1+ in ounger adults
, 2 to 2(+ in older adults* 'n stud of elderl veterans) #(+ had at least
one ADE in !ast ear) and J of those re
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ADE Training Overhead #
9os!itals and ADEs
* ate of ADEs in older hos!itali=ed !atients G2 to 1(+
* 'n 1&) it "as estimated that ADEs ran%edbet"een the fourth and si$th leading causes of
death in the 7.0.* 2 millionK !atients have severe ADEs ever ear
* Due to ADEs) for ever 1) !atients admittedto the hos!ital:
, # "ill die, 1 "ill suffer serious long-term disabilit
* Estimated cost of in!atient ADE ranges fromL1) to L()
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ADE Training Overhead #1
Drug Allergies - Ana!hla$is
* AnaphylacticBan-uh-fuh-A;-ti%Creaction: A severe allergicreaction that can be life-
threatening* are res!onses but dangerous
* Medical hel! is needed andshould be sought immediatel.
* 6all 11 or ta%e the individual tothe emergenc room.
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ADE Training Overhead #2
Ana!hla$is 0m!toms
* 9ives
* 'tching
* 3eeling "arm
* 3lushing
* hee=ing
* Di==iness or
lightheadedness
* 0"elling in the throat
* 'rregular heartbeat
* 4ausea and vomiting
* Diarrhea
* Abdominal cram!ing
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ADE Training Overhead ##
Most 6ommon 6ul!rits:
* /enicillin-related antibiotics are the N1most common , and !enicillin allergies %ill& !eo!le in the 7.0. ever ear
* 0ulfa drugs
* Anti-sei=ure drugs
*Allo!urinol Ba drug for goutC* Drugs for heart rhthm !roblems
* ocal anesthetics
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ADE Training Overhead #&
Most at is% of Allergic eaction:
* Alread have allergies ingeneral
* Ta%e a drug often
* Ta%e a drug in largedoses
*Ta%e a drug in shotsrather than !ills
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ADE Training Overhead #(
6ommon 0m!toms 3rom ADEs
* 6onfusion
* 4ausea
* Decreased balance* 6hange in bo"el !attern
* 0edation
* Orthostatic h!otension
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ADE Training Overhead #5
6lassifications of ADEs
* 0ignificant ,falls "ithout fractures) oversedation)rashes) hemorrhages not re
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ADE Training Overhead #8
4ursing 9ome 0tud
* 9igh rates of adverse drugevents BADEsC:
, 1. ADEs !er 1 residents,About one-half B.5 !er 1
residentsC "ere !reventable
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ADE Training Overhead #
3ound Those Most at is%:
* 4e" residents
* esidents "ith multi!le medical conditions
* esidents ta%ing multi!le medications Bfive or
moreC* esidents ta%ing !schoactive medications)
o!ioids) or anti-infective drugs
* Those at lo"er ris%:, esidents ta%ing nutrientsFsu!!lements
, Men
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ADE Training Overhead #
'n a 6ommunit-?ased 0tud:
* There "ere 1)(2# adverse drug eventsamong #)#8 Medicare !atients
* 2+ "ere considered !reventable
* Overall rate G (.1 !er 1) !erson-ears
* ate of !reventable adverse drug events G1#. !er 1) !erson-ears
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ADE Training Overhead &
ADEs b 6lassification:
* (8 B#+C "ere categori=ed as serious)life-threatening) or fatal:
* 0ignificant &( B52.+C
* 0evere B2.#+C
* ife-threatening 1#5 B .+C
* 3atal 11 B .8+C
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ADE Training Overhead &1
11 3atalities
* & fatal bleeding
* 1 !e!tic ulcer
* 1 neutro!eniaFinfection
* 1 h!oglcemia Blo" blood sugarC
* 1 drug to$icit relating to lithium
* 1 drug to$icit relating to digo$in
* 1 ana!hla$is
* 1 from com!lications of antibiotic-associated diarrhea
* Of the more severe events) in addition to the fatalities)five B(C resulted in !ermanent disabilit) including astro%e.
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ADE Training Overhead &2
Most 6ommonl 'nvolved Drugs:
* 6ardiovascular 25.+
* AntibioticsFanti-infectives 1&.8+
* Diuretics 1#.#+* 4ono!ioid analgesics 11.+
* Anticoagulants 8.+
* 9!oglcemics 5.+
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ADE Training Overhead
Most 6ommon ADEs:
* >astrointestinal tract events22.1+
* ElectrolteFrenal 15.8+
* 9emorrhagic 12.8+
* MetabolicFendocrine .(+
* Dermatologic Bs%inC Fallergic 8.+
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ADE Training Overhead &&
hat ;ind of Errors ed to ADEs
* /rescribing
* Monitoring
* /atient adherence
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ADE Training Overhead &(
'f /rojected toAll Medicare Enrollees:
* 1)) ADEs each ear) among the #million Medicare enrollees
* Of these ADEs:
, More than 1) that "ill be life-threatening
or fatal, More than half of those could have been
!revented
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ADE Training Overhead &5
'ndividuals at 'ncreased is% ofADEs:
* Older) es!eciall age K* More co-morbidit* Multi!le medications
* 'ndividuals ta%ing medications in thesecategories:* Anticoagulants* Antide!ressants* Antibiotics
* 6ardiovascular drugs* Diuretics* 9ormones* 6orticosteroids
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ADE Training Overhead &8
ADE Error /revention for 5(K
Reason "ntervention
Multi!le drug use evie" medication indications
Age-related !hsiologicalterations in metabolism)e$cretion) or drug effects
A!!ro!riate dose adjustments anddecisions) "ith careful considerationof comorbidities
Drug %no"ledge dissemination)allerg chec%ing) and dis!ensing
6om!uteri=ation) !hsician orderentr) decision su!!ort) and bar-coding technolog
7nder!rescribing Avoid age bias
3alls due to medications imit !schoactive !harmacothera!
