University of California, San Francisco, School of Medicine
This series of three "small group cases" is intended to teach medical students some principles of drug therapy in the elderly. Each group takes about one-and-one-half hours.
The goal of this exercise is to give second year medical students a chance to explore common issues in drug prescribing in elders in a small group format. Case #1: 1. Recognize medication non-adherence as a possible explanation of lack of therapeutic benefit. 2. List common sources of non-adherence. 3. Discuss effective methods for exploring non-adherence with a patient. 4. Discuss the importance of drug prices as a potential cause of non-adherence, and list strategies for dealing with this issue. 5. (Optional: discuss policy issues surrounding drug marketing and pricing, the physicians role, and Medicare Part D). Case #2: 1. List physiologic changes in elders that impact pharmacokinetics of commonly used drugs. 2. Use the MDRD to calculate the decline in renal function with aging, and describe its advantages over the Cockroft and Gault equation. 3. Use the Cockroft and Gault equation to estimate the decline in renal function with aging and describe advantages and limitations of this tool. 4. Recognize symptoms of digoxin toxicity. 5. Gain an awareness of the range of costs of medications, appreciating how much cheaper "older" and generic drugs can be than newer brand name drugs. Case #3: 1. Define polypharmacy in the context of appropriate drug prescribing. 2. Describe adverse consequences of polypharmacy, including drug-drug interactions, side effects, and a "prescribing cascade". 3. Discuss the importance of exploring medications as a potential cause of new or unexplained symptoms.
600 second year medical students have used these cases in small group sessions. We are totally open to having you update and modify these cases for your own setting. Please share improvements and updates with us!