ELDERLY CARE
Excretion – Renal elimination is one of the most important pharmacokinetic changes associated with the aging process with creatinine clearance decreasing after the age of 30 years. Age related changes in creatinine clearance vary significantly from patient to patient. Serum creatinine levels are often within normal limits regardless in the observed decrease in glomerular filtration rate as elderly patients generally have less muscle mass, are less physically active and as such produce less creatinine.8
Patients
renal elimination is often estimated by formulative assessment (Cockcroft & Gault) and serves as a guide to drug dosing. As renal function is a dynamic process, in constant fluctuation many drugs require constant monitoring, with adjustments required if a patient becomes ill, dehydrated or when they recover from such a period of illness. Many medicines used in elderly patients including analgesics, antibiotics, cardiovascular drugs, diuretics and psychoactive compounds are heavily affected by patient renal function and consequently require intensive monitoring to ensure safe and effective dosing is maintained.
NEWS
Nexium Control available without Prescription
The MHRA has this month approved the reclassification of the well- established proton pump inhibitor (PPI) Nexium Control® (esomeprazole), making it available for consumers to purchase it without a prescription.
PPIs, recommended by NICE as a first- line treatment for heartburn, have a long safety history when used in accordance with the label instructions. With heartburn regularly affecting more than 8 million people across the UK, the reclassification of Nexium increases treatment options available OTC and presents greater accessibility, therefore enabling heartburn sufferers to self-manage their symptoms more effectively. It is also hoped this reclassification will also help relieve some of the burden on GPs through appropriate and effective self-care, in line with government strategy.
The launch of Nexium Control® as an OTC medicine will be welcome news for the one in 6 UK adults who experience frequent heartburn, twice or more a week. Frequent heartburn is not only common, but it can have a negative impact on a person’s quality
42 - SCOTTISH PHARMACIST
of life throughout the day and night – from limiting a person’s food and drink choices through to sleep disruption.
Nexium Control® provides 24-hour protection from heartburn3 and is indicated in the UK for short-term management of reflux symptoms (heartburn, acid regurgitation) in adults aged 18 or over. The OTC treatment is recommended for a maximum of 14 consecutive days, and heartburn sufferers are advised to contact a healthcare professional should symptoms persist.
Nexium Control® offers an important, alternative option to antacids or alginates which, until now, have been the main options available for people to self-select from pharmacies and supermarkets. Antacids and alginates provide immediate relief, but do not deliver the sustained relief that some frequent sufferers need and want to keep their symptoms under control. By blocking acid production in the stomach, Nexium Control® can provide 24-hour protection against heartburn with just one tablet a day.
Kirit Patel, Chief Executive, Day Lewis Pharmacy, comments, “Frequent heartburn is a common reason for repeat visits to the pharmacy. Our role as pharmacists is mainly to advise customers on the best treatment to suit their individual needs, and to
Crazy Christmas jumpers have almost become an essential fashion item over the festive period, but one pharmacy in Leven used this recent trend to raise some money for a local charity.
Staff at TW Buchanan Chemists on Commercial Road donned their best festive attire in the shop for four days
provide advice on contraindications and when to seek further medical advice if symptoms persist. The reclassification of Nexium as an OTC treatment is good news as it provides customers with access to another effective heartburn medication.”
Pharmacy raises money for Fife Gingerbread
in a bid to raise funds, and also raise Christmas cheer, with all proceeds going to Fife Gingerbread.
Generous shoppers were treated to all manner of whacky jumpers, and donated a fantastic £63.43 over the
four days.
Changes in each of these areas with respect to age, however some changes are clinically more relevant than others.8
The metabolism and
excretion of a number of drug classes alter dramatically, requiring in some instances significant dosing adjustments. As a result, toxicity can develop slowly; owing to chronic use of some medicines can increase over 5 to 6 half lives, before a steady state level is reached. Typically signs of toxicity in elderly patients receiving certain benzodiazepines, such as diazepam, fluazepam or chlordiazepoxide (with half lives reported as up to 96 hours in older people), may not become apparent until days or weeks after therapy has been initiated.8
A number of community specific interventions for pharmacy have been implemented and have proven to be of benefit in delivering a comprehensive package of care to all patients. The introduction of home and community based medication reviews have helped to demonstrate Pharmacists professional ability to provide a reliable and effective service. Additionally, multi-compartmental
compliance aids (known by many names, to me “Weekly trays”), have demonstrated increased concordance with agreed medicine regimens, thus reducing the stress many patients associate with managing their daily quota of medicines. “Weekly trays” are a subject of distress for many community pharmacists, of whom, most are able to recite stories of great strife. These compliance aids have been widely accepted in the community, yet often, the pharmacy can feel underappreciated in their efforts to maintain continuity of therapy in conjunction with numerous weekly or even daily alterations.
Pharmacy staff should be commended for their efforts, and encouraged to continue providing high standards of service, knowing they are able to positively impact on patient quality of life. With the population heading towards an older norm, the pharmacy profession has been pro-actively making changes to daily practices, and should remain steadfast in the aspiration to be one of the key components in a successful solution to the aging challenge.
REFERENCES:
1. Barnett NL, Taylor D. Care of the Elderly – how pharmaceutical care has developed. The Pharmaceutical Journal Available
www.pharmaceutical-journal. com/learning/learning-article/care-of-the- elderly-how-pharmaceutical-care-has- developed/
10977332.article. Accessed 2nd Jan 2015.
2. Alison Taylor, Policy Lead, Integration Division, The Scottish Government.
3. Conference: HealthCare Improvement Scotland – Improving Pharmaceutical Care for Older people, NHS Education for Scotland, the NHS Scotland Directors of Pharmacy and The Royal Pharmaceutical Society.
4. Crome P. What’s different about older people. Toxicology 2003;192(1):49-54.
5. Polypharmacy: a necessary evil. BMJ Available:
www.bmj.com/content/347/bmj. f7033. Accessed 6th Jan 2015.
6 Mental Health in Later Life. Available:
www.mentalhealth.org.uk/help- information/mental-health-a-z/o/older- people. Accessed 3rd Jan 2015.
7. Scotland’s National Dementia Strategy: 2013-2016. Available:
www.scotland.
gov.uk/Topics/Health/Services/Mental- health/Dementia/DementiaStrategy1316. Accessed 4th Jan 2015.
8. Pharmacokinetics in the Elderly - Merck Manuals. Available:
www.merckmanuals. com/professional/geriatrics/drug_therapy_ in_the_elderly/pharmacokinetics_in_the_
elderly.html. Accessed 2nd Jan 2015.
9. Pharmacotherapy in the elderly – Merck Manuals: Available:
www.merckmanuals. com/professional/geriatrics/drug_therapy_ in_the_elderly/pharmacodynamics_in_the_
elderly.html. Accessed 3rd Jan 2015.
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