Safe Use of Acetaminophen

FDA_Whyte-9922R

John J. Whyte, MD, MPH
Director, Professional Affairs & Stakeholder Engagement
U.S. Food and Drug Administration

Millions of people use pain relievers every day and when used correctly, these medicines are safe and effective. As we age, we may find ourselves using these medications more often than in the past. Making sure we use them according to the label directions is important because they can really take a toll on our health when not used correctly.

The key is making sure you know the active ingredients of, and directions for, all your medicines before you use them.

Many over-the-counter (OTC) medicines that are sold for different uses actually have the same active ingredient. Also, active ingredients in OTC medicines can be the same as ingredients in prescription medicines. For example, a cold-and-cough remedy may have the same active ingredient as a headache remedy or a prescription pain reliever.

There are two basic types of OTC pain relievers. Some contain acetaminophen and others contain non-steroidal anti-inflammatory drugs (NSAIDs). These medicines are used to temporarily reduce fever, as well as temporarily relieve the minor aches and pains associated with:

  • minor pain of arthritis
  • headaches
  • muscle pain
  • backache
  • menstrual pain
  • toothaches
  • the common cold

We’ll focus on acetaminophen here. Acetaminophen is a common pain reliever and fever reducer, but taking too much can lead to liver damage. The risk for liver damage may be increased if you drink three or more alcoholic drinks while using medicines containing acetaminophen. Continue reading

Older Adults and Medication: A Geriatrician’s Experience

ST picStephanie Trifoglio, MD, FACP
AGS Member
Private Practice Internist & Geriatrician 

As a geriatrician, I see all of my patients myself, carefully take their history, and review all of their medications, both prescribed and over the counter (OTC).  One patient’s story highlights why this is still very important and worth the time and effort.

A new patient, Mrs. B, came to me for help in managing her dementia. Her husband was remodeling their home to make it accessible as she was now barely able to walk.  She was becoming more confused.  She had previously seen an internist and two neurologists.  Her husband gave a history of Parkinson’s disease, along with a several-year history of colitis and longstanding diarrhea.

The initial history revealed that Mrs. B. had progressive weakness, unsteady gait, and confusion.  She had muscle jerks at night.  She had three recent car crashes and subsequently stopped driving.  She had even lost her ability to do sudoku. This was significant as she had been a doctorate-level biologist.  A review of her medications showed that she had four years of taking Pepto-Bismol, two tablets, four times per day, prescribed for collagenous colitis.  She took this dose consistently.

The active ingredient in Pepto-Bismol is bismuth, and I have never before had a patient take this much bismuth.  Being naturally curious, and always looking for potentially reversible causes of dementia, I did a bit of research and ran basic blood tests on Mrs. B.  I also instructed her to stop taking the bismuth. Continue reading

Older Adults and Substance Abuse Awareness

Palmer MH high(8) res

Alice Pomidor, MD, MPH, AGSF
Professor
Florida State University School of Medicine

Mary Palmer, PhD, RN, FAAN, AGSF
Helen W. and Thomas L. Umphlet Distinguished Professor in Aging
UNC School of Nursing

It’s been called the “invisible epidemic.” In recent years, for the first time, the number of older adults receiving treatment for substance abuse is outpacing that of younger adults.

There are many reasons why the number of older adults who are receiving treatment for substance abuse is on the rise. With aging come very real challenges that can make some older adults more likely to abuse alcohol or drugs.

Job loss, either through retirement or downsizing, caretaking for (or losing) a spouse, children moving away, illness, and financial worries are among the challenges older adults can face. What’s more, some older adults have had had lifelong problems with alcohol or drugs that can become more serious as they age.

What is Substance Abuse?

Substance abuse is an umbrella term that means misusing legal or illegal medications and drugs, as well as misusing alcohol and tobacco. Officially, substance abuse is the use of chemicals that lead to an increased risk of problems and an inability to control your use of the substance.

Addiction, dependence, or “getting hooked” on a drug or alcohol can have especially dangerous consequences for older adults. These substances can cause mental problems, kidney and liver disease, and can cause falls resulting in injuries. Even if you’ve never had a problem with alcohol or drugs, you can become dependent on them in your later years.

