ʻO ka lāʻau lapaʻau kiʻekiʻe e hoʻopaʻa ʻelua, huikau polypharmacy, a me nā hopena lāʻau ʻino¶

ʻO ka lawe ʻana i ʻelima a ʻoi aku ka lāʻau lapaʻau i kēlā me kēia lā a me nā lāʻau lapaʻau kūʻai ʻole, i ʻike ʻia ma ke ʻano he polypharmacy, waiho ʻia nā poʻe ʻelemakule i nā hewa dosing weliweli a me nā pilina lāʻau ʻawaʻawa. Ke poina ke kanaka makua ua lawe mua lakou i ko lakou mau papa kakahiaka a lawe i ka lua o ka pahu piha he kanakolu mau minuke ma hope mai, ale pohihihi i ko lakou mau mea hoomaha i ka manawa e moe ai i ka aina kakahiaka, a i ole ia e lawe i ka antibiotic hou a i ole ka painkiller e poloka ana i ke akepaa a i ole i ka puupaa ka wehe ana i ko lakou mau laau na'au mau, e pii koke ana na hopena physiological. Ma muli o ka kānana ʻana o nā puʻupaʻa a me nā ʻāʻī i nā lāʻau he 30 a 50 pakeneka ʻoi aʻe ka lohi ma mua o nā ʻōpiopio ʻōpio, ʻo ka hoʻokahi pānaʻi ʻelua o ka insulin, kahi mea hoʻoheheʻe koko, beta-blocker, digoxin, a i ʻole ka opioid hiki ke hoʻoulu i ka hypoglycemia make, ka hemorrhage i loko, ka puʻuwai a i ʻole delirium i loko o nā hola.

ʻO ka ʻike ʻana i kahi pahu hakahaka i loko o ka mea hoʻonohonoho pila i kēlā me kēia pule, a i ʻole ka loaʻa ʻana o nā lāʻau i hoʻokahe ʻia ma ka papa kīhini i ka wā e hiamoe ana kou makua a i ʻole kou hoa kāne, ʻaʻole paʻa, a huikau paha, pono e hoʻāʻo koke ʻia. ʻAʻole pono i kēlā me kēia lāʻau huaʻai ʻelua a i ʻole ka cholesterol i kahi kaʻa kaʻa, akā ʻo ka hoʻopaneʻe ʻana i ka hana ma hope o ka hoʻopaʻa pālua ʻana o kahi **High-Alert Narrow Therapeutic Index (NTI) lāʻau hiki ke make. Ke alakaʻi nei kēia alakaʻi iā ʻoe ma o ka Poison Control a me ka hoʻāʻo ulia pōpilikia, nā lula nānā pono no nā papa lāʻau lapaʻau ʻeono weliweli loa, pehea e hooki ai i ka "Prescribing Cascade" kahi i hana hewa ai nā kauka i kahi hopena ʻaoʻao o ka lāʻau me kekahi lāʻau ʻē aʻe, a pehea e hoʻololi ai i nā pūʻolo pharmacy blister-proof.

