Medication Therapy Management in Hospitalized Elderly Patients

A Focus on OTC Agents

Lynn Chan, PharmD; Philip J. Gregory, PharmD, MS, FACN; Lee E. Morrow, MD, MSc, FCCP; Mark A Malesker, PharmD, FCCP, FCCP, FASHP, BCPS


US Pharmacist. 2016;41(10):HS16-HS21. 

In This Article

Role of the Pharmacist

Many consumers and even some healthcare providers consider OTC agents to be completely safe and do not consider these products to be "real medications." From the patient perspective, medication monitoring of OTC products primarily focuses on the efficacy related to relief of symptoms rather than potential adverse effects or laboratory changes. Unfortunately, comprehensive MTM is often limited when it comes to OTC products due to an incomplete medication list.

The challenge for the healthcare professional is to identify the true medication list for each patient and to ensure that each patient's medications (prescription and OTC) are appropriate, the safest possible alternative, the most effective for each condition, void of duplication, and used correctly. Medication reconciliation can be a challenging and timeconsuming task. Pharmacy technicians, pharmacy students, and nursing staff can all work with pharmacists in verifying an up-to-date, accurate medication list. Pharmacists in the hospital setting should be individually assessing each new admission and provide recommendations for medication discontinuation or adjustment based upon patient presentation. Pharmacists can collaborate with providers to optimize medication therapy goals for each patient.

Elderly patients are more susceptible to ADRs compared to the general population.[52] The physiological changes with aging also can affect the pharmacokinetic properties of both prescription and OTC products.[53] Elderly patients may also be taking five or more medications (polypharmacy) for chronic illnesses, increasing the likelihood of drug interactions.[54] OTC products with significant drug-drug interaction potential include acetaminophen, ASA, NSAIDs, cimetidine, and omeprazole.[55] Finally, older adults with decreases in visual acuity and hearing, along with memory impairment, can forget to take their medications correctly.

It is reasonable for the pharmacist to counsel patients on medications upon discharge. This discussion should include the appropriate use of prescription and OTC medications, what medications to avoid, and the potential for side effects. In addition, the importance of follow-up with a single community pharmacy provider and regular mediation review with providers and their pharmacists should be stressed in order to keep the medication profile updated. Finally, it is important to remind patients to seek counsel from their caregivers before starting and continuing OTC medications for long-term use.