A Short Note On The Problem Associated With Peripheral Arterial Disease ( Pad ) Patients

Our working hypothesis is that most interactions occur due to continuous or additional use of an over the counter medication despite change in therapy, without consulting the primary care provider. We will test this hypothesis by analyzing hospital records and determining hospitalization and death that are a result of over the counter medications and compare to those that result from prescription medications.

Perhaps the most challenging aspect of older adult pharmacology is the concomitant use of multiple medications. Among community-

According to an article written by Anna Gorman of Health Leaders Media, the use of prescription drugs is a growing concern. The article mentions Lola Cal, a patient in a geriatric unit in Santa Monica, California whose medical records show that she is on 36 different medications. Although people born from 1946 to 1964, known as the baby boomer generation, only make up 16% of the U. S. population, this generation accounts for one-third of prescription drug use. Many elderly patients take several medications to treat chronic illnesses and raise their chances for serious side effects and dangerous drug interactions. Dr. Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica states that polypharmacy is “America’s other drug problem.

Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are

Patients walk into our clinics daily with a variety of complaints. Many things we can observe and assess drive our decisions for plans of care. However, there are some things about our patients we can’t see. Some things nobody would know under normal circumstances. How most medications are metabolized is predictable across the population, but some medications throw us a curve ball. Polypharmacy is a necessity in primary care. As primary care providers (PCPs) we see patients for both chronic and acute pathologies. Understanding metabolic pathways is expected of us as providers, but that doesn’t make us invulnerable to poor outcomes despite best efforts. In the following

Hospital readmission rates among the elderly are steadily becoming a growing topic of concern. Robinson, Esquivel, and Vlahov (2012) describe readmission or re-hospitalization "as a return to the hospital shortly after discharge from a recent hospital stay" (p. 338). The elderly, defined as 60 years of age and older, account for the highest hospital readmission rates in comparison to other age groups (Robinson, Esquivel, & Vlahov, 2012). With medical advances, life expectancy is on the rise, which means older people will have more comorbidities and consequently be required to take more medications for symptom management. Generally when a person takes anywhere from two-nineteen medications, the term "polypharmacy" is introduced (Pasina et al., 2014). In hospital settings polypharmacy is not an issue because there are nurses and medical providers to address questions and concerns, administer medications, and monitor a patient for potential adverse effects. However, once discharge occurs, this patient is left to juggle all aspects of their care on their own. A plan of care formulated to improve the elderly population 's quality of life outside of the hospital, speaks to one of the Institute of Medicine 's (IOM) core competencies, applying quality improvement.

There are a variety of negative effects that smoking has on a person’s overall health. For example, lung cancer, pulmonary disease, and cardiovascular disease can be related to cigarette smoking. But why does cigarette smoking cause complications with foot and ankle surgery?

Polypharmacy has become one of the strongest factors to increase the risks of drug to drug interaction, drug disease related, and wrong dose of medication (Tseng, Lee, Chen, Hsu, Huang, & Huang, 2015). Additionally, polypharmacy has impacted the healthcare industry in the most common ways imaginable, which is associated to several geriatric syndromes, decrease functional ability, and the most popular one is the increase of healthcare cost (Seng, et. al., 2015). Furthermore, polypharmacy is defined as various drugs simultaneously taken by a patient, such as five or more drugs.

The clinical pathway of “good” prescribing in the older patient can be more extensive than younger populations. It is also over looked and can cause many problems in the elderly patients. In regards to any kind of prescription one has to have an accurate diagnosis to begin with. It is important for a physician to first and foremost understand the pathophysiology of the diagnosis so that the correct drug can be matched. Secondly the health care provider must assess the pros and cons of the treatment or to even treat the patient at all (Aronson, 2006). With elderly patients inappropriate prescribing is on the rise. Older adults are usually on multiple drugs so its important to have background information before prescribing any form of treatment. This is where it is good to limit the number of people that