E hana i kēia i kēia manawa¶

1. E kelepona koke i nā lawelawe ulia pōpilikia inā paʻakikī ke kanaka e ala, ʻōlelo hoʻomākeʻaka, ʻūlū i ke kū ʻana, loaʻa ka ʻeha o ka umauma, a paʻakikī paha i ka hanu. Mai kali i ka nui o nā hōʻailona a mai kelepona i ka leo leo keʻena inā hōʻike kekahi kanaka ʻelemakule i nā loli neurological, naʻau, a i ʻole hanu ma hope o ka hewa o ka lāʻau. Kāhea i kāu helu pilikia kūloko (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom) me ka hoʻohana ʻana i kā mākou helu pilikia papa kuhikuhi.
2. E kāhea koke i ka Poison Control inā e ala ana ke kanaka i kēia manawa a ʻaʻohe hōʻailona ma hope o ka hui ʻana o ka lāʻau ʻelua a i ʻole ka hui ʻana o ka pila. Ma mua o ke kaʻa ʻana i kahi lumi ulia pōpilikia a hāʻawi i ka meaʻai a i ʻole ka wai, e kelepona i kāu kikowaena Poison Control aupuni manuahi 24-hola (1-800-222-1222 ma ʻAmelika Hui Pū ʻIa, 1-844-764-7669 ma Kanada, 111 ma United Kingdom, 13 11 26 ma Australia). Hoʻopili nā kauka lāʻau toxicology a me nā kahu hānai i ka paepae ʻawaʻawa milligram-per-kilogram ma muli o ke kaumaha o ke kino o ke kanaka makua, ka hana ʻana o ke kīpē, a me nā lāʻau lapaʻau ʻē aʻe, a haʻi iā ʻoe i loko o ʻelua mau minuke inā hiki iā ʻoe ke nānā pono ma ka home a i ʻole pono i kahi kaʻa kaʻa i kēia manawa.
3. Mai hoʻoulu i ka luaʻi, mai hāʻawi i ka lanahu hoʻōla ma ka home, a mai "hoʻokuʻu i nā lā ʻekolu e hiki mai ana" me ka ʻae ʻole ʻana i nā mea ʻona. ʻO ka hoʻoikaika ʻana i kahi ʻelemakule e luaʻi i ka hopena o ka maʻi maʻi maʻi maʻi a i ʻole haehae ʻia esophageal, a ʻo ka hāʻawi ʻana i ka wai hou a i ʻole ka meaʻai hiki ke hoʻolōʻihi i ka ʻai ʻana o ka ʻōpū o kekahi mau papa hoʻokuʻu lōʻihi.
4. E nānā inā he papa Hoʻokuʻu Hoʻokoʻa (ER / XR / SR / LA / CR) ka pila i hoʻopaʻa ʻia i ka wā i nau ʻia, ʻokiʻoki ʻia, a ʻokiʻoki paha. Inā nau a ʻokiʻoki paha kekahi kanaka ʻelemakule i ka pila hoʻokuʻu koko no 24 mau hola, ka mea hoʻopaʻa ʻana i ka calcium-channel blocker, a i ʻole ka lāʻau lapaʻau opioid, ua luku ʻia ka matrix hoʻokuʻu manawa hoʻokuʻu (**" 24-hola bolus i loko o ke koko i ka manawa hoʻokahi. E mālama i ka puʻuwai hoʻokuʻu lōʻihi ʻia a i ʻole nāu ʻia i ka puʻuwai hoʻomaha a i ʻole ka mea hoʻomaha ma ke ʻano he hanana lumi ulia pōpilikia.
5. E hana i 3-Minute Pill Count a hōʻiliʻili i kēlā me kēia omole i loko o kahi ʻeke kūʻai ʻilika ("The Brown Bag Audit"). E nānā i loko o ka mea hoʻonohonoho pila o kēlā me kēia pule e ʻike ai i ka lā/manawa manawa i nele, a e helu i ke koena o nā pila i loko o nā ʻōmole amber hale kūʻai mua (e unuhi i ke koena o ka helu pila mai ka nui o ka hoʻopiha ʻana a me ka lā hoʻopiha i paʻi ʻia ma ka lepili). Inā hele i ka haukapila, kahili ** i kēlā me kēia omole kauoha, lāʻau ʻeha ma luna o ke kūʻai aku, mea hoʻohui lāʻau, hāʻule maka, a me ka mea hoʻonohonoho pili kino ponoʻī** i loko o kahi ʻeke e hāʻawi aku i ke kauka pilikia.
6. E nānā koke i ke kiʻekiʻe o ka glucose koko a me ke kahe koko i ka manamana lima inā loaʻa iā ʻoe nā mea nānā home. ʻElua o nā mea pepehi wikiwiki loa i ka hoʻopaʻa ʻana i ka lua o ka poʻe kahiko ʻo ** hypoglycemia koʻikoʻi** (mai ka insulin pālua a i ʻole sulfonylurea mau hua maʻi diabetes e like me glipizide, glimepiride, a i ʻole glyburide) a me ** hypotension hohonu / bradycardia ** (mai nā beta-blockers a i ʻole calcium). Inā emi ke kō koko ma lalo o 3.9 mmol/L (70 mg/dL) a hiki i ke kanaka ke ale me ka palekana, e hāʻawi koke i 15 kalama o ke kō wikiwiki (120 mL / 4 oz o ka wai huaʻai a i ʻole ka soda maʻamau, a i ʻole ka glucose gel).

flowchart TD
    A["Hoʻopiʻi ʻia ʻo Lapaʻau Lapaʻau Kiʻekiʻe ʻelua, ʻAʻole i hala, a i ʻole Pill Mix-Up"] --> B{"He mau hōʻailona Hae ʻula i kēia manawa? (Moe, Pioloke, Puuwai <50, Ho'ohu/Lūlū, Ke koko)"}
    B -->|"ʻAe - Loaʻa nā hōʻailona koʻikoʻi"| C["E kelepona iā 911 / 112 / 999 koke + E nānā i ke kō a me ke koko"]
    B -->|"ʻAʻole - Ala a me ka manaʻo maʻamau"| D{"Ua hoʻopālua lākou i kahi lāʻau 'Ala Kiʻekiʻe' a i ʻole Nau i kahi Pill Hoʻokuʻu Hoʻokoʻa (ER/XR)?"}
    C --> E["ʻEke ʻO nā ʻōmole Pill a pau + Hoʻonohonoho Pill Kino no nā Paramedic"]
    D -->|"ʻAe (Insulin, Sulfonylurea, Thinner Blood, Beta/Calcium Blocker, Digoxin, Opioid)"| F["Kāhea i ka Poison Control (1-800-222-1222) koke a hoʻomākaukau no ka nānā ʻana iā ER wikiwiki."]
    D -->|"ʻAʻole maopopo a i ʻole ka lāʻau maʻamau (Statin, Vitamin, PPI, Thyroid)"| G["Kāhea i ka Poison Control (1-800-222-1222) me ka inoa Pill pololei, ka ikaika o ka Milligram, a me ka manawa i lawe ʻia."]
    F --> H["E hahai i nā ʻōlelo aʻoaʻo Toxicologist: Mai hoʻoulu i ka luaʻi + kiaʻi mau i nā mea waiwai"]
    G --> H
    H --> I["Ma hope o ka hoʻoholo ʻana o ka pilikia: e hoʻololi mai ka pahu pahu pahu i ka lāʻau lapaʻau Multi-Med Blister Packs"]

ʻO nā lāʻau lapaʻau kiʻekiʻe-makaʻala: He aha ka mea i hana ʻia i ka wā o ka hoʻohālua pālua¶

Hoʻokaʻawale ka Institute for Safe Medication Practices (ISMP) a me ka American Geriatrics Society (AGS) i nā lāʻau lapaʻau ma ke ʻano he ** High-Alert Medications** a me Narrow Therapeutic Index (NTI) nā lāʻau lapaʻau i ka poʻe ʻelemakule. Me kēia mau lāʻau lapaʻau, ʻo ka ʻokoʻa ma waena o ka lāʻau lapaʻau maʻamau i kēlā me kēia lā a me kahi maʻi ʻawaʻawa, hoʻoweliweli i ke ola he ʻumi ʻumi.

