THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 526.4 Guest: Dr. Michael Miller,Director, Center for Preventive Cardiology, Univ. of MD Medical School Topic: Watching for Drug Interactions in the Elderly Host: Steve Girard Producer: Ed Graham

NEMA: Dr. Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical School. How are we doing, monitoring the interactions of the many drugs many elderly people have to take....

MILLER: First you need to be concerned that the patient, the elderly patient, is on the medication he or she should be on, so if an elderly person has had a heart attack, we now know that certain medications are useful in preventing another heart attack. Those medications include aspirin...we know that up to 25%, if not more, of elderly patients are not taking aspirin after they've had a heart attack. These are the patients that should be taking it. In addition....beta blockers have been shown to be effective against recurring heart attacks, and so elderly patients, unless there's a reason they shouldn't be taking the beta blocker, should be on it. There's another medication known as the ace inhibitor, that is useful in the elderly patient with heart squeezing problems, so if the elderly patient has had a heart attack, and his heart pumping function is not adequate, then consideration for an ace inhibitor should be implemented. As well as we discussed the cholesterol lowering medication and medications for high blood pressure. Now, these medications in concert, may cause problems if they're not monitored closely, so a patient should be seen by his physician where tests such as examining the liver of the kidney function test, to make sure there's no impairment, because if there is impairment of those organs, then there might need to be a change in the dose of the medication.

NEMA: What about over the counter medications...can they cause some problems?

MILLER: Some over the counter medications ..if an elderly patient has a cold, and decongestants are needed, then some of these over the counter medications may actually increase blood pressure. And it can be a problem in an elderly individual who has a tendency to high blood pressure, and may need to be monitored. It's important that some of the over counter medications just need to be discussed briefly with the physician or the nurse at the physician's office.

NEMA: Dr., give me some combinations of medications you watch out for in treating patients...

MILLER: Some of the medications that need just to be monitored more closely include combinations of medications that are used for cholesterol, for example, so we now are using a lot of the statins...and these are medications that have a good tendency to lower LDL. But we also know that statins work primarily in the liver, so any of the medications that also work in the liver might need to be monitored...and a lot of medications, some of which might be antibiotics, some might be blood pressure medications need to be evaluated prior to their use. Often times, the dose of the medication could be altered so as to potentially prevent this problem from occurring.

NEMA: My uncle tells me, "Don't get old"!....and I say, "I don't like the alternative"! But he keeps in good shape, takes some medications, and takes his doctor's advice about his diet. Doesn't sound like someone who minds being old. Our thanks to Dr. Michael Miller for his help on our mini focus on the elderly this week. I'm Steve Girard.