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Objective: To review the assessment and recommended management of mild to moderate chronic pain in the older adult. Data sources: Medline search using the terms pain, older adult, and analgesics, current national guidelines, and authors' case experiences. Data synthesis: Assessing pain in cognitively intact and impaired older adults is essential to safe use of psychoactive medications. Following the guidelines of the American Geriatrics Society for persistent pain in the older adult provides guidance to the safe use of analgesics and other psychoactive drugs. Dosing of acetaminophen should be limited to avoid liver toxicity, and topical analgesics are preferred for focal pain. Full-dose nonsteroidal anti-inflammatory drugs should not be used for more than short periods, in order to avoid gastrointestinal, renal, and cardiovascular complications. Potentially inappropriate opioid analgesics and safer alternatives are encouraged. A description of other psychoactive medications for neuropathic pain and the role of vitamin D and depression in chronic pain is provided. Conclusion: The assessment of pain and use of analgesics in the older adult should benefit and not increase drug-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To review fall epidemiology, risk factors, assessments and intervention methods, and outcomes in order to provide guidance to pharmacists. Data sources: Recently published articles listed in Medline and resources on the Agency for Healthcare Research and Quality website (www.ahrq.gov) identified using the search terms falls, medications and falls, fall risk factors, and falls interventions and outcomes; personal data in preparation for publication consideration by the authors; and bibliographies from gathered articles. Data synthesis: Falls may result from multiple risk factors that should be considered to both prevent falls and intervene when a fall has occurred. Careful consideration of the total psychoactive drug load, especially psychotropic drugs, and well-planned recommendations for tapering, discontinuing, and/or replacing drugs implicated in increasing fall risk are presented. A fall risk assessment method that incorporates fall history and risk factors, current disease states and conditions, and medications that may increase fall risk is provided. Two cases with interventions and outcomes are detailed. Because anemia may increase fall risk, adequate assessment of the cause(s) of anemia and conservative recommendations to correct it may decrease fall risk. Adequate vitamin D and calcium intake also may be essential to both decrease falls and fall-related fracture risk. Suggested alternatives and tapering for drugs implicated in increasing falls are considered. Osteoporosis risk assessment is a further area requiring delineation for possible pharmacist assistance to the patient and prescriber to reduce the risk of both fall-related and nontrauma fractures. Interventions to change medications may reduce falls by up to 70%. Additional fall-related resources on the Internet are provided. Conclusion: Pharmacists can play an important role by identifying patients who may have fall risk factors and history and by providing information for drug changes that may reduce fall risk. [ABSTRACT FROM AUTHOR]

The contribution of a consultant pharmacist to a 33‐month study of analgesic and anti‐inflammatory drug usage by 210 elderly long‐term patients was evaluated by a fifth‐year pharmacy student. In the 143 patients who used analgesics and anti‐inflammatory agents, significant changes were noted, viz, decreased use of codeine (p = .002); increased use of acetaminophen (p = .003) and anti‐inflammatory agents (p = .020); increased regular scheduling of aspirin and acetaminophen; and an overall decrease in total drug usage from 7.2 to 4.8 drugs per patient. No effect was noted on the number of analgesics per patient, and the percentage of aspirin or propoxyphene or acetaminophen combinations used. A protocol was established for pain therapy, including a system of stop orders for propoxyphene and codeine.

Affixed auxiliary prescription labels are widely used in the practice of pharmacy because they supposedly provide the patient with pertinent information that is not contained within the prescription signature. Yet, whether the labels are effective is not known, nor is it known whether the label's elements, such as color, form, and logo, affect perception of the written text. Sound scientific analyses of these questions are limited. Therefore, a pilot study involving a series of experiments was designed to determine whether individual perception of pertinent information is affected by the use of affixed auxiliary prescription labels. The second objective of this study was to evaluate how color and logo differences affected perception of the label's written text.Participants were selected for the experiments after being screened for color blindness, corrected vision, and, in some cases, previous pharmacy employment. Subjects viewed labels affixed to prescription vials via a two-channel tachistoscope. The tachistoscopic methodology measured perception, and its accuracy was verified through a forced-choice instrument.Results from the pilot study were threefold: (1) a sound scientific analysis found affixed auxiliary labels to be effective, (2) significant variance could be attributed to both individual and subject differences, and (3) the unique effects of color and logo could not be determined.

ABSTRACT: In a rural 116‐bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one‐year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health‐care students and the nursing supervisor, who facilitated physician‐pharmacist communication. The physician‐nurse‐pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop‐order and standing‐order protocols were developed. During the one‐year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall reduction was from 7.22 to 4.78 drugs per patient (33.8 percent decrease). The most significant reduction was associated with the protocol and stop‐order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally‐mandated system of consultant pharmacists are discussed.

The liquid and solid solution interactions of eight FD&C dyes in 1% concentration with pharmaceutical gelatins and the effects of the dyes on the disintegration behavior of gelatins were observed. In liquid solution by visible region spectroscopy, all FD&C dyes interacted with a type A gelatin. The xanthene dye, FD&C Red No. 3 (erythrosine), interacted to the greatest extent by a combination of ionic, hydrogen, and hydrophobic types of bonds. The FD&C dyes did not appear to interact with a type B gelatin. A method for simulating a gelatin capsule shell wall was devised to examine solid-state interactions by visible and IR-attenuated total reflectance spectroscopy, dye release patterns, and the effect of the dyes on gelatin disintegration. FD&C Red No. 3 and Violet No. 1 in solid solution appeared to interact to a greater extent than the other FD&C dyes. Hydrogen bonding changes in the solid solution films of both gelatins were not observable by IR-attenuated total reflectance spectroscopy until very high (1:10 to 1:5) dye-protein ratios were attained. The same two dyes (FD&C Red No. 3 and Violet No. 1) that showed the greatest spectral changes exhibited the slowest release times from both gelatins at temperatures both below and within the temperature range at which gelatins disintegrate and go into colloidal solution. In simulated gastric fluid USP without pepsin, the FD&C Red No. 3 dye greatly diminished the average disintegration rate of both gelatins. The addition of pepsin essentially eliminated the effect of FD&C Red No. 3 on gelatin disintegration. In simulated intestinal fluid USP without pancreatin, both gelatins disintegrated slower than in simulated gastric fluid without pepsin. FD&C Red No. 3 also had a detrimental effect on gelatin disintegration in simulated intestinal fluid without pancreatin. Pancreatin was not added to the simulated intestinal fluid because of its interference with visualization of disintegration.

Pulmonary drug interactions are concerned primarily with drugs used to treat chronic obstructive airway diseases (COAD) such as asthma, chronic bronchitis, and/or emphysema. COAD interactions In COADs, the eighth leading [...]

Anticoagulant drug interactions (September/October '85 column) dealt with cofactors, toxic and therapeutic signs and lab tests to monitor the oral anticoagulants, and an overview of significant interactions. This column (Part [...]

Guidelines for consultant pratice Consultant pharmacy is a blend of community and institutional practice. The three overlapping areas of professional functions are administrative, distributive, and clinical as outlined in the [...]

Gastrointestinal Drug Interactions Gastrointestinal complaints of nausea, queasiness, heartburn, and alternating constipation or diarrhea are perhaps the most frequent functional complaint seen in the long-term-care facility patient. Many such complaints [...]