Papaʻaina hoʻāʻo pilikia no nā kaulua pālua maʻamau¶

Palapala kelepona pololei i ke kāhea ʻana i ka Poison Control (1-800-222-1222)¶

I ka lawe ʻana o kahi kanaka ʻelemakule i ka ʻai pālua a i ʻole i hui pū ʻia i nā keʻena kakahiaka a me ke ahiahi, ʻo ka loaʻa ʻana o nā ʻike kikoʻī pololei i hoʻonohonoho ʻia ma mua o ka pane ʻana o ka mea toxicologist e mālama i nā minuke koʻikoʻi. E kau i nā ʻōmole pila ma kou lima a heluhelu i kēia papa inoa:

1. Ka heluna kanaka maʻi a me ke kūlana kumu: E hōʻike i ka makahiki pololei o ke kanaka makua, ke kaumaha ma ke kilo (a me nā paona), inā paha e ala ana lākou, makaʻala, a me ka hanu maʻamau, a inā he maʻi maʻi maʻi maʻi (CKD Stage 3, 4, a i ʻole 5) a i ʻole maʻi ate.
2. Ka ʻike a me ka hana ʻana i ka lāʻau lapaʻau pololei: E heluhelu i ka inoa maʻamau a me ka inoa inoa piha mai ka lepili lāʻau lapaʻau, ka milligram pololei (mg) a i ʻole microgram (mcg) ikaika no ka papa, a me nā leka ma hope o ka inoa lāʻau (ER, XR, XL, SR, CR, LA, a i ʻole DR). E haʻi i ke kauka inā ua moni ʻia ka pilala a pau, nahu, ʻoki, a ʻoki ʻia paha.
3. Ka helu ʻoi loa o ka maʻi ʻino loa a me ka manawa o ka ʻai ʻana: E hōʻike i ka manawa pololei i lawe ʻia ai ka maʻa mua, ka manawa i lawe ʻia ai ka lua o ka pōʻino, a me ka helu kiʻekiʻe o nā papa i hiki ke nalo mai ka ʻōmole a mea hoʻonohonoho paha.
4. Laau lapaʻau like i lawe ʻia i ka manawa hoʻokahi: E heluhelu i nā inoa o nā mea ʻē aʻe a pau ke kahe koko, ka puʻuwai, ka maʻi diabetes, a i ʻole nā ​​lāʻau hoʻomaha hoʻokahi i lawe ʻia i ke kakahiaka a i ʻole ke ahiahi pūʻulu, ʻoiai ʻelua mau papa ʻelua maʻalahi (e like me ka beta-blocker a me ka alpha-blocker a i ʻole diuretic) he synergistic nā hopena hoʻohaʻahaʻa i ke koko.

He aha kāu e hana ai inā HOLO ʻia kahi maʻi (a no ke aha ʻaʻole pono ʻoe e "Palua" me ka makapō)¶

ʻO ka ʻike ʻana ua hala ʻo kahi makua ʻelemakule ** i nā lāʻau lapaʻau i nehinei a i kēia kakahiaka paha e like me ka maʻamau e like me ka hoʻopaʻa ʻana ʻelua, a hiki i ka hopena hewa ke hoʻoulu i kahi pilikia olakino.

ʻO ke kānāwai gula o nā wai i hala¶

Mai lawe i ʻelua mau kau i ka manawa like e "hoʻoponopono" no kahi maʻi i hala ʻole ke ʻole ke kauoha a ke kauka lapaʻau a kauka paha iā ʻoe e hana pēlā no kēlā lāʻau lapaʻau kikoʻī.

