Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review

Therapeutics and Clinical Risk Management, Год журнала: 2021, Номер Volume 17, С. 927 - 949

Опубликована: Сен. 1, 2021

Abstract: The rising of global geriatric population has contributed to increased prevalence dementia. Dementia is a neurodegenerative disease, which characterized by progressive deterioration cognitive functions, such as judgment, language, memory, attention and visuospatial ability. not only profoundly devastating physical psychological health outcomes, but it also poses considerable healthcare expenditure burdens. Acetylcholinesterase inhibitors (AChEIs), or so-called anti-dementia medications, have been developed delay the progression neurocognitive disorders decrease needs. AChEIs widely prescribed in clinical practice for treatment Alzheimer's account 70% use results adverse drug reactions (ADRs) cardiovascular gastrointestinal effects, resulting from overstimulation peripheral cholinergic activity muscarinic receptor activation. Changes pharmacokinetics (PK), pharmacodynamics (PD) pharmacogenetics (PGx), occurrence interactions are said be major risk factors ADRs this population. To date, comprehensive reviews so far scarcely studied. Therefore, we aimed recapitulate update diverse aspects AChEIs, including mechanisms action, characteristics ADRs, preventive strategies their ADRs. collation knowledge essential facilitate efforts reduce AChEIs. Keywords: older adults, dementia, acetylcholinesterase inhibitors, reactions, drug–drug

Язык: Английский

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Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review

Drugs & Aging, Год журнала: 2023, Номер 40(12), С. 1085 - 1100

Опубликована: Окт. 20, 2023

To reduce prescribing cascades occurring in clinical practice, healthcare providers require information on the they can recognize and prevent. This systematic review aims to provide an overview of cascades, including dose-dependency recommendations that use prevent or reverse them. The Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) was followed. Relevant literature identified through searches OVID MEDLINE, Embase, CINAHL, Cochrane. Additionally, Web Science Scopus were consulted analyze reference lists citations. Publications English included if analyzed occurrence cascades. Prescribing at least one study demonstrated a significant association excluded when adverse drug reaction could not be confirmed Summary Product Characteristics. Two reviewers independently extracted grouped similar Descriptive summaries provided regarding analyses these A total 95 publications included, resulting 115 with reactions which found. For 52 dose dependency Dose 12 example, antipsychotics may cause extrapyramidal syndrome followed by anti-parkinson drugs. Recommendations focused dosage lowering, discontinuing medication, medication switching. Explicit alternative options given three One example switching ondansetron granisetron is experienced using metoclopramide. In total, them generated provided. Nonetheless, managing scarce.

Язык: Английский

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Optimising the use of electronic medical records for large scale research in psychiatry

Translational Psychiatry, Год журнала: 2024, Номер 14(1)

Опубликована: Июнь 1, 2024

Abstract The explosion and abundance of digital data could facilitate large-scale research for psychiatry mental health. Research using so-called “real world data”—such as electronic medical/health records—can be resource-efficient, rapid hypothesis generation testing, complement existing evidence (e.g. from trials evidence-synthesis) may enable a route to translate into clinically effective, outcomes-driven care patient populations that under-represented. However, the interpretation processing real-world sources is complex because important ‘signal’ often contained in both structured unstructured (narrative or “free-text”) data. Techniques extracting meaningful information (signal) text exist have advanced re-use routinely collected clinical data, but these techniques require cautious evaluation. In this paper, we survey opportunities, risks progress made use medical record (real-world) psychiatric research.

Язык: Английский

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“Kind of blurry”: Deciphering clues to prevent, investigate and manage prescribing cascades

PLoS ONE, Год журнала: 2022, Номер 17(8), С. e0272418 - e0272418

Опубликована: Авг. 31, 2022

Background Prescribing cascades, where a medication is used to treat the side effect of another medication, contribute polypharmacy and related morbidity. Little known about clinicians’ patients’ experiences with prescribing cascades. In this study, we explored why how cascades occur across variety care settings they are managed. Methods findings This descriptive qualitative study employed semi-structured interviews older adults who may have experienced cascade(s), their caregivers, healthcare providers. Interviewees were recruited through physician referral from Geriatric Day Hospital, two long-term homes in Ottawa, Ontario, self-referral Canada. An inductive approach was code data determine themes. Thirty-one conducted for ten unique patient cases. Some interviewees involved more than one case, resulting 22 interviewees. Three themes identified. First, recognition linked awareness effects. Second, investigation management simultaneous iterative (rather linear sequential). Third, prevention requires intentional strategies help people anticipate recognize Difficulty recruitment both central limitation. exemplifies challenges associated studying poorly recognized underexplored phenomenon. Conclusions order better recognize, investigate manage clinicians patients need know effects; ask ‘can be caused by drug?’ when signs symptoms arise or worsen; access information benefit-risk discussions make decisions deprescribing. Approaches raising public should trialed raise profile issue facilitate continued exploration

