Impact of Anticholinergics on the Aging Brain: A Review and Practical Application

Boustani, Malaz; Campbell, Noll L.; Munger, Stephanie; Maidment, Ian; Fox, Chris

doi:10.2217/1745509x.4.3.311

Cited by 608 publications

(658 citation statements)

References 45 publications

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“…These resources coupled with effective communication are gaining greater importance as time allotted for health care visits decreases [5]. Healthcare practitioners can play a significant role in educating parents in how to manage fever and febrile illnesses in their children.…”

Section: Resultsmentioning

confidence: 99%

Prescribing and Research in Medicines Management (UK & Ireland) Conference 2016 Health Foundation London January 29th 2016 “Ethics, Economics and the Future of Medicines – A Population Perspective”

2016

Pharmacoepidemiology and Drug

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Background: Poor communication of information at healthcare transition is responsible for over 50% of all medication errors and up to 20% of adverse events. 1 It is well recognised that transfer of patients between different care settings presents significant risks to maintaining adequate communication about changes to medicines regimes. It is estimated that between 30 and 70% of patients have either an error or an unintentional change to their medicines when their care is transferred. 2 The Royal Pharmaceutical Society published guidance in 2012 with the aim of improving the transfer of information across all care settings. 3 An area that can easily be overlooked is where a cancer medicine is prescribed and/or directly supplied to patients by organisations outside of a general medical practice. The number of these medicines is likely to increase as long-term oral chemotherapy becomes the norm. This presents a challenge to primary care to ensure that clinicians are aware of these medicines in order to make effective clinical decisions, avoid interactions or other risks when a new medicine is prescribed. This study aimed to quantify the scale and nature of the how non-primary care cancer medicines are recorded in the patient's clinical records.Methods: This study was undertaken across one clinical commissioning group in North East England. The details of patients being prescribed oral anticancer medicines (erlotoib, gefitinib, imatinib, lenalinamide, thalidomide and topotecan) were extracted from the secondary care Trust's oncology notes and pharmacy system. The practice clinical system was checked to see how the medicine was recorded and if the practice had received information about the medicine. Primary care pharmacists collected the data on a pro forma, which was faxed or posted back to the researcher. The data were analysed descriptively.Results: 20 patients registered with 15 general medical practices, across one clinical commissioning group, were prescribed five oral anticancer medicines: erlotonib (n = 5), (imatinib (n = 5), lenalinamide (n = 5), thalidomide (n = 1) and topotecan (n = 1). The majority of patients (n = 18; 90%) had the cancer medicine noted somewhere in the patient's electronic clinical record. However, only 6 patients (30%) had the drug listed in the prescribing section of the clinical record. Of the remaining 14 patients, one had a 'pop up' alert warning with the name of the drug. For 18 patients (90%), the general practice had received information about the anticancer medicine from the hospital via letter. Two practices had received no information. Four patients (20%) were co-prescribed interacting medicines with two of these cases involving co-prescribing erlotinib with a proton pump inhibitor, which the manufacturers have advised to avoid.Discussion: In this small study, while showing communication of patients receiving chemotherapy is successfully recorded on the GP system, there is a potential safety concern. Only one-third of patients on oral anticancer medicines have the medic...

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Section: Resultsmentioning

confidence: 99%

Prescribing and Research in Medicines Management (UK & Ireland) Conference 2016 Health Foundation London January 29th 2016 “Ethics, Economics and the Future of Medicines – A Population Perspective”

2016

Pharmacoepidemiology and Drug

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“…We obtained data on drugs published in anticholinergic rating scales from seven articles [7][8][9][10][11][12][13] used in a systematic review [3] that evaluated the differences between each anticholinergic rating scale and the relation between anticholinergic burden and adverse effects. In these articles, drugs were ranked by the strength of their anticholinergic effects.…”

Section: Drugs Used In the Decision Tree And Their Anticholinergic Ementioning

confidence: 99%

<b>Analysis of physicochemical properties of drugs included in anticholinergic rating scales</b>

Nagai

Kagaya

Uesawa

2018

CBIJ

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Adverse effects induced by the duplication of drugs with anticholinergic effects are a problem among elderly people who take many drugs. Various anticholinergic rating scales have been published and are applied clinically to evaluate a patient's anticholinergic burden; however, there are some problems with these scales, such as drugs that are assessed differently between scales. We aimed to construct a method to more correctly distinguish between drugs with and without anticholinergic effects and to understand the properties of drugs that have anticholinergic effects. We constructed a model for identifying anticholinergic effects via a decision tree, using descriptors indicating the physicochemical properties of the drugs. The best split yielded a decision tree with 46 branches (area under the receiver operating characteristic curve = 0.99). However, only seven branches, defined by six descriptors: ASA_P, GCUT_PEOE_0, opr_brigid, PEOE_VSA+1, GCUT_SLOGP_0, vsa_pol (related to van der Waals surface areas, partial charges, and molecule structures), were required to identify drugs with anticholinergic effects. This result suggests a relationship between the hydrophobic interactions of drugs and the muscarinic receptor. In this study, we constructed a model to predict whether drugs have anticholinergic effects, and obtained essential physicochemical information on the drugs to distinguish their anticholinergic effects. It is our hope that these findings provide useful information for predicting anticholinergic effects of drugs in clinical settings.Key Words: anticholinergic rating scales, adverse effects, polypharmacy, Structure-Activity Relationship, decision tree Area of Interest: Information and computing approach for drug design and ADMET study

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“…33 They have developed the ABC Anticholinergic Cognitive Burden Scale in order to help physicians to identify those medications taken by the patients which can impair their cognition and state the severity of their anticholinergic effect. 34 These drugs with documented anticholinergic activity were identified through a systematic review of the literature before they were included in the scale. These tools can be found at http://www.agingbraincare.org.…”

Section: Antimuscarinic Treatmentmentioning

confidence: 99%

Treatment of Overactive Bladder in Elderly Patients: Clinical Considerations

2015

Clinical Medicine Insights: Geriatrics

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Overactive bladder (OAB) is a highly prevalent disorder among elderly and frail elderly patients, who are frequently polymedicated, suffer from kidney and liver failure and are susceptible to adverse events. Particular attention is, therefore, being given to efficacy and side effects of the treatment in patients older than 75 years. The introduction of newly developed drugs specifically designed for the treatment of OAB is opening new frontiers on this respect. The authors summarize the most recent evidence on this topic.

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Impact of Anticholinergics on the Aging Brain: A Review and Practical Application

Cited by 608 publications

References 45 publications

Prescribing and Research in Medicines Management (UK & Ireland) Conference 2016 Health Foundation London January 29th 2016 “Ethics, Economics and the Future of Medicines – A Population Perspective”

Prescribing and Research in Medicines Management (UK & Ireland) Conference 2016 Health Foundation London January 29th 2016 “Ethics, Economics and the Future of Medicines – A Population Perspective”

<b>Analysis of physicochemical properties of drugs included in anticholinergic rating scales</b>

Treatment of Overactive Bladder in Elderly Patients: Clinical Considerations

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