Medications prescribed by specialists in nursing homes.

摘要

The existence of specialty prescribers is challenging.1 Multiple prescribes have been identified as a risk factor for treatment with medications considered to be "inappropriate." The use of "inappropriate" medications, in turn, has been associated with adverse outcomes such as hospitalization and death. In my experience, specialty prescribed medications include muscle relaxants for spasticity induced by upper motor neuron lesions (tizanidine, baclofen, and dantrolene), antiseizure medications (phenobarbital, carbamazepine, phe-nytoin), and the anti-arrhythmic (amiodarone).4'5 Other examples include immunornodulating agents for rheumatoid arthritis and psychiatric medications. Primary physicians may be uncomfortable determining if these "specialty" medications are indicated or the lowest effective dose. Unfortunately, office-based specialty consultants may not be aware of the "big picture." The urology consultant may focus on a single problem such as urge incontinence and give little attention to systemic anticholinergic effects. ' The neurology consultant may advance the dose of medications for Parkinson's disease in an effort to maintain ambulation without awareness of hallucinations and agitation triggered by the medications.