Because many older adults manage more than one chronic illness, they may take one or more medications that can interact harmfully. The drugs you take may also react badly with alcohol. The symptoms you may experience as a result may seem to you like typical signs of aging, such as confusion, forgetfulness, dizziness, or sleepiness. In fact, symptoms like these may be reactions due to substance abuse. Continue reading

Polypharmacy and Deprescribing

WebDoes the number of medications you’re taking sometimes seem too high? Maybe it’s time for you and your healthcare provider to give your medication list a check-up by taking a closer look at the prescription and over-the-counter (OTC) treatments you take.

As you grow older, you’re more likely to develop health conditions that require taking multiple medications—some of which you may take for a long time. Many older people also take OTC medications, vitamins, or supplements as part of their routine care. As a result, older adults have a higher risk of overmedication, also known as “polypharmacy”—the medical term for taking four or more medications at the same time. Polypharmacy can increase your chances of unwanted reactions (also called “adverse drug reactions”) due to medications taken on their own or together.

To address this increasingly common problem, healthcare providers are focusing on how to reduce the number of medicines older adults are using through a practice called “deprescribing.” Dr. Michael Steinman, a member of the American Geriatrics Society (AGS) and a geriatrician at the University of California, San Francisco, recently appeared on WPUR—Boston’s NPR News Station—to discuss deprescribing with Dr. Barb Farrell, a pharmacist from Bruyère Geriatric Day Hospital in Ottawa, and Laura Landro, assistant managing editor at the Wall Street Journal. Hear what they had to say.

Want access to more tips and tools to help you manage multiple chronic conditions or multiple medications? We’ve got you covered.

 

The 2015 Updated AGS Beers Criteria: What’s New

Donna-Fick headshotTodd-Semla headshot

Donna M. Fick, PhD, RN, GCNS-BC, FGSA, FAAN

Todd P. Semla, PharmD, MS, AGSF

Co-Chairs of the 2015 Updated AGS Beers Criteria Expert Panel

 

 

 

Today, the American Geriatrics Society (AGS) released its 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. For more than 20 years, the Beers Criteria have served as a valued resource for healthcare professionals about the safety of prescribing medications to older adults. In fact, the AGS Beers Criteria have become one of the most frequently used reference tools in the field of geriatrics. The AGS Beers Criteria were previously updated in 2012.

How We Updated the Beers Criteria
The 2015 Updated AGS Beers Criteria reflect work done by a panel of 13 geriatrics experts convened by the AGS. The panel searched for clinical trials and research studies since the 2012 AGS Beers Criteria were issued, and found more than 20,000 results! From this pool, our team reviewed more than 6,700 studies. From there, we were able to identify more than 40 potentially problematic medications or classes of medications, which we organized into five lists. While these lists aren’t exhaustive, they can be very helpful as conversation-starters between older adults and their healthcare providers about what treatment options work best from one individual to the next.

What’s New?
In addition to updating two lists of medications that may be potentially harmful for people aged 65 and older who are not receiving palliative or hospice care, the 2015 Updated AGS Beers Criteria now contain:

  • Separate guidance on avoiding 13 combinations of medications known to cause harmful “drug-drug interactions.” Some medications may be inappropriate when prescribed together because they can increase an older adult’s risk for falls, fractures, or urinary incontinence, for example.
  • A list of 20 potentially problematic medications to avoid or for which doses should be adjusted depending on an older person’s kidney function. These medications could raise risks for problems such as nausea, diarrhea, bleeding, problems affecting the brain and nervous system, and changes in mental well-being and bone marrow toxicity (a condition in which bone marrow makes fewer blood cells).
  • Three new medications and two new “classes” of medications added to the Criteria. An example of a new class of medication includes the proton-pump inhibitors that some people take for acid reflux or stomach ulcers. Recent studies have linked these medications to an increased risk for bone loss, fractures, and serious bacterial infections, which is why they were added to the 2015 AGS Beers Criteria.

Continue reading