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Introduction:
Polymedication is a well-known issue in the elderly
since it is linked with potentially inappropriate medication (PIM). One
of the objectives of the IPOP study was to evaluate the prescriptions in
the community setting in France in order to have a descriptive view of
the potential PIM in a large cohort of elderly patients.
Methods:
Elderly patients (>65 years) with 3 or more medications
visiting one of the 81 participating community pharmacies were
included. Prescriptions were analyzed with the Beers criteria (JAGS-
2015) for the detection of PIM in elderly patients according to their 5
main lists of criteria.
Results:
905 patients (1 prescription/patient) were included (women:
54.4%; median age: 77). 6839 drugs were prescribed (mean/median:
7.6/7 drugs). 751 (83.0%) patients had at least one Beers criteria for PIM
use. 664 (73.4%) patients had at least one Beer criteria for PIM due to
drug
–
disease/syndrome. 489 (54.0%) patients had at least one Beers
criteria for PMI to be used with caution. 139 (15.4%) patients had at
least one Beers criteria for potentially clinically important non-anti-
infective drug
–
drug interactions. 167 (18.5%) patients had at least one
Beer criteria for non-anti-infective medications that should be avoided
or have their dosage reduced with renal function. Multivariate analysis
reported that when the number of drugs/prescription increased then
the risk of PIM increased.
Conclusion:
IPOP reported that many patients are potentially exposed
to PMI because of their age. It is therefore important to use tools/
criteria in order to improve the safety of the treatment.
P-780
Comprehensive geriatric care reduces potentially inappropriate
prescribing in frail, anemic elderly patients with a hip fracture
M.E.J. Jensen
1
, M. Gregersen
1
, E.M. Damsgaard
1
.
1
Department of
Geriatrics, AUH Aarhus University Hospital, Aarhus, Denmark
Introduction:
Frail elderly patients are vulnerable to potentially
inappropriate prescriptions (PIPs) and accordingly comprehensive
geriatric care (CGC) includes a review of the patient
’
s medication. The
Screening Tool of Older Peoples Prescriptions (STOPP) has been
developed to identify PIPs among elderly patients. The present study
aims to investigate if CGC reduces the number of PIPs among frail,
anemic, elderly patients with hip fracture.
Methods:
Using data from the
“
Transfusion Requirements In Frail
Elderly
”
(TRIFE) study, we investigated medication among 50 conse-
cutive frail patients aged 65 or more, admitted to Aarhus University
Hospital from a nursing home or sheltered housing with a unilateral
hip fracture between October 10, 2012 and June 6, 2013. All the
patients received CGC. Using the STOPP criteria, we identified the
prevalence of PIPs at admittance and after the termination of CGC
(30 days).
Results:
The mean age of the patients was 87 years (SD 7.4), 80% were
women, and 70% came fromnursing homes. The prevalence of patients
with at least one PIP, as defined by the STOPP criteria, was 86% at
admission and 79% at termination of the CGC. The median number of
PIPs at admittance was 2 (IQR 1
–
3) compared to 1 (IQR 1
–
3) at
termination (P = 0.0045).
Conclusion:
CGC significantly reduced the prevalence of PIPs in this
group of patients, but did not remove them entirely. This may indicate
that some patients
’
PIPs represent necessary medication. It certainly
emphasises the need for continued focus on the quality of prescribing
among frail, elderly people.
P-781
Hypoglycemic coma with fatal outcome in a patient treated with
cotrimoxazole and sulphonylurea
C. Joyau
1,4
, G. Veyrac
1,4
, L. Nicolet
2
, F. Delamarre-Damier
3,4
, P. Jolliet
1,5
.
1
Pharmacology Department, Biology Insitute, University Hospital,
2
Intensive Care Unit, University Hospital, Nantes,
3
Monfort Nursing
Home, Saint Laurent sur Sèvre,
4
AGREE French Nursing Home Research
Organization Chateau Thébaud,
5
EA4275 Biostatistics,
Pharmacoepidemiology and Subjective Health Measure, Medicine
University, Nantes, France
Introduction:
Hypoglycemia can lead to severe complications such
as coma. Some drugs like sulfonylureas can cause this disorder.