Delirium due to medications A!!ro!riate drug and dosingindications and non!harmacologicala!!roaches to insomnia
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ADE Training Overhead &
The Main /oints
* Adverse drug events are co$$on
* Adverse drug events can be
dangerous
* 'ever take use o# $edications lightly especially a$ong older adults%
* &ene#its vs! risks
M d l Th 0 i l ' ith
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ADE Training Overhead &
Module Three: 0!ecial 'ssues ithMedications - Objectives
1. E$!lain "h some medications are considered!otentiall ina!!ro!riate for older !eo!le.
2. ?e familiar "ith the ?eers list of !otentiall
ina!!ro!riate medications and ho" it "asdevelo!ed.
#. Describe the safe use of over-the-counter !ainrelievers.
&. 7nderstand concerns about use of insulin fordiabetes.
(. Discuss safet issues "ith cholesterol lo"eringmedications.
/ t ti ll ' i t
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ADE Training Overhead (
/otentiall 'na!!ro!riateMedications for Older Adults
* 9ave a ris% of adverse outcomes thatout"eighs the !otential benefit for most
older !atients.
* There are other alternative medications
that are less li%el to cause !roblems andbe more effective.
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ADE Training Overhead (1
?eers ist
* Effort led b Dr. Mar% ?eers
* /anel of e$!erts in geriatric medicine and!harmacolog
* 11 , 3irst !ublished for nursing homeresidents
* 18 , E$!anded to cover all older adults
* 2# , 7!dated
' i t M di ti
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ADE Training Overhead (2
'na!!ro!riate Medicationsfor Older Adults
* 4ot all !hsicians agree on the criteria
* 7se continues to be a serious !roblem:,Adverse drug reactions
, orse !hsical function
, E$cess healthcare use
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ADE Training Overhead (#
0tud B3eb. 2&C 0ho"ed:
* 'na!!ro!riate medications "ere !rescribed forolder !atients in + of their doctor visits in 2
* Most li%el:
, 'f on multi!le medications, omen t"ice as li%el
* Most common:, /ain reliever !ro!o$!hene BDarvonC
,Antihistamine hdro$=ine BPistaril) Atara$C,Antian$iet dia=e!am BPaliumC
,Antide!ressant amitri!tline BElavilC
, 7rinar tract rela$er o$butnin BDitro!anC
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ADE Training Overhead (&
0tud BAug. 2&C 0ho"ed:
* oo%ed at medication records for over 8()older !atients for 1
* 3ound 21+ filled a !rescri!tion for one or moreina!!ro!riate medications, + filled one !rescri!tion
, 15+ filled t"o or more
, &+ filled three or more
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ADE Training Overhead ((
0tud BAug. 2&C 0ho"ed:
* T"o medications res!onsible for 2.(+ of totalclaims for ?eers list drugs:, amitri!tline BElavilC
, dia=e!am BPaliumC
* Others among the most common:, ccloben=a!rine B3le$erilC
, do$e!in B0ine
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ADE Training Overhead (5
Qhan A!!ro!riateness6lassification
* AA G Al"as should be avoided
* A G arel a!!ro!riate
* 0' G 0ome indications
* 46 G 4ot classified
* 3ound among older !atients:, #+ using at least one of the 11 AA medications
, + using at least one of the A medications
* Most li%el:, Multi!le medications
, /oorer health
0h ld @Al ? A id d f
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ADE Training Overhead (8
0hould @Al"as ?e Avoided for5(K
* ?arbituates
* 3lura=e!am BDalmaneC
* Me!robamate BMilto"n and E
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ADE Training Overhead (
@arel A!!ro!riate for 5(K
* 6hlordia=e!o$ide BibriumC
* Dia=e!am BPaliumC
* /ro!o$!hene BDarvon !roductsC
* 6ariso!rodol B0omaC
* 6hlor=o$a=one B/arafle$C
* 6cloben=e!rine B3le$erilC
* Meta$alone B0%ela$inC* Methocarbamol Boba$inC
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ADE Training Overhead (
OT6 /ain elievers
* Analgesics
* Anti!retics
* 4onsteroidal anti-inflammatordrug B40A'DC
* Acetamino!hen
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ADE Training Overhead 5
Dangers of OT6 /ain elievers
* Aceta$inophen, too much can lead toliver damage) es!eciall if !erson ta%es #Kalcoholic drin%s a da
* '(A"D(, stomach bleeding. 'ncreased
ris%:,Are over 5
, Ta%e !rescri!tion blood thinners Be$am!le)
6oumadinC, 9ave !revious stomach ulcers or otherbleeding !roblems
, Ta%e steroid medications or other 40A'Ds
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ADE Training Overhead 51
Dangers of OT6 /ain elievers
* '(A"D(, also can cause reversibledamage to the %idnes. 'ncreased ris%:
, Over 5
, 9ave high blood !ressure) heart disease) or!re-e$isting %idne disease
, Ta%e a diuretic
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ADE Training Overhead 52
0afe 7se of OT6 /ain elievers
* evie" the A6T'PE '4>ED'E4T0 of andrug being considering
* A !erson "ith an of the ris% factors listed
earlier should tal% to the doctor
* Ta%e medication in the recommendeddoses , do not e$ceed them , and for onl
short !eriods of time.
