The prescribing cascade and medication therapy management between cholinesterase inhibitors and anticholinergic drugs / 中国药学杂志

ABSTRACT

OBJECTIVE: To discuss about one patient with Alzheimer′s disease and urinary incontinence and to investigate the prescribing cascade between cholinesterase inhibitors and anticholinergic drugs further more. METHODS: Clinical pharmacists participated in a medication therapy management program aiming at one patient with Alzheimer′s disease and urinary incontinence. By doing this they successfully identified and interrupted a prescribing cascade. Then some constructive advices were provided to doctors and patients on the rational administration of drugs. RESULTS: The drug treatment plan was adjusted by clinical pharmacists and doctors after evaluating the benefits and risks about the use of cholinesterase inhibitors and anticholinergic drugs in the elderly patient with chronic disease. And this change directly led to a significant relief of urinary incontinence in the patient. CONCLUSION: The use of cholinesterase inhibitors in Alzheimer′s patients increases the risk of urinary incontinence, and at the same time additional use of anticholinergic drugs in the treatment of urinary incontinence can further damage the cognition.Therefore, clinical pharmacists and doctors should pay great attention to the prescribing cascade of cholinesterase inhibitors and anticholinergic drugs. To identify and interrupt prescribing cascades is important when clinical pharmacists and doctors are prescribing prescriptions for elderly patients with chronic diseases. They must work closely for the optimization of prescriptions and the improvement of medication safety in elderly patients.