1. Pehea e hana ai ka "Halfway Rule" no nā lāʻau lapaʻau maʻamau i kēlā me kēia lā (a inā ʻaʻole pili ia):
   • No ka nui o nā lāʻau lapaʻau mālama maʻamau i kēlā me kēia lā (e like me ka statin cholesterol pill, levothyroxine, a i ʻole ka lāʻau paʻi koko maʻamau), hoʻohana pinepine ka poʻe lāʻau lapaʻau i ka 50% Interval Rule: inā ʻike ʻoe ua hala ka maʻi i loko o ka hapa mua o ka pōʻai dosing (no ka laʻana, me ka hoʻomanaʻo ʻana i ka hola 1:00 PM ua hala ka lāʻau lapaʻau i ka hola 8:00 AM i kēia lā; inā kokoke loa ia i ka ma'i i ho'onohonoho 'ia e hiki mai ana, 'oe ** ho'oku'u loa i ka ma'i i hala** a ho'omaka hou i ka papa hana ma'amau i ka lā 'apōpō.
   • E kelepona i ka hale kūʻai lāʻau hāʻawi (24-hour chain pharmacy pharmacist) e hōʻoia ma mua o ka hāʻawi ʻana i ka pila lohi: ʻO kēlā me kēia 24-hola Walgreens, CVS, Boots, a i ʻole lāʻau lapaʻau halemai e pane i kahi nīnau manawa i hala ʻole ma ke kelepona i 60 kekona me ka uku ʻole.
2. 4 Nā lāʻau i loaʻa i ka MISSING kahi maʻi he pilikia olakino koʻikoʻi i ka manawa (Mai lele wale me ke kelepona ʻole ʻana i ke kauka):
   • ** ʻO ka maʻi o Parkinson Levodopa / Carbidopa (Sinemet, Rytary):** ʻO ka poʻe ʻelemakule me ka maʻi o Parkinson e hilinaʻi nei i ka hoʻopiha hou ʻana i ka dopamine i kēlā me kēia 3-a-4-hola. ʻO ka nele ʻana i hoʻokahi a ʻelua paha kaʻa e hiki ai i ka mea maʻi ke "hoʻokuʻu" holoʻokoʻa (akinetic crisis), nalowale ka hiki ke ale me ka palekana (pilikia i ka hū ʻana/aspiration), a i ʻole e hoʻoweliweli i ke ola Parkinsonism-Hyperpyrexia Syndrome (ke kuni kiʻekiʻe, nā ʻiʻo ʻoʻoleʻa, a me ka pilikia ʻole o ka autonomic e like me Neuroleptic Malignant Syndrome).
   • ** ʻO nā Anticoagulants Oral Direct (DOACs: Eliquis / Apixaban, Xarelto / Rivaroxaban, Pradaxa / Dabigatran) no Atrial Fibrillation a i ʻole nā ​​Koko Koko Hou: ** ʻAʻole like me Warfarin (e noho ana i loko o ka ʻōnaehana no nā lā), he pōkole ka hapalua o ke ola o ka DOAC o ** 8 a 14 mau hola **. ʻO ka nalowale ʻana i ʻelua mau kau ʻana o Eliquis a i ʻole Xarelto e waiho i kahi maʻi fibrillation atrial me ka pale ʻole ʻia i kahi embolic nui. hahau. ʻO nā lula hoʻokomo pūʻolo FDA kikoʻī e hoʻomalu i nā puka makani hopu pololei no Xarelto vs. Eliquis; e kāhea koke i ke kauka lāʻau.
   • ** ʻO nā Beta-Blockers (Metoprolol, Atenolol, Propranolol) a me Clonidine:** Ke hooki koke nei a i ʻole ka nalo ʻana i nā ʻano he nui o ka beta-blocker a i ʻole nā ​​clonidine e hoʻoulu ai Rebound Sympathetic Surge: ka piʻi koke ʻana o ke koko (rebound hypertension), ka piʻi ʻana o ka naʻau (**tachy chestcardia.
   • ** Nā Laʻau Anti-Seizure (Levetiracetam / Keppra, Lamotrigine, Valproate, Phenytoin) a me Chronic Corticosteroids (Prednisone):** ʻO ka hala ʻole ʻana o nā lāʻau anti-epileptic hiki ke hoʻoulu i ka holomua status epilepticus seizures, a hoʻōki koke i ka hoʻohana ʻana i ka lā lōʻihi i kēlā me kēia lā i ka prednisone (> 2 a hiki i ka 2 mau pule o ka lāʻau lapaʻau. (kuʻi koko, luaʻi, huikau, a me ka haʻalulu).

ʻO ka ʻike ʻana i ka ʻona polypharmacy huna a me ka "Prescribing Cascade"¶

I kekahi manawa, ʻaʻole i hana hewa kekahi kanaka ʻelemakule i ka helu pila; aka, ua make malie ia lakou e ko lakou **kaukaukau. I loko o ka lāʻau lapaʻau maʻi maʻi, pono e manaʻo ʻia kekahi hōʻailona kino hou a noʻonoʻo paha i loko o kahi kanaka ʻelemakule he Adverse Drug Event (ADE) a hiki i ka hōʻoia ʻana.

1. ʻO ka 3 mea make loa i ka Drug-on-Drug a me OTC Interactions i ka poʻe kahiko¶

E nānā i ka papa inoa lāʻau lapaʻau a kāu mea i aloha ai i kēia lā no kēia mau hui ʻekolu e hoʻouna ana i nā tausani o nā ʻelemakule i ka mālama koʻikoʻi i kēlā me kēia mahina:

1. Ka "Triple Whammy" (Acute Kidney Failure Trap):
   • Ka Hui: (1) He ACE Inhibitor a i ʻole ARB pili i ke kahe koko (lisinopril, enalapril, losartan, valsartan) + (2) He Diuretic / Water Pill (furosemide / Lasix, hydrochlorothiazide, spironolactone) +-SA **(3) An Overiller N. Advil / Motrin, naproxen / Aleve, meloxicam, diclofenac, a i ʻole aspirin kiʻekiʻe *).
   • No ke aha ia e pepehi ai i nā puʻupaʻa: Hoʻonui ka mea hoʻopaneʻe ACE i ke kīʻaha puka o ka puʻupaʻa, hoʻemi ka diuretic i ka nui o ke koko, a hoʻopaʻa ka NSAID i ka ipu koko komo o ka puʻupaʻa. Ke lawe kekahi kanaka makua ma ke koko a me nā hua wai iā Advil a i ʻole Aleve no ka maʻi ʻāʻī o ke kuli no ʻekolu lā wale nō, ʻoi aku hoʻi i ka wā maloʻo maloʻo o ke kauwela a i ʻole ka ʻōpū o ka ʻōpū, hāʻule ka puʻuwai kānana glomerular, e hōʻeha ai i ka ** Acute Kidney Injury (AKI)** a me ka hoʻoweliweli ʻana i ke ola ** hyperkalemia (ke koko kiʻekiʻe o ka potassium cardiac arrest)**.
2. Nā Antibiotic + Lapaʻau Maʻamau ʻAi ʻAi ʻAi (CYP450 & Renal Clearance Blockade):
   • Ke kuhikuhi nei ke keʻena mālama koʻikoʻi i kahi lāʻau antibiotic maʻamau 5 a 10 mau lā no ka maʻi maʻi mimi a i ʻole bronchitis me ka nānā ʻole ʻana i ka pakuhi piha o ke kanaka makua:
     • Trimethoprim-Sulfamethoxazole (Bactrim / Septra) + Warfarin OR ACE Inhibitor/Spironolactone: Na Bactrim ke kumu o ka Warfarin INR e hoʻokahe koko i ke kiʻekiʻe e piʻi i loko o ka wahi hoʻokahe koko make i loko o 3 a 5 mau lā, a hoʻopaʻa i ka hoʻokuʻu ʻana o ka potasiuma kidney, e hoʻomaka koke ai ( ka lawe ʻana i ka maʻi maʻi maʻi maʻi maʻi hyperkalemia) a i ʻole spironolactone.
     • Clarithromycin / Erythromycin A I ʻole Ciprofloxacin + Statins, Calcium-Channel Blockers, a i ʻole Sulfonylureas: Hoʻopaʻa i nā enzymes CYP3A4 ate, e hoʻonui ai i 500 pakeneka o nā pae amlodipine/diltiazem (shock/hypotension) a i ʻole nā ​​pae statin (acutedomyolysis muscle breakdown).
3. Hui "Anticholinergic Burden" (Chemical Dementia & Delirium):
   • He nui nā lāʻau lapaʻau maʻamau ma mua o ke kūʻai ʻana a me nā lāʻau lapaʻau i hoʻopaʻa ʻia i ka ** acetylcholine **, ka neurotransmitter o ka lolo kahiko e pono ai no ka hoʻomanaʻo, ka nānā ʻana, a me ka neʻe o ka ʻōpū.
   • ** ʻO nā mea hewa ʻino loa (American Geriatrics Society Beers Criteria):** Ma luna o ka hale kūʻai ** "PM" kōkua hiamoe a me nā lāʻau allergy** i loaʻa iā Diphenhydramine (Benadryl, Tylenol PM, Advil PM, ZzzQuil) a i ʻole Doxylamine (Unisom); nā antispasmodics o ka pūpū (oxybutynin / Ditropan, tolterodine / Detrol, solifenacin); nā antidepressants tricyclic (amitriptyline, nortriptyline); mea hoʻomaha i ka ʻiʻo (cyclobenzaprine / Flexeril); a me nā lāʻau maʻi neʻe / vertigo (* meclizine, promethazine, scopolamine *).
   • ʻO ka lawe pū ʻana i ʻelua a ʻekolu paha o kēia mau lāʻau e hōʻeha ai i ka ʻawaʻawa anticholinergic acute: huikau nui e like me ka maʻi o Alzheimer, nā hiʻohiʻona hiʻohiʻona, ka waha maloʻo, ka ʻike pohihihi, ka paʻa paʻa ʻana, a me ka ka paʻa ʻana o ka mimi (hiki ʻole ke hoʻokahe i ka ʻōpū).

2. Pehea e ʻike ai a hoʻōki i kahi "Prescribing Cascade"¶

Hoʻomaka ka Prescribing Cascade inā ʻaʻole ʻike ke kauka he hopena ʻaoʻao ka hōʻailona hou o ke kanaka makua i ka lāʻau lapaʻau A, ʻike ʻo ia he maʻi lapaʻau hou loa, a kuhikuhi i ka lāʻau B e mālama i ka hopena ʻaoʻao o ka Lapaʻau A:

