AMDCP Credit Designation:
This session has been approved for a total of 3 Clinical credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).
The American Medical Directors Association designates this educational activity fora maximum of 3 AMA PRA Category 1 Credit(s)TM
. Physicians should only claim credit commensurate with the extent of their participation in the activity. Presenter(s):
Mario Cornacchione, DO, CMD(Moderator); Michael Bottorff, PharmD, FCCP; Naushira Pandya, MD, CMD; DennisChapron, PharmD; T.S. Dharmarajan, MD, FACP; Meri Hix, PharmD, CGP; S Disclosure(s):
Dr.Hix will discuss off-label use of mirtazapine,megestrol, and dronabinolin the anorexia of aging.
MichaelBotteroff received speaker honoraria from Sanofi Aventis, AstraZeneca and Pfizer Inc.
MarioCornacchione, DO, CMD will discuss off-label use of Mirtazapine,Omega III Fatty Acids and Megestrol.
Allother presenters report they had no relevant financial relationships todisclose Session Description:
This session takes the form of a moderated pro/conevidence-based debate utilizing a long term care physician and pharmacist foreach topic. What is the evidence forusing megestarol, mirtazepine or dronabinol in unintended weight loss? Is theefficacy data and side effect profile of amiodarone enough to support its useversus simple rate control in the frail elderly? Is there enough evidence tosupport using Vitamin D as part of a fall prevention program? In addition, itprovides valuable insight into the sometimes differing perspectives ofconsulting pharmacists and physicians on topics such as these. Learning Objectives:
- Describe the evidence for and against use of megestrol acetate,mirtazapine and dronabinol in unintended weight loss in long term care
- Perform a risk benefit analysis for use of amiodarone in atrialfibrillation- rate control vs. rhythm control
- Discuss the evidence for and against use of Vitamin D in FallPrevention
1.Orexigenic Use in Unintended Weight Loss: Miller LJ, Kwan RC. Pharmacological treatmentof undernutrition in the geriatric patient. Consult Pharm. 2002; 17:739-747.
Kennedy DH, Ward CT, Salvig B. Retrospective review ofmegestrol use for weight loss in an elderly population. Consult Pharm. 2005;20:301-305.
Bodenner D, spencer T, Riggs AT, Redman C, Strunk B, HughesBA. A restrospective study of the association between megestrol acetateadministration and mortality among nursing home residents with clinicallysignificant weight loss. Am J Geriatr Pharmacother. 2007;5:137-146.
Yeh SS, Wu SY, Lee TP, Olson JS, Stevens MR, Dixon T, et al.Improvement in quality-of-life measures and stimulation of weight gain aftertreatment with megestrol acetate oral suspension in geriatric cachexia: resultsof a double-blind, placebo-controlled study. J Am Geriatr Soc. 2000;48:485-492.
Sullivan DH, RobersonPK, Smith ES, Price JA, Bopp MM. Effects of musclestrength training and megestrol acetate on strength, muscle mass, and functionin frail older people. J Am Geriatr Soc. 2007; 55:20-28.
Reuben DB, Hirsch SH, Shou K, Greendale GA.The effects of megestrol acetate suspension for elderly patients with reducedappetite after hospitalization: a phase II randomized clinical trial. J AmGeriatr Soc. 2005; 53:970-975.
Yeh SS, Wu SY, Levine DM, Parker TS, Olson JS, Stevens MR,Schuster MW. Quality of life and stimulation of weight gain after treatmentwith megestrol acetate: correlation between cytokine levels and nutritional status,appetite in geriatric patients with wasting syndrome. J Nutr Health Aging.2000; 4:246-251.
Raji MA, Brady SR. Mirtazapine for treatment of depressionand comorbidities in Alheimer disease. Ann Pharmacother. 2001; 35:1024-1027.
Laimer M, Kramer-Reinstadler K, Rauchenzauner M,Lechner-Schoner T, Strauss R, Enl J, et al. Effect of mirtazapine treatment onbody composition and metabolism. J Clin Psychiatry. 2006; 67:421-424.
Nelson JC, Hollander SB, Betzel J, Smolen P. Mirtazapineorally disintegrating tablets in depressed nursing home residents 85 years ofage and older. Int J Geriatr Psychiatry. 2006; 21:898-901.
Wilson MG,Philpot C, Morley JE. Anorexia of aging in long term care: is dronabinol aneffective appetite stimulant? – a pilot study. J Nutr Health Aging. 2007;11:195-198.
Volicer L, Stelly M, Morris J, McLaughlin J, Volicer BJ.Effects of dronabinol on anorexia and disturbed behavior in patients withalzheimer’s disease. Int J Geriat Psychiatry. 1997; 12:913-919.
2.Amiodarone Use for A. Fib: JACC 2003;42:20-29JACC. 2005;46:1891-9 Circulation. 2006;114:e257-e354
3.Vitamin D Use in Fall Prevention: Morley JE. Mo Med. 2007; 8: 276-8
Dharmarajan TS. J Am Med Dir. Assn. 2007; 8: 549-50
Swift CG. Age Ageing. 2006; 35: S2: ii 65-8
Holick MF. NEJM. 2007; 357: 266-81
Holick MF. Mayo Clin Proc. 2006; 81: 353-73
N Engl J Med 2005;352:1861-1872
T.S. Dharmarajan, M. Akula, S. Kuppachi, EP Norkus J NutrHealth Aging. 2005; 9:145
Janssen HC, et al. Am J Clin Nutr. 2002; 75: 611-5
Burleigh E et al. Age and Ageing. 2007; 36: 507-13
JacksonRD et al. N Eng J Med. 2006; 354:669-83
Law M et al. Age Ageing. 2006; 35: 482-6