The Effects of Long-Term Benzodiazepine Use and Withdrawal in the Elderly

Benzodiazepines remain a commonly prescribed medication in the United States, and the high usage of this drug class is especially a concern in the elderly population for several reasons. First, elderly patients metabolize drugs differently, leading to varying responses. Age-related changes also have a significant impact on the effects of benzodiazepines. Second, elderly patients are more likely to be taking multiple centrally-acting drugs, which can further exacerbate negative effects. In regard to long-term benzodiazepine use, elderly patients experience an increased risk of cognitive impairment, motor vehicle accidents, decline in physical performance, falls and subsequent fractures, and sleep disturbances. Withdrawal is also a significant concern with long-term benzodiazepine treatment, which can lead to rebound symptoms in addition to mood swings, tremor, headache and loss of appetite. A taper of less than six months is recommended when discontinuing benzodiazepines after use longer than the recommended three month duration of treatment. Pharmacists can have a substantial impact in reducing the detrimental effects of long-term use of benzodiazepines by aiding in the tapering process, as well as identifying inappropriate prescribing and use of benzodiazepines in the elderly population. Overall, pharmacists should be knowledgeable on the appropriate use of benzodiazepines, associated side effects and withdrawal concerns to reduce the negative effects elderly patients may experience with long-term use

Crohn\u27s Disease: Management, Emerging Therapies and the Role of the Pharmacist

Crohn\u27s disease is a relapsing-remitting disorder of the gastrointestinal tract caused by a mixture of genetic and environmental factors. Pharmacologic treatment of Crohn\u27s disease is patient-specific, and regimens vary widely between individuals. Drug regimens are typically based on 5-aminosalicylate therapy and may include a combination of steroids, histamine 2 receptor antagonists, proton pump inhibitors, immunomodulators, antibiotics, biologic agents and other medications aimed at symptom relief. A new medication, vedolizumab, is currently in phase III clinical trials awaiting U.S. Food and Drug Administration (FDA) approval for use in Crohn\u27s disease. Vedolizumab is an alpha-integrin inhibitor, which is anticipated to have a better safety profile than Tysabri® ( natalizumab ), an alpha-integrin inhibitor already approved for treatment of Crohn\u27s disease. Pharmacists have an opportunity to educate Crohn\u27s disease patients about nonpharmacologic management including counseling on diet, exercise, stress-relief therapy and use of multivitamins as well as the importance of regular colonoscopies and visits to a primary care practitioner. Pharmacists can also educate patients and practitioners about alternative therapies including probiotics, fecal microbiota transplantation and fish oils which may help manage the disease

Whooping Cough: A Pharmacist\u27s Role in an Emerging Endemic

Pertussis is an acute infectious disease caused by the organism Bordetella pertussis and characterized by a whooping cough. Incidence of the disease had declined since the development of a vaccine, but is now increasing in reported cases. This increase has been attributed to both an increased awareness but also surmised to be related to a decrease in vaccinations. The pertussis vaccine is given in conjunction with tetanus and diphtheria vaccines to children before the age of 6 in five separate injections over the course of four to six years. A booster is now recommended for the older child and adults due to the declining protection of the vaccine over time. Pertussis is highly contagious and early treatment with a macrolide antibiotic is recommended to limit the severity and prevent transmission. It can be deadly in infants, which is why prevention via immunizations is so important. The pharmacist can assist with advising individuals of the importance of vaccination

The Role of a Home Health Care Pharmacist-Medication Management for Patients with Feeding Tubes

Home health care is a method of medical care that patients receive inside their home under the supervision of a collaborative team of physicians, nurses, pharmacists and sometimes other health care professionals. Home health provides patients with the same standard of care that they would be receiving in a nursing home or hospital. However, the treatment and continued monitoring at home reduces health care costs and makes the patient feel more comfortable. Pharmacists analyze, resolve and prevent medication-related problems in home health care in order to minimize hospitalizations and improve patient quality of life. Pharmacist involvement with other health care professionals in the patient transition of care can help maximize the quality of patient care. To become a home health care pharmacist, neither a residency nor certification is required. Home health pharmacists perform medication reconciliation, comprehensive medication reviews, monitor intravenous drug therapy and enteral therapy, identify high-risk medications and adverse drug reactions, prevent polypharmacy and improve patient adherence. Patients that must be fed through enteral nutrition tubes in the home health care setting have a set of special concerns that the home health care team must address. Pharmacists\u27 extensive knowledge of medication necessitates their involvement on the home health care team