Hypoglycemia is also a known side effect of cotrimoxazole.
Objectives:
To report a fatal case of hypoglycemic coma in a patient
treated with glimepiride and cotrimoxazole.
Observation:
This case concerns a 62 year-old male patient treated
with glimepiride for diabetes. In August 2015, cotrimoxazole treat-
ment was started in a context of Staphylococcus aureus infection and
the patient developed renal failure. A few days later, the patient fell
into a coma with Glasgow score 3 and capillary blood sugar level of
0,13 g/L. Hypoglycemic coma was retained. The patient died 7 days
after the beginning of the first symptoms.
Conclusion:
Fixation of glimepiride on potassium channel ATP-
sensitive in the beta cells of Langerhans islets causes inhibition of
potassium efflux, resulting in cellular cell depolarization causing
insulin release. Sulfamethoxazole is a sulfonamide chemically similar
to sulphonylureas. Glimepiride is metabolized by cytochrome 2C9;
sulfamethoxazole is a potent inhibitor of this cytochrome. These data
suggest pharmacodynamic and pharmacokinetic interaction. In the
summary of products characteristics (SPC) of glimepiride, potentiation
of hypoglycemic effect is mentioned with certain drugs including
some long acting sulfonamides. In cotrimoxazole SPC, safety precau-
tion is noted with chlorpropamide, tolbutamide (two sulfonylureas).
Several publications suggest an increased risk of hypoglycemia when
cotrimoxazole is associated with glyburide or glipizide. We didn
’
t find
any publication mentioning an interaction between cotrimoxazole
and glimepiride. Health professionals should remain vigilant for
hypoglycemia in patients receiving these drugs, especially in patients
with renal failure.
P-782
Use of QT- interval prolonging drugs in patients admitted to
geriatric department
S. Krajcik
1
, P. Mikus
1
, Z. Janoskova
2
.
1
Slovak Medical University,
2
University Hospital Bratislava
Usage of QT interval prolonging drugs was assessed in 231 patients (65
men and 166 women) being admitted to geriatric department with
average age 82 yrs (range 66
–
99 yrs). 80.3% of patients came from
home, the rest were transferred from other departments. 80 (34.6%)
patients used no drug prolonging QTc 72(31.2%) 1 drug, 50 (21.6%) 2
drugs, 23(10%) 3 drugs and 5(2.1%) 4
–
6 drugs. Use of QT prolonging
drugs was increasing with age (60% in age group 65
–
74 years, 67.9% in
age group 75
–
84 years and 78% in patients over 84 years) Patients
transferred from other departments used these drugs more often than
those coming from home (75.6%, resp. 69.9%). The most frequently
used groups were diuretics (36%), antipsychotics (24%), pantoprazol
(22.5%) and antidepressive drugs (10.4%). Patients using QTc prolong-
ing drugs died more often in next 3 months (30.3% versus 16.7%). The
difference was biggest in those using more than 1 drug (43.7% in
deceased and 28.7% in surviving patients).
P-783
STOPP Frail (Screening Tool of Older Persons Prescriptions in Frail
Adults with Limited Life Expectancy): consensus validation
A.H. Lavan
1,2
, P. Gallagher
1,2
, C. Parsons
3
, D. O
’
Mahony
1,2
.
1
Cork
University Hospital,
2
University College Cork,
3
Queens University Belfast
Introduction:
To validate STOPPFrail, a list of explicit criteria for
potentially inappropriate medications (PIMs) in frailer older adults
with limited life expectancy. A Delphi consensus survey of an expert
panel (n = 17) comprising specialists in geriatric medicine, clinical
pharmacology, palliative care, psychiatry of old age, clinical pharmacy
and general practice.
Methods:
STOPPFrail criteriawas initially created by the authors based
on clinical experience and appraisal of the available literature. Criteria
were organised according to physiological system. Panellists ranked
their agreement with each criterion on a 5-point Likert scale and
invited to provide written feedback. Criteria with a median Likert
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S235