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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S145
Methods:
Inclusion of 31 patients of 60 years and older receiving a
lingering treatment by transdermal fentanyl from January 2013 to
February 2014. We carried out the measures of daily peroral dose of
grade 3 opioids in morphine-equivalent and dose correspondences
observed during a relay of transdermal Fentanyl and a grade 3
peroral morphinic.
Results:
Average age of the patients: 80.6 (
±
8.3) years. Sex ratio
M/F: 1.4.
Three groups:
1. Patients treated by transdermal fentanyl with a complete
analgesia (41.95%)
2. Patients treated by transdermal fentanyl combined with
interdoses of peroral morphinics (38.70%). Pain control was
obtained only by means of regularly administered interdoses.
3. Patients for who were realized a transdermal fetanyl–peroral
morphinics relay due to its insufficient efficacy (19.35%). The
dose of peroral morphine that allowed a complete pain control
was different from the recommended dose (ratio average daily
dose of peroral morphinic/theoretical morphinic dose 0.11–2.38).
In 2/3 of the patients, the administration of half of the peroral
recommended dose caused the appearance of signs of morphine
overdose.
Conclusion:
The efficacy of the analgesic treatment by transdermal
fentanyl varies significantly in the elderly. The clinical dose
equivalence of peroral morphine doesn’t always correspond to
recommendations. We suggest starting the transdermal Fentanyl–
peroral morphine relay by 1/3 of the peroral dose recommended
and adjust it rapidly according to the clinical response.
P-422
Asymptomatic bradycardia due to rivastigmine and delirium
in an elderly patient with Lewy Body Dementia
P. Soysal
1
, A.T. Isik
1
1
Center for Aging Brain and Dementia, Department of Geriatric
Medicine, Dokuz Eylul University, Izmir, Turkey
Objectives:
Rivastigmine is a reversible cholinesterase inhibitor
(ChEI) with demonstrated efficacy in thetreatment of Lewy Body
Dementia (LBD). Although brain is the main target organ during
rivastigmine therapy, cardiac muscle tissue, which is rich from
cholinesterase, could be adversely affected.
Case report:
An 83-year-old male patient was brought to the
department of geriatrics by his relatives for routing control.
The patient, who was being followed for probable LBD, had
been receiving rivastigmine 18mg patch. On his physical
examination, blood pressure was 125/80mmHg, heart beat rate was
45–50/minute. On his analyses performed just after hospitalization,
there was sinus bradycardia (heart rate: 46/min), a PR interval
of 0.24 sec, and incomplete right bundle branch block on
his electrocardiogram (ECG). Blood biochemistry demonstrated
normal hepatic, renal, thyroid functions and no electrolyte
imbalance. Cardiac enzyme levels were within the normal ranges.
Echocardiography revealed no pathological sign except for mild
mitral insufficiency. Considering that bradycardia has resulted from
rivastigmine use, the drug was discontinued. His bradyarrhythmia
disappeared on the next day (heart rate:68/min). Rivastigmine
was commenced again to verify rivastigmine–bradycardia relation
and it was observed that bradycardia developed again.The rhythm
of the patient returned back to normal after discontinuation of
rivastigmine therapy.
Conclusion:
Patients that are receiving ChEIs such as rivastigmine
should be monitored in cardiac aspect even they are asymptomatic.
If another potential cardiotoxic drugs are added to the therapy of
these patients, phsyicians should keep in mind that the risk of
bradycardia may increase, and hypotension, syncope or confusion
may ocur.
P-423
Survey of prescribing data of older adults at dispensing
pharmacies
Y. Suzuki
1
, T. Hirose
2
, M. Sakakibara
3
, M. Akishita
4
, M. Kuzuya
2
1
Nagoya University, Nagoya, Japan;
2
Japan;
3
Sugi Pharmacy, Anjo,
Japan;
4
Tokyo University, Tokyo, Japan
Objectives:
To clarify the status of potentially inappropriate
prescribing in older patients based on prescription data collected
at dispensing pharmacies.
Methods:
We examined the prescriptions of 180,673 patients over
65 years of age (mean age: 76.1
±
7.7) dispensed at 585 pharmacies
during the period between October 1 and October 31, 2014.
Results:
The average number of prescriptions was 4.0
±
3.2 in
the entire study population, 25% of which were prescribed more
than 6 medications. There was a trend that the number of
prescriptions increased with advancing age. The prescription of
medications on the “List of drugs requiring caution in prescribing
to older adults”, released by the Japan Geriatrics Society in 2005,
accounted for 22.9% of the total prescriptions. The most commonly
prescribed drugs on the list were loxoprofen (3.6%, excluding topical
usage and external application), followed by etizolam (3.5%) and
brotizolam (3.4%).
Conclusions:
The present survey clarified status of medication to
older patients based on actual prescribing record at dispensing
pharmacies. Prescription rates of drugs on the list were higher
than we had expected. Despite accumulating evidences of potential
harms in older population, chronic use of benzodiazepines
confirmed in the present survey needs particular attention.
Medication review, which is becoming a standard procedure in
hospital pharmacies, needs warranted in the community healthcare
for older population, who are susceptible to potential harms of
drugs requiring caution. Creating a system for comprehensive
review of prescribed medications by making maximal use of
multidisciplinary expertise would be necessary to endorse safety
of pharmacotherapy in community-dwelling older population.
P-424
Warfarin dose standardizing adjustment in home healthcare
patients in Qatar
F. Umminiyattle
1
, M.E. Shalatt
1
, E. Al Sulaiti
1
, H. Al Hamad
1
,
W. Alam
1
1
Hamad Medical Corporation, Doha, Qatar
Introduction:
Home Healthcare Services (HHCS) in Qatar caters to
around 950 patients with multiple comorbidities. Out of these 10%
of patients are on warfarin for conditions like atrial fibrillation and
valve replacement to prevent stroke and blood clots. Inappropriate
adjustment of warfarin dose after monitoring of International
Normalization Ratio (INR) results in complications like stroke, blood
clots or bleeding.
Objective of the project:
To improve Warfarin dose adjustment by
HHCS physicians, according to the international guidelines, from
45% to 90% from February 02, 2014 to April15, 2015.
Methods:
The project team reviewed literature for evidence based
guidelines for Warfarin dose adjustment. Based on these guidelines
a template was created. It consisted of two parts including an
evidence based guideline and a prescription which had to be filled
by the physician during each dose adjustments. Template also gave
information about the probable weeks for next INR test. The staff
was instructed to trigger the physicians to complete the checklist.
All physicians, staff and clinical pharmacists were educated on use
of the template.
Measurement and improvement:
Base line data in March 2014
showed only 45% of patients had their warfarin dose adjusted
according to evidence based practices.
After intervention in July 2014 92% of patients had their warfarin
dose adjusted according to evidence based practices.