Marijuana Use in the Elderly: Implications and Considerations.

OBJECTIVE: This article reviews the literature on the use of marijuana in the elderly. Pharmacists play an important role in the management of medications including drug use of potentially illegal drugs, including marijuana. The use of both recreational and medical marijuana has grown exponentially in the general population, including in older adults. As of 2017, marijuana for medical use is legal in 26 states and the District of Columbia. DATA SOURCES: PubMed and Internet search using the following terms: marijuana, cannabis, delta-9-tetrhydrocannabinol (THC), cannabidiol, cannabinoid, elderly, geriatric, and pharmacology. Findings are based on data collected from older adults (65 years of age and older) through August 2016. STUDY SELECTION: Because of the lack of research and funding, reputable literature on the impact of marijuana on older adults is scarce. The available evidence suggests that elderly individuals should be cautious when consuming marijuana, especially those who have certain comorbid conditions. DATA EXTRACTION: The geriatric population has a higher likelihood of having multiple comorbidities and is subject to polypharmacy. Marijuana use, medicinal or recreational, complicates the picture with additive central nervous system side effects. DATA SYNTHESIS: This article reviews the growing information on marijuana use and discusses issues to consider and cautions in usage that can apply to day-to-day clinical practice and geriatric care. The role of the pharmacist in educating patients, caregivers, and health care providers is expanding with the growing number of states that have legalized medical marijuana (26 states and the District of Columbia, as of 2017). Important education points including drug-drug interactions, drug-disease interactions, and signs and symptoms of acute overdose should be considered. CONCLUSION: With this review, pharmacists will be informed on recommendations on the use of marijuana in the older adult. Monitoring of therapy, as well as adverse effects, will be reviewed, including some legal issues and challenges.

Cholesterol management in geriatric patients: new guidelines.

Pharmacists play an important role in the management of primary care disease states such as hypercholesterolemia. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines provide the pharmacist with pertinent treatment recommendations relevant to day-to-day clinical practice and geriatric care. This article reviews these new evidencebased guidelines for cholesterol management in general and for the elderly specifically. The new guidelines have implications for older adults remaining on or starting statin therapy. With this review, and based on the new guidelines, pharmacists will be informed on how to provide hyperlipidemia recommendations for the older adult. Monitoring of therapy, as well as adverse effects, will be reviewed, including differences among various practice settings.

JNC 8: what's covered, what's not, and what else to consider.

JNC 8 guidelines offer greater discretion in drug choice and modest relaxation of some BP targets. This review summarizes the recommendations and provides guidance on 2 patient populations that aren't addressed.

The role of besifloxacin in the treatment of bacterial conjunctivitis.

OBJECTIVE: To evaluate the role of besifloxacin in bacterial conjunctivitis treatment. DATA SOURCES: Searches were made on MEDLINE/PubMed and EMBASE (January 2007 to January 2014) using the terms besifloxacin and Besivance. References from these publications were reviewed for additional resources. Additional information was collected from Bausch & Lomb, the manufacturer of Besivance; www.clinicaltrials.gov; and American Academy of Ophthalmology. STUDY SELECTION AND DATA EXTRACTION: English-language documents were reviewed for pharmacology, pharmacokinetics, efficacy, and safety, with priority on clinical trials. DATA SYNTHESIS: Three large randomized controlled clinical trials established the safety and efficacy of besifloxacin ophthalmic suspension 0.6% compared with placebo or active comparator (moxifloxacin ophthalmic solution 0.5%) given 3 times a day for 5 days for acute bacterial conjunctivitis (BC) treatment. Compared with placebo, besifloxacin had clinically superior bacterial eradication rates and was noninferior to moxifloxacin. Besifloxacin was compared with placebo in 2 randomized, placebo-controlled trials, dosed twice a day for 3 days. Superior efficacy was seen compared with placebo, which supports the shorter dosing schedule. Ophthalmic besifloxacin is well tolerated; the most common adverse effect (conjunctival redness) occurred in 2% of patients. Adverse effects in 1% to 2% of patients included blurred vision, eye pain, eye irritation, eye pruritus, and headache. CONCLUSION: Besifloxacin 0.6% ophthalmic suspension 3 times a day for 5 days is safe and effective for BC. Twice-a-day dosing for 3 days was also effective-a simplified regimen compared with other fluoroquinolones. Disadvantages include price and lack of a generic. Further evaluation is needed to evaluate comparative efficacy among other ocular fluoroquinolones and unlabeled uses.

Alcaftadine for the prevention of itching associated with allergic conjunctivitis.

OBJECTIVE: To evaluate the safety and efficacy of alcaftadine for the prevention of itching associated with allergic conjunctivitis. DATA SOURCES: A medical literature search was conducted in MEDLINE/PubMed (2006-February 2012) and EMBASE (2006-February 2012) using the search terms alcaftadine and Lastacaft. References from these publications were reviewed for additional resources. Additional information was collected from Web sites of the US government (http://www.clinicaltrials.gov, http://www.fda.gov) and of Allergan Inc., the manufacturer of Lastacaft (http://www.lastacaft.com). STUDY SELECTION AND DATA EXTRACTION: All identified articles and publications in English were reviewed for pharmacology, pharmacokinetics, efficacy, and safety data. Priority was placed on clinical trials. DATA SYNTHESIS: Two published clinical trials evaluated the efficacy of alcaftadine in the prevention of ocular itching and conjunctival redness associated with allergic conjunctivitis. One trial compared alcaftadine to placebo, and another trial compared alcaftadine to placebo and olopatadine HCl to placebo. Both studies showed superior efficacy, both clinically and statistically, in the prevention of ocular itching associated with allergic conjunctivitis compared to placebo. Although conjunctival redness was evaluated in the 2 trials, neither trial demonstrated both clinical and statistical significance. Both trials demonstrated a rapid onset of action of less than 15 minutes, as well as a duration of action greater than 16 hours, which supports the use of once-daily administration. Overall, alcaftadine was well tolerated, and common adverse effects, reported in less than 4% of patients, included ocular irritation, pruritus, erythema, and stinging or burning upon instillation. Ocular adverse effects were typically mild in severity and self-limiting. CONCLUSIONS: Alcaftadine is a safe and effective option for the prevention of ocular itching associated with allergic conjunctivitis, is dosed once daily, and is competitively priced among prescription medications for allergic conjunctivitis. Additional studies are needed to further evaluate the comparative efficacy among ocular antihistamine/mast cell stabilizing medications.