Peripheral artery disease (PAD) is considered as a clinical manifestation of systemic atherosclerosis affecting primarily the blood supply to the lower extremities, but other noncardiac and non-intracranial arteries may also be involved. More than 200 million individuals worldwide are estimated to have diagnosed PAD and the prevalence continues to rise. In Europe and North America, an estimated 27 million people have PAD and around 413,000 annual hospital admissions are attributed to PAD. Due to an imbalance between the supply and demand for blood flow, patients with PAD most commonly experience exertional leg pain (intermittent claudication), which is triggered by ambulation and relieved by rest. The severity of the symptoms depends upon

Falstein who is an elderly patient that was prescribed two different benzodiazepines by the same doctor. Polypharmacy is one of the major risk factors for drug-drug interactions and adverse reactions associated with medication use. Yet the article states that the “use of the drugs has risen among older people, even though they are particularly vulnerable to the drugs’ ill effects.” This does not come as a surprise when considering the pharmacy curriculum and how medical professionals are taught to approach patient care (and the assumed similar physician curriculum). The current pharmacy curriculum promotes the use of disease state guidelines that map out which medications to prescribe and when. Pre-conventional pharmacists and physicians will strictly follow the guidelines and the pattern of prescribing more medications when more problems arise in a patient. The course I mentioned earlier, geriatric pharmacotherapy, was the one of the only courses that stressed the importance of de-prescribing and when de-prescribing should be considered in elderly patients. This course was an elective not required by the college leaving a majority of student without special instruction on the geriatric

Peripheral Vascular Disease (PVD) is a progressive circulation disorder that involve peripheral blood vessels (veins and arteries), and, the lymphatic vessels. PVD that affects the arteries are called Peripheral Artery Disease (PAD), which is the most common form of PVD. PVD and PAD are often used to denote the same condition. Although the upper limbs are not immune, PVD typically affects the lower limbs.

The causes of premature discontinuation are adverse events, consent withdrawal, and loss to follow-up. Patient demographics are reported as well, and the authors provide a useful table with basic patient information including age, weight, gender, and renal function. There are some very miniscule differences in groups for both studies, but these differences should not affect the results because of randomization. The trial results are reported in percentages of event occurrence in a population. While these are useful in understanding the frequency of harmful effects or successful treatment, a surrogate measurement and use of INR measurements may provide a better idea of the extent of safety or efficacy. In the Acute DVT Study, the primary efficacy endpoint occurred in 2.1% of rivaroxaban patients and in 3.0% of standard therapy patients (Hazard ratio 0.68; 95% CI 0.44 to 1.04; P<0.001 for non-inferiority with a one-sided test, and P = 0.08 for superiority with a two-sided test). The principal safety endpoint of clinically significant bleeding occurred in 8.1% of rivaroxaban patients and in 8.1% of standard therapy patients (hazard ratio with rivaroxaban 0.97; 95% CI 0.76 to 1.22; P =

Poly-pharmacy is the simultaneous utilization of numerous pharmaceuticals by a patient. Poly-pharmacy is most normal in the elderly, influencing around 40% of more seasoned grown-ups living in their own homes. Around 21% of grown-ups with scholarly handicap are additionally presented to polypharmacy. Polypharmacy isn't generally awful, however it is terrible in numerous occurrences, frequently being more destructive than accommodating or introducing excessively chance for too little advantage. In this manner, wellbeing experts think of it as a circumstance that requires observing and audit to approve whether the greater part of the solutions are as yet vital. Worries about polypharmacy incorporate expanded unfavorable medication responses,

Another study was conducted by (Lowe and Raynor 2000). That looked at the reasons for non-adherence. They sampled a random sample of 161 patients aged 65 years and above with the mean age being 76 years, and the mean number of medicines given was 4. They used a self-report method, participants were seen at their home where they carried out an interview with the use of a structured questionnaire. Questions were asked about the medicines they took, dosage and how regular the dosages were taken. The results presented a difference in 53% of cases.