Jason A. Gregg

Benzodiazepines and Geriatrics: What Clinical Practice Strategies Can Be Used to Reduce the Inappropriate Prescribing?

Abstract In the elderly, Potentially Inappropriate Prescriptions (PIPs) are quite common and connected with adverse drug events (ADEs), hospital stays, increased medical acuities, and inefficacious healthcare. Benzodiazepines as a class have been identified as an independent risk factor for ADEs and shown to be associated with sedation and impairments in cognition, memory, and balance, lending to an increased risk for falls. Clinically inappropriate medications continue to be prescribed and preferred by many clinicians over non‐pharmacological strategies despite continued evidence demonstrating poor outcomes in older adults. Due to the increasing evidence in positive elderly outcomes through the reduction in use of inappropriate drugs, medication reduction strategies are now required policy components in the Centers for Medicare and Medicaid Services regulations along with Medicare Part D. Quality measures now focus on extensive drug reviews with reduction strategies that incorporate use of: the Beers Criteria; multidisciplinary approaches; involving patients and caregivers; and de‐prescribing strategies.

How Do You Recognize Opiate Addiction in the Rehabilitation Patient

Robert Jones, a 42-year-old male, has been under medical management for chronic low back pain (CLBP) for the past 9 months. His rehabilitation program consists of weekly physiotherapy treatments along with medication therapies including a nonsteroidal anti-inflammatory drug (NSAID) and prescription opioid. Robert has missed his last three rehabilitation therapy sessions, and he presents to the clinic today with no appointment demanding to be seen by the nurse practitioner for an escalation in CLBP symptoms. When questioned about his missed rehabilitation therapy appointments, his anxious demeanor quickly demonstrates irritability. He states, “The only thing that helps my pain is the Percocet pills. The rehab and ibuprofen are a waste of time.” He adds, “My family doctor doesn’t know how to treat my pain so I need you to refill my Percocet prescription.” Introduction

What clinical practice strategies can be utilized to help reduce the incidence of heroin abuse in rehabilitation patients on chronic opioid therapy

Justin Smith, a 26-year-old Caucasian male, presents to the clinic for a follow-up visit related to medical management of his chronic low back pain. For the past 4 months, he has been receiving biweekly physiotherapy including stretching and back strengthening exercises, low-impact aerobic conditioning, and spinal manipulation. Along with these treatment methods, he has been receiving Oxycodone for pain relief. The physical rehabilitation team is in the process of weaning the patient off this medication since he has been progressing as expected. The patient’s Kentucky All Schedule Prescription Electronic Reporting (KASPER) report (Kentucky Cabinet for Health & Family Services, 2013) demonstrates he has only received scheduled prescriptions including Oxycodone from this office. At today’s visit, his wife expresses concern that Justin has recently begun exhibiting impulsivity in his decision-making.