• Kākoʻo maʻamau #1 (The Swollen Ankles -> Dehydration Fall): Kau ʻia e ke kauka Amlodipine (Norvasc) no ke koko kiʻekiʻe -> ʻO Amlodipine ke kumu o ka hoʻoulu ʻana o ka wai ma nā kuʻekuʻe wāwae (peripheral edema, he hopena mechanical capillary i 15% o nā mea maʻi) -> Kuhi hewa ke kauka i ke kuhikuhi ʻana no ka puʻuwai pehu a me nā kuʻekuʻe wāwae hou. (Lasix)** pill wai -> Hoʻomaʻemaʻe ʻo Furosemide i ke kanaka makua a hoʻomaka i ka holo ʻana i ka pō i ka lumi ʻauʻau -> Pohihihi, hāʻule i ka pōʻeleʻele, a haki ko lākou ʻūhā.
• ** ʻO ka Cascade Maʻamau #2 (The Memory Pill -> Bladder Pill -> Delirium):** Kau ʻia ke kauka Donepezil (Aricept) (kahi lāʻau pro-cholinergic no ka pohō haʻahaʻa o ka hoʻomanaʻo ʻana) -> Hoʻoulu ʻo Donepezil i ka ʻokiʻoki ʻana o ka ʻōpū, e hoʻoulu ai i ka mimi hou / incontinence -> Kauka ʻo Urologist i ka ** Oxybutynin** (he lāʻau anticholinergic e hoʻopau pololei i ka lolo ma waho o ka lolo) huikau a me ka hallucinations -> Ua kauoha ka halemai i kahi antipsychotic (Haloperidol a i ole Quetiapine).
• Kākoʻo Kūlana #3 (The NSAID -> Blood Pressure Pill): Hoʻomaka ka poʻe kahiko e lawe ma luna o ka hale kūʻai Ibuprofen a i ʻole Naproxen i kēlā me kēia lā no ka ʻeha hui -> NSAID ka mea e paʻa ai ka sodium a hoʻokiʻekiʻe i ke koko e 10 a 15 mmHg -> Hoʻohui ke kauka i ka lāʻau lua o ke koko ma mua o ka hoʻololi ʻana i ka mālama ʻeha o ka arthritis i ka gel diclofenoac topical.

No ke aha i hāʻule ʻole ai ka hoʻonohonoho ʻana i nā pill plastic (a pehea e hoʻoponopono ai i ka ʻōnaehana home i kēia lā)¶

ʻO ka pahu pīkoʻo flip-top 7 lā maʻamau i kūʻai ʻia ma nā hale kūʻai lāʻau, ʻo ia kekahi o nā kumu nui o ka hewa o ka lāʻau lapaʻau i ka wā e ulu ai kahi kanaka ʻelemakule i ka hōʻino o ka naʻau, ka degeneration macular (ʻike maikaʻi ʻole), a i ʻole nā manamana lima ʻāʻī.

• No ke aha i hāʻule ʻole ai nā pahu plastik: (1) Ma ka ʻauinalā ʻo ka lā Sābati "kau hoʻopiha i ka pila," e hoʻolei ka makua luhi a i ʻole ka hoa kāne i ʻelua mau hua lāʻau keʻokeʻo keʻokeʻo i loko o ka keʻena hoʻokahi a i ʻole e lele i kahi lālani; (2) i ka wā i hoʻokuʻu wale ʻia ai ka pahu ʻiʻiʻa i lalo, ** hāmama nā keʻena he 28 i ka manawa hoʻokahi**, e hui pū ana i 140 mau huaʻai keʻokeʻo a me ka ʻulaʻula i hoʻopaʻa ʻole ʻia i loko o kahi puʻu ʻike ʻole ʻia ma ka moena; a (3) poina i ke kanaka makua huikau ka la o ka pule a lawe i na keena kakahiaka o ka Poalua a me ka Poakolu i ka hora hookahi.