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ADE Training Overhead 5#
'nsulin
* /eo!le "ith diabetes have a !roblem"ith high blood sugar) so the mahave to ta%e insulin
* Too much insulin can cause lo" blood
sugar* Tr to give the !erson a fast-acting
sugar such as orange juice or soda
* 'f it gets too lo") the !erson can
!ass out.* This is an e$ergency% )et help
right away%
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ADE Training Overhead 5&
6holesterol-o"ering Drugs
* 6an be ver beneficial for a lot of !eo!le
&*T...
* 6an have dangerous side effects:
, Mositis) a severe muscle inflammation
,6an develo! into rhabdomolsis) "hich canbe fatal
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ADE Training Overhead 5(
The Main /oints
* A number of medications are !otentiallina!!ro!riate to use "ith older adults) becausethe ris%s out"eigh the benefits or alternativemedications are available that are safer andFor
more effective.* Even common medications should al"as be
used "ith care
*Again) the im!ortant
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ADE Training Overhead 55
Module 3our: 0afe 7se ofMedications - Objectives
1. 'dentif seven or more
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ADE Training Overhead 58
9o" to >et ?est esults ithMedications
* egible !rescri!tion
* >et !rescri!tions filled at the same !harmac
* Ta%e the medicine in the e$act amount and at the
times that the doctor !rescribes* 7se a !ill organi=er if needed or store all
medications in their original containers
* 0tore medications in a !lace "here the can beeasil seen) but not in the bathroom
* 6ontact the doctor right a"a if the individual hasan !roblems "ith the medicine or an ne"sm!toms
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ADE Training Overhead 5
ules for OT6 Medicines
1. Al"as start b reading the label , all of it.2. oo% for an OT6 medication that "ill treat onl the
current sm!toms.
#. ;no" "hat to avoid "hen ta%ing an OT6 medicine.
&. hen in doubt) as% before using an OT6 medicine.
(. Ta%e the medicine ERA6TH as stated on the label.
5. 7se e$tra caution "hen ta%ing more than one OT6drug !roduct at a time.
8. Do not combine !rescri!tion medicines and OT6 drugs"ithout tal%ing to the doctor first.
. Ma%e sure all doctors have a com!lete list of all themedicines being ta%en.
. Dont use OT6 medicines after their e$!iration date.
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ADE Training Overhead 5
DO 4OT
0to! ta%ing a !rescri!tion medicineunless the doctor sas it is o%a.
Double u! on a dose if one is forgotten.
Mi$ alcohol "ith medicine unless the doctorsas it is o%a.
7se or ta%e medicines in the dar%.
7se or ta%e medicines !rescribed forsomeone else.
>ive ones medicine to someone else.
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ADE Training Overhead 8
Medication ecord
* ;ee! an u!dated record of A++their medicines, including !rescri!tion) over-the-counter)vitamins) and herbal medicines or su!!lements
* Dosage) fre
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ADE Training Overhead 81
4e" @Eas to ead 3ormat
* Must be in standardi=ed eas to follo" format
* 0im!le language must be used) for e$am!le:, @7ses instead of @indications
, @Ma%e "orse instead of @aggravate, @Thro" a"a instead of @discard
, @9el! instead of @assistance
* Must be in !rint that is large enough to readeasil
* 7se gra!hics to ma%e it easier to read
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ADE Training Overhead 82
Drug abels
* Active 'ngredients
* /ur!ose
* 7ses
* arnings
* Directions
* Other 'nformation* 'nactive 'ngredients
* Suestions or 6omments
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@The Three s , Main /oints
* Respectthat OT6s are serious medicine andmust be ta%en "ith care.
* All medications have Risksas "ell as benefits.(Same as the question e !eep as!ing")
* Ta%e Responsibility for learning about ho" tota%e medications safel. 'f in an doubt) as%
healthcare !rovider first.