Язык: Английский

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Prescribing cascades in community‐dwelling adults: A systematic review

Pharmacology Research & Perspectives, Год журнала: 2022, Номер 10(5)

Опубликована: Сен. 19, 2022

Abstract The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing additional medication, referred cascade. aim this systematic review is identify published cascades in community‐dwelling adults. A was reported line with PRISMA guidelines and pre‐registered PROSPERO. Electronic databases (Medline [Ovid], EMBASE, PsycINFO, CINAHL, Cochrane Library) grey literature sources were searched. Inclusion criteria: adults; risk‐prescription medication; outcomes‐initiation new medicine “treat” reduce ADR risk; study type‐cohort, cross‐sectional, case‐control, case‐series studies. Title/abstract screening, full‐text data extraction, methodological quality assessment conducted independently duplicate. narrative synthesis conducted. total 101 studies (reported 103 publications) included. Study sample sizes ranged from 126 11 593 989 participants 15 examined older adults specifically (≥60 years). Seventy‐eight potential cascade including calcium channel blockers loop diuretic ( n = 5), amiodarone levothyroxine inhaled corticosteroid topical antifungal 4), antipsychotic anti‐Parkinson acetylcholinesterase inhibitor urinary incontinence drugs 4). Identified occurred within three months one year following initial medication. Methodological varied across included Prescribing occur for broad range medications. ADRs should be differential diagnosis patients presenting symptoms, particularly those who started medication preceding 12 months.

Язык: Английский

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Drug Utilisation Review among Geriatric Patients with Noncommunicable Diseases in a Primary Care Setting in Malaysia

Healthcare, Год журнала: 2023, Номер 11(12), С. 1665 - 1665

Опубликована: Июнь 6, 2023

A prospective cross-sectional study was conducted to analyse the drugs prescribed elderly population with noncommunicable diseases and determine polypharmacy at a primary care clinic in Negeri Sembilan, Malaysia. The for 6 months of Gemas. Geriatric patients above age 65 diagnosed were included upon providing written informed consent. majority geriatric between 69 years (mean: 69.72 ± 2.85) 4 or more medications 5.18 0.64, p = 0.007). More than 95% (n 295) geriatrics found have multimorbidity, which around 45% 139) had type-2 diabetes together hypertension dyslipidaemia. Combination therapy 97% 302) elderly, whereas cardiovascular endocrine most commonly prescribed. Ten prescriptions drug-related problems, prescribing cascade (80%), lack medicine optimisation (10%), inappropriate prescription (10%). In this study, multimorbidity; seen among patients. Polypharmacy is biggest threat population, as it increases chances falls fall-related injuries. Medicine deprescribing will reduce problems morbidity mortality associated over-consumption medications. Hence, recommends health fraternity look medication future complications polypharmacy.

Язык: Английский

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Prescribing cascades in ambulatory care: A structured synthesis of evidence

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy, Год журнала: 2023, Номер 44(1), С. 87 - 96

Опубликована: Сен. 25, 2023

The strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by index drug, has not been well characterized. To perform structured, systematic, and transparent review the supporting cascades. Ninety-four potential cascades identified through previously published systematic review. Systematic search literature further characterize (1) Grading based on observational studies investigating associations between drugs, including: Level I-strong [i.e. multiple high-quality studies]; II-moderate single study]; III-fair [no but one or more moderate-quality IV-poor [other]. (2) Listing associated with product's United States Food Drug Administration (FDA) label. (3) Synthesis mechanisms linking drugs events. Of 99 94 were supported confirmatory therefore included this related 30 types reactions affecting 10 different anatomic/physiologic systems investigated total 88 studies, including prescription sequential symmetry analysis (n = 51), cohort 30), case-control 7) studies. Overall, from was strong 18 (19.1%) moderate 61 (64.9%), fair 13 (13.8%), poor 2 (2.1%). Although that link events variable, FDA labels information about most 86) all we clinical are label, evidentiary basis varies, many requiring relevance.