3 mau mea ʻokoʻa hōʻoia hewa e kau ʻia i kēia pule¶

1. E hoʻololi i ka lāʻau lapaʻau manuahi "Multi-Med Compliance Blister Packs" (Strip Packaging / PillPack / Dispill):
   • Aneane nā hale kūʻai kūʻai nui a kūʻokoʻa hoʻi ma ʻAmelika Hui Pū ʻIa, Kanada, UK, a me Australia i kēia manawa ke hāʻawi nei Multi-Medication Compliance Packaging (e like me Amazon PillPack, CVS SimpleDose, Walgreens Adherence Strip/Blister Packs, Dispill, a i ʻole **NHS / Community Pharmacy Monitored Dosage Systems/ka uku maʻamau ma mua o ****linked Dosage Systems / uku uku maʻamau. copays.
   • Pehea ia hana: Ma kahi o ka hāʻawi ʻana aku iā ʻoe i 12 mau hue ʻalani ʻalani ʻokoʻa, ua hoʻopaʻa ʻia e ka lāʻau lapaʻau robotic dispenser i nā lāʻau lapaʻau a pau o ka Pōʻakahi 8:00 AM i loko o hoʻokahi ʻeke pohu a i ʻole nā ​​puʻi kāleka punch i paʻi ʻia me nā leka nunui nui: MONDAY, NOV 4: MORNING (8:00 AM) me ke kiʻi a me ka wehewehe ʻana o kēlā me kēia pila i loko.
   • No ke aha ia e ho'ōla ai i nā ola: ʻAʻohe kanaka e hoʻokaʻawale hou i nā pila ma ka home; inā hāʻule ka pahu i ka papahele, ʻaʻohe mea e kahe; a hiki i kekahi kahu hānai e hele ana i loko o ka lumi kuke i ka hola 10:00 AM hiki ke haʻi i loko o ʻelua kekona me ka 100 pakeneka maopopo inā MONDAY MORNING Ua wehe ʻia ka blister a i ʻole.
2. E hoʻohana i ka mea hoʻopuka paʻa i ka manawa i hoʻopaʻa ʻia (Hero, MedMinder, Philips, a i ʻole Carousel Alarm Dispenser) no nā poʻe ʻelemakule me ka Dementia:
   • Inā he dementia ha'aha'a a ha'aha'a kāu mea i aloha ai a ho'ā'o pinepine e lawe i nā lā'au lapa'au hou a'e i ka lā a pau, 'a'ole palekana ka pu'upu'u po'o ke waiho 'ia ma ka papa no ka mea hiki ke haehae i nā 'eke o ka lā 'apōpō.
   • Hoʻopaʻa ʻia kahi ** ʻĀpana Carousel Paʻa Paʻa Paʻa ** ($40 a i $80 ma Amazon, a i uhi pinepine ʻia e Medicaid HCBS Home and Community-Based Services waivers / VA Aid & Attendance) e laka i nā kau a pau e hiki mai ana ma hope o kahi uhi hōʻoia. Ma ka hola 8:00 AM, hoʻololi ka mīkini wale nō i ka ʻāpana 8:00 AM i loko o ka pahu hāmama, e ʻā ana i ke kukui, a hoʻokani i kahi puʻupuʻu a hiki i ka hoʻokomo ʻia ʻana o nā huaʻai i loko o ke kīʻaha, ʻaʻole hiki ke hoʻopaʻa ʻia i ke kino.
3. Noi i kahi "Hōʻike Lapaʻau piha (CMR) / Deprescribing Audit" me kahi Kauka Geriatric:
   • Ma lalo o Medicare Part D Medication Therapy Management (MTM) ma ʻAmelika Hui Pū ʻIa, NHS Structured Medication Reviews (SMR) ma UK, MedsCheck ma Kanada, a me Home Medicines Review (HMR) ma Australia, ʻo ka poʻe ʻelemakule e lawe ana i nā lāʻau lapaʻau maʻamau he nui ke kuleana no ka free, 1-on-1 Medication Review
   • E nīnau i ke kauka lāʻau lapaʻau a i ʻole ke kauka mālama mua: * "Ke lawe nei koʻu makua i 14 mau lāʻau i ka lā a huikau i ka papa kuhikuhi. Hiki iā mākou ke nānā i kā lākou papa inoa e pili ana i ka AGS Beers Criteria a me STOPP/START Criteria no ka haʻalele ʻana i nā lāʻau lapaʻau pono ʻole, kāpae i nā lāʻau anticholinergic a pau, a hoʻohui i ʻelua mau lā i kēlā me kēia lā a i ʻekolu mau lā i kēlā me kēia kakahiaka?"

Nīnau pinepine¶

He aha kaʻu e hana ai inā hoʻolei koʻu makua i 15 mau minuke ma hope o ka lawe ʻana i kā lākou mau lāʻau puʻuwai kakahiaka a me ke koko; E hāʻawi anei au iā lākou i kahi ʻē aʻe?¶

E hahai i ke keʻena lapaʻau **"Visible Intact Pill Rule"** i hoʻohana ʻia e nā lāʻau lapaʻau a me nā keʻena pilikia: **Mai hoʻohana hou ʻia** ke ʻole hiki iā ʻoe ke ʻike kino i ka papa holoʻokoʻa, paʻa ʻole, ʻaʻole i hoʻoheheʻe ʻia i loko o ka emesis (vomit). ʻO ka hapa nui o nā papa i hoʻokuʻu koke ʻia e hoʻomaka e wāwahi a komo i loko o ka ʻōpū a me ka ʻōpū liʻiliʻi luna i loko o **15 a 30 mau minuke** o ka ʻai ʻana. Inā ʻaʻole hiki iā ʻoe ke ʻike i ka paila paʻa a hāʻawi ʻoe i ka lua piha, hiki i ke kanaka makua ke komo i ka 150 a i ka 180 pakeneka o ko lākou koko a i ʻole ka lāʻau lapaʻau puʻuwai a loaʻa i kahi pōʻino pili koko. Inā ʻoi aku ma mua o 30 a 60 mau minuke ma mua o ka luaʻi ʻana, ua manaʻo ʻia ke ʻano o ka maʻi; E kāhea aku i ke kauka lapaʻau hāʻawi a i ʻole kauka kuhikuhi no ka ʻōlelo aʻo pili i ka lāʻau lapaʻau e pili ana i nā lāʻau koʻikoʻi e like me nā anticoagulants a i ʻole nā ​​​​lāʻau anti-seizure.

Pehea e hiki ai iaʻu ke haʻi i ka ʻokoʻa ma waena o ka "ʻelemakule maʻamau / dementia ʻino" a me nā hopena ʻaoʻao lāʻau ʻawaʻawa?¶

E nānā pono i ka **timeline e pili ana i nā hoʻololi ʻōlelo kuhikuhi hou**. ʻO ka maʻi Alzheimer ʻoiaʻiʻo a i ʻole ka dementia vascular e holomua mālie i nā mahina a me nā makahiki. Inā ʻike ʻia kahi kanaka ʻelemakule i ka huikau, ʻaʻole paʻa, hiamoe i ka lā, hoʻomāinoino, a i ʻole ʻaʻai ʻana i ka mimi hou ** i loko o 2 mau lā a i 4 pule ma hope o ka hoʻomaka ʻana i kahi lāʻau hou, hoʻonui i ka lāʻau, a i ʻole ka hoʻōla ʻana mai kahi maʻi/dehydration episode**, e mālama iā ia e like me ** ka lāʻau ʻawaʻawa a i ʻole delirium nui** a hiki i ka hōʻoia ʻana. E mālama mau i kahi **"Medication Change Log"** i kākau ʻia i ka lā pololei i hoʻomaka ʻia ai kekahi lāʻau lapaʻau a i ʻole mea hoʻohui OTC.

