The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
-
To consider the risk and impact of hypoglycemia in older adults with type 2 diabetes (T2DM), to describe how to interpret blood glucose readings in an older patient's medical record, and to discuss strategies for avoiding hypoglycemia in this patient population. ⋯ Consultant pharmacists can play a critical role in preventing hypoglycemia in long-term care facilities by recommending the use of more physiologic insulin regimens, developing facility protocols for glycemic management, and providing staff education.
-
To review the chemistry, pharmacodynamics, pharmacokinetics, clinical efficacy, tolerability, indications, and dosing and administration of methylnaltrexone methobromide, the first approved peripherally selective opioid receptor-antagonist. ⋯ Methylnaltrexone methobromide is administered into the upper arm, abdomen, or thigh once every other day, with the frequency of dosing being increased, if needed, to a maximum of once daily. Recommended doses are 8 mg, 12 mg, or 0.15 mg/kg, depending on patient weight. For creatinine clearances less than 30 mL/min, the dose should be reduced by 50%. The average wholesale price is $83.33 for a 12 mg single-use vial (Medispan, accessed December 4, 2008). Clearly, parenteral agents are not as useful as oral agents and results of ongoing studies with new oral formulations of this product are eagerly awaited.
-
Over the past few decades, hospices have grown in both number and popularity, and there are now more than 4,500 hospice programs across the United States. Recent changes in the Centers for Medicare and Medicaid Services' Conditions of Participation for hospice programs provide greater opportunities for pharmacists to become members of the interdisciplinary teams caring for hospice patients.
-
Discuss geriatric considerations in the treatment of diabetes mellitus and review the advantages and disadvantages of the various pharmacologic agents, including oral medications and insulin, currently available for the treatment of type 2 diabetes mellitus (T2DM). ⋯ The approach to managing T2DM in the elderly should be conservative and methodical in nature, with careful consideration of side effects, drug-disease and drug-drug interactions, and the risk of inducing hypoglycemia in this at-risk population.
-
Pain is a phenomenon experienced by many older adults, with the majority reporting chronic or recurrent pain. Across the breadth of practice care settings, pain is poorly assessed and poorly managed for older patients and for those with dementia, and the pain management provided is typically even more deficient. Consultant pharmacists have the expertise to help other health care professionals do better in assessing and addressing pain in the older adult, especially those with cognitive impairment. The quality of life for elders can be greatly improved by sharing that expertise.