Язык: Английский

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Research on prescribing cascades: a scoping review

Frontiers in Pharmacology, Год журнала: 2023, Номер 14

Опубликована: Июль 3, 2023

Background: The concept of prescribing cascades has been proposed for more than 20 years, but the research progress and cognitive level varied in different countries. aim this study was to systematically evaluate current status relevant original on cascades, provide references further continuous improvement clinical practice. Methods: We searched three English databases four Chinese from inception until January 2022. Relevant studies about meeting eligibility criteria were extracted independently by two reviewers, a descriptive analysis conducted compare methods outcomes included studies. Results: A total 32 involving 7,075,200 patients 11 countries included, including 13 cross-sectional studies, case reports, 7 cohort 1 case-control study. target population mainly elderly people (24 studies). purpose could be divided into categories: prevention (4 studies), identification (17 resolution (11 studies) cascades. 49 cascade routes identified attributed cardiovascular system, most primary diseases which dementia, initial medications calcium channel blockers, six drugs involved routes. Conclusion: Prescribing have attracted attention internationally focused their nervous diseases, still not yet formed integral other special populations drug use, such as children pregnant women. It is necessary conduct in-depth with broader range, establish series effective measures decrease incidence high-risk group use.

Язык: Английский

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Predictors of Adverse Drug Reaction-Related Hospitalisations Among People with Dementia: A Retrospective Case-Control Study

Drug Safety, Год журнала: 2024, Номер 47(8), С. 771 - 781

Опубликована: Май 13, 2024

Adverse drug reactions (ADRs) are common among people with dementia; however, little is known about the magnitude and predictors associated ADR-related hospitalisation these individuals. This study aimed to determine magnitude, types, drugs implicated of ADRs dementia. retrospective case-control analysed medical records individuals aged ≥ 65 years dementia admitted major public hospitals in Tasmania, Australia, from July 2010 2021. were identified using administrative data cross-checked hospital records, consensus reached research team. Of 7928 at least once within period, 1876 (23.7%) experienced one hospitalisation. these, 300 case patients 311 control randomly selected. The most types renal (acute kidney injury; AKI) (36.0%), followed by neuropsychiatric (17.6%), cardiovascular (16.0%) haematological (13.1%). Diuretics, renin-angiotensin system (RAS) inhibitors anti-thrombotics constituted main classes. was with: chronic disease (CKD) (OR 8.00, 95% CI 2.63–24.28, p < 0.001), Australian-born 1.62, 1.08–2.43, = 0.019), hypertension 1.48, 1.01–2.17, 0.044) number medicines 1.06, 1.00–1.12, 0.022). Potentially inappropriate medication use anticholinergic burden did not predict These could help identify highest risk enable targeted interventions be designed.

Язык: Английский

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Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

Journal of the American Geriatrics Society, Год журнала: 2022, Номер 71(2), С. 505 - 515

Опубликована: Окт. 26, 2022

Abstract Background The use of a new medication (e.g., potassium supplementation) for managing drug‐induced adverse event loop diuretic‐induced hypokalemia) constitutes prescribing cascade. However, diuretics are often stopped while may be unnecessarily continued (i.e., relic). We aimed to quantify the occurrence relics using older adults previously experiencing diuretic‐potassium cascade as an example. Methods conducted prescription sequence symmetry analysis population‐based Medicare Fee‐For‐Service data (2011–2018) and partitioned 150 days following initiation by day assess daily treatment scenarios alone, combination potassium, or neither). calculated proportion patients developing relic, person‐days under probability filling after diuretic discontinuation. also identified risk factors relic. Results 284,369 initiators who were 8 times more likely receive supplementation simultaneously cascade), rather than before, (aSR 8.0, 95% CI 7.9–8.2). Among 66,451 subsequently (≤30 days) initiated 20,445 (30.8%) remained on discontinuation, 9365 (14.1%) filled another supplementation. Following initiation, 4.0% relic was highest 90 (5.6%). Older age, female sex, higher dose, greater baseline comorbidities having same prescriber pharmacy involved in both medications less experience Conclusions Our findings suggest need clinicians aware potential avoid unnecessary drug use.

Язык: Английский

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