More Rules for Improving Pharmacotherapy in Older Adults

Rule 8: Establish a Monitoring Plan for Each Medication Prescribed for Both Efficacy and Toxicity

Patient monitoring for a drug's efficacy and toxicity is critical. Practitioners should address the monitoring plan at the time a drug is prescribed. A monitoring plan for each medication on the patient's profile should be a part of the patient's medical record. Suggestions regarding monitoring include the following:

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  Understand the pharmacologic profile of every drug prescribed.
  
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  Understand that monitoring for efficacy may be as simple as taking blood pressure measures (eg, for antihypertensive agents) or as complicated as assessing a chest x-ray for pneumonia (eg, for antibiotics).
  
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  Know which drugs have a narrow therapeutic index; slight changes in concentration can yield ADEs.
  
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  Know the adverse effect profile for every drug prescribed so that the patient can be assessed for these effects.
  
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  Double-check doses based on renal or hepatic function using an appropriate resource. Contact a pharmacist if necessary.
  
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  Individualize doses for each individual patient—one size does not fit all.