S M Vouri1, J M Chung2, E F Binder3. 1. Department of Pharmacy Practice, Center for Health Outcomes Research and Education, St. Louis College of Pharmacy, St. Louis, MO, USA. 2. Mercy Clinic Internal Medicine and Geriatrics - Old Tesson, St. Louis, MO, USA. 3. Division of Geriatrics and Nutritional Science, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Abstract
WHAT IS KNOWN AND OBJECTIVE: A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient. CASE SUMMARY: A 77-year-old women experienced probable acetylcholinesterase inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine which lead to worsening cognitive function. We reduced the dose of the acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms of rhinorrhea were subsequently reduced without negatively impacting cognition. WHAT IS NEW AND CONCLUSION: This was the first published prescribing cascade intervention that did not require discontinuation of both medications, which may be emulated in future prescribing cascade cases.
WHAT IS KNOWN AND OBJECTIVE: A prescribing cascade if often treated by discontinuing both medications. We describe an intervention to mitigate a prescribing cascade while continuing a clinically necessary medication without negatively impacting the patient. CASE SUMMARY: A 77-year-old women experienced probable acetylcholinesterase inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine which lead to worsening cognitive function. We reduced the dose of the acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms of rhinorrhea were subsequently reduced without negatively impacting cognition. WHAT IS NEW AND CONCLUSION: This was the first published prescribing cascade intervention that did not require discontinuation of both medications, which may be emulated in future prescribing cascade cases.
Authors: J C Morris; A Heyman; R C Mohs; J P Hughes; G van Belle; G Fillenbaum; E D Mellits; C Clark Journal: Neurology Date: 1989-09 Impact factor: 9.910