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Renal impairment and medication: DISCUSSION(3)

Renal impairment and medication: DISCUSSION(3)

Two possibilities may explain this finding. First, the institution pharmacy plays an active consultation role with physicians by reviewing medications and dosages. Several studies have demonstrated that the number of medication errors decrease with the involvement of pharmacists . The second possibility is that only one physician was assigned to each ward. Other investigators have shown that for any one patient, the involvement of many physicians increases the risk of prescription errors . Also, the physicians’ ability to manage medications optimally may have been enhanced by their familiarity with the complexity of the patients’ conditions. In our study of long term care facilities, fewer inappropriately dosed medications were found in facilities where fewer physicians cared for greater numbers of residents. buy ortho tri-cyclen

The main caveat of the present study is the limited gener-alizibility of the findings obtained with our small sample size. It is unclear whether the prevalence of renal impairment would be the same in other settings, and unlikely that the proportion of inappropriately dosed medications would be as low as that observed in our setting. Nonetheless, our findings illustrate important considerations in the care of older psychiatric patients. Issues of renal clearance may seem less relevant to psychiatric patients because most psychotropic medications (with the exception of lithium) are eliminated through the liver . However, in older patients, medications are often used to treat an increasing number of other conditions associated with aging. A review of 868 older psychiatric inpatients revealed an average of 5.6 other, nonpsy-

chiatric, medical conditions per patient . Similarly, our patients took an average of 10 regular and as-needed medications, many of which were used to treat conditions other than psychiatric problems. Although our patients were receiving dosages congruent with their renal capacity, more than half had borderline to severe renal impairment. These results highlight the need for vigilance when dosing medications for older psychiatric patients.

Category: Psychogeriatric inpatients

Tags: Creatinine clearance, Medication use, Older adults, renal function, Serum creatinine

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