He kānāwai anei ka hūnā ʻana i ka lāʻau i paʻi ʻia i loko o ka pudding a i ʻole ka applesauce a kahi ʻelemakule ("hilinaʻi huna") inā loaʻa iā lākou ka dementia a hōʻole i ka ʻai ʻana i kā lākou mau lāʻau?¶

ʻO ka mea mua, mai kahi ʻano palekana olakino, pono ʻoe e kiʻi i kahi ** hōʻoia a ke kauka lapaʻau ** ʻo kēlā me kēia pila kikoʻī he palekana ke ʻoki ʻia a ʻaʻole pili me ka waiu/calcium i loko o ka pudding a i ʻole ka yogurt (no ka laʻana, hoʻopaʻa ʻia ka calcium i ka waiu i ka fluoroquinolone a me ka tetracycline antibiotic a me ka thyroid hormone levothyroxine, ke kāohi ʻana i kā lākou absorption). ʻO ka lua, ke hōʻole ke kanaka me ka dementia i nā lāʻau no ka mea ua nausea a hoʻomaha paha, hiki ke hoʻopaʻa huna i nā lāʻau 12 a pau e uhi i ka lāʻau ʻawaʻawa weliweli. Kūkākūkā i ka hōʻole ākea me kā lākou kauka a me ka mea koho olakino e ** wehewehe i nā lāʻau lapaʻau koho koho ** (e like me nā statins, bisphosphonates, a i ʻole multivitamins) no laila pono ʻoe e lawelawe i nā lāʻau 1 a i ʻole 2 pono maoli no ko lākou hōʻoluʻolu koke ʻana, ke kahe koko, a i ʻole ka hoʻomalu ʻana i nā hōʻailona, ​​me ka hoʻohana ʻana i nā wai hoʻoheheʻe a i ʻole nā ​​​​palapala hoʻoheheʻe waha inā hiki (ODTs).

He aha kaʻu e hana ai me nā ʻeke kahiko, i hoʻopau ʻia, a i ʻole nā ​​ʻōmole lāʻau lapaʻau i pau e hoʻopuʻi ana i ke keʻena lāʻau o koʻu makua?¶

ʻO ka mālama ʻana i nā ʻōmole i hoʻopau ʻia (e like me ka ʻōmole lisinopril 20 mg o ka makahiki i hala e noho pono ana ma ka ʻaoʻao o ka hue lisinopril 40 mg o kēia makahiki, a i ʻole nā ​​​​mea hōʻeha ʻeha opioid i koe mai kahi ʻoki ʻūhā ʻelua makahiki i hala aku nei) ʻo ia kekahi o nā kumu nui o ka overdoses o ka poʻe kahiko. I kēia lā, wehe kino i kēlā me kēia ʻōmole i hoʻopau ʻia, ʻelua, a i ʻole ka pau ʻana mai ka lumi kuke a me ka lumi ʻauʻau. E lawe iā lākou i kahi **DEA Authorized Drug Take-Back Kiosk** manuahi ʻole i loko o nā hale kūʻai kūʻai nui (CVS, Walgreens, Walmart, Rite Aid), lobby halemai, a i ʻole lobby hale mākaʻi kūloko.

Nānā ʻia nā kumu¶

• American Geriatrics Society (AGS): 2023 Hōʻano hou i ka AGS Beers Criteria no ka hiki ʻole ke hoʻohana ʻia i nā lāʻau lapaʻau i nā poʻe ʻelemakule (United States / International).
• Institute for Safe Medication Practices (ISMP): ISMP List of High-Alrt Medications in Community/Ambulatory Healthcare & Oral Dosage Forms That should not be crushed (Do Not Crush List) (United States).
• Nā Pūnaehana Poison o ʻAmelika (AAPCC ma mua) a me National Capital Poison Center: *Nā Kuhikuhi Hoʻokele Hoʻomaʻamaʻa No ka Hoʻohana ʻAʻole Manaʻo ʻAi ʻAi ʻelua o nā Beta-Blockers, Calcium-Channel Blockers, Oral Anticoagulants, a me Sulfonylureas i nā ʻelemakule * (ʻAmelika Hui Pū ʻIa).
• European Geriatric Medicine Society (EuGMS): STOPP/START Criteria (Version 3) for Potentially Inppropriate Prescribing in Old People (European Union / United Kingdom).
• National Institute on Aging (NIA) & U.S. Food and Drug Administration (FDA): Safe Medication Use in Old Adults, Avoiding Polypharmacy Drug Interactions, and Medicare Part D Medication Therapy Management (MTM) Standards (United States).

Nā alakaʻi pili¶

• ʻO ka delirium o ka haukapila, huikau koke, a me ka ʻōlelo aʻoaʻo o nā poʻe kahiko
• Hāʻule ka poʻe ʻelemakule i ka wā hiki ʻole ke kū
• ʻAʻole hiki ke mālama ʻia a me ka hoʻopakele kanaka makua
• ʻO ka Dementia auwana a me ka nalo ʻana o ka ulia pōpilikia
• Papa kuhikuhi helu pilikia