I did my IPPE rotation at a pharmacy where I did a lot of LTC consulting. This was the first time I was really able to evaluate patient's medications profiles as a student. In specific classes, I found it easier to evaluate medications because you knew you were supposed to be looking at the cardiac meds, or the diabetes meds. In real life, you have to make sure you are looking at everything.

Some commonly seen issues I learned were:

  Donepazil and Oxybutinin. One is an anticholinergic and one is a cholinergic. Both are common to see in the elderly.

  Levothyroxine at the same time as certain medications. It was pretty common for the patient to be admitted to the nursing home and all their meds timed together in the morning.

   Watching out for meds that have been left on for too long, such as omeprazole or statins with no labs.

   Watching out for Beers List medications, such as Macrobid, which I saw a lot. 

   Watching out for medications that were never titrated up. A lot of these problems that I had to watch for were typical in the elderly because of how rarely they had comprehensive medication evaluations. Lots of therapies were started during hospital admissions or by physicians and never followed up on.

   Keeping an eye out for diminishing CrCl was very important as well. Lots of these patients were losing their renal function over time and were on medications with CrCl cutoffs.

It was nice to come away with a list of things I can remember to keep an eye out when working with geriatric patients!