Even a seemingly benign prescription such as Celebrex or Tramadol, or recommending OTC Acetominophen, for pain for a patient whom on first glance seems to be a candidate can spell trouble. 

As it turns out, many of our elderly, and even not so elderly patients are on blood thinners now, and current guidelines are to proceed with caution, but what I have found out is IT IS BEST TO CHECK WITH THEIR PCP FIRST!

Why? 

They do not want their patient on any of these prescription medications, and they would prefer that we, as their Podiatrist, ONLY administer CLINICAL treatments.  Of course, these clinical treatments include: injections in the way of steroid plus local anesthetic, nerve blocks, padding & strapping, palliative care, topical pain relievers (lidocaine, emla, lidoderm- and even then- caution is advised in the cardiac labile patient), and orthoses.

Here is a review article that may enlighten us on this important topic.  Some of it does admittedly get a bit lengthy, so I have reduced some of the more pithy and PCP-relevant content where you see "[...]."

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Adverse Drug Events and Older Patients: A Practical Approach
By Gerard Kerins, MD |April 23, 2012 /Dr Kerins is section chief of Geriatrics at the Hospital of Saint Raphael in New Haven, Connecticut.
Adverse drug events were associated with an estimated 100,000 emergency hospitalizations involving older patients—US adults 65 years or older—during each of the years 2007, 2008, and 2009, according to a recent review of data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project. Half of these occurred in persons 80 years or older, and women accounted for the majority of hospitalizations.
 
For the very old (70 years or older), the study found, the hospitalization rate for
adverse drug events is 3.5 times higher than for those aged 65 to 69 years.
This finding has important public health implications because the fastest-growing segment of the US population is the group at greatest risk for adverse drug events.
There is a dramatic increase in the number of persons over the age of 65 and in particular, those 85 and older, who represent the fastest-growing segment of the US population. As adults age, they are more likely to use increasing numbers of both prescription and nonprescription medications, increasing the risk of drug interactions. Concomitant with this trend is the increased risk for inappropriate prescribing and adverse drug events. Such events have significant effects and contribute markedly to the morbidity and mortality of older
patients.
It is important, then, that primary care providers are aware of some of the common scenarios in which adverse drug events may occur. Equally as important, providers need to help older patients understand the medications they are taking and the potential for negative drug interactions. When patients are aware of how their medications work, they may be less likely themselves to become the source of errors that lead to dangerous adverse drug events.
 
Adverse drug events are described as any injury resulting from the medical use of a drug. This may be the result of intrinsic properties of the drug, of drug interactions when one mediation is combined with others, or of inappropriate dosage. These situations tend to occur more commonly in older patients. By contrast, a medication error is defined as an error in medication use, which is usually the result of inappropriate prescribing and/or dispensing or an error in interpretation of other information related to use of the drug.

Four common medications or medication classes were implicated alone or in combination in 67.0% of emergency hospitalizations1: warfarin(Drug information on warfarin) (33.3%), insulins(Drug information on insulins) (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). High-risk medications were associated with only 1.2% of hospitalizations.1

Adverse drug events are also common among long-term–care and nursing home residents and contribute significantly to the morbidity, mortality, and health care costs in those populations. Living in a supervised and structured setting, therefore, does not guarantee protection for older adults from potential adverse drug events. Changes associated with aging, including loss of physiologic reserve, decline in hepatic and renal blood flow, and related metabolism, may render this population more vulnerable to adverse drug events. Long-term use of multiple drugs, or polypharmacy, is also common in older adults and poses a significant risk for untoward drug interactions.
 
By the year 2030, it is postulated that approximately 20% of the US population will be older than 65 years and that by the year 2030, approximately 40 to 60 million Americans will be members of this age group.2 With this demographic shift comes increased burden related to chronic illnesses such as diabetes, chronic obstructive pulmonary disease, emphysema, hypertension, glaucoma, and congestive heart failure. The combined effect of increased chronic disease burden and loss of physiologic reserve makes the aging population particularly susceptible to adverse drug events. Such events may be the result of prescribing errors, transcribing errors, and compounding errors, usually at the level of the pharmacy; and administration errors, usually at the level of nursing.

All physicians who treat older adults should be familiar with the risk factors mentioned here. These patients may take from 6 to 8 medications, sometimes prescribed by different professionals, as well as fortified over-the-counter medications. Primary care physicians, who see a large percentage of these patients, are in a particularly good position to take steps to help reduce adverse drug outcomes. I propose the following list of practical suggestions to help minimize adverse drug events in the aging population.

1. Review all medications at every patient encounter. This may mean having patients actually bring the prescriptions with them, commonly referred to in geriatrics as the “brown bag” approach. [...]

2. Make sure the patient has a concise list of medications and has a general understanding of why each drug has been prescribed. Many older adults have been given medications at one time and the provider may continue to prescribe the drug without any specific medical indication. Digoxin(Drug information on digoxin) is an example of an agent that may have been prescribed for a condition that has resolved. [...]

3. Ensure at every visit that a patient is taking medications as prescribed. Cognitive impairment or more significant dementia may impair an older adult’s ability to take medication or to tolerate medication administration. In such cases, if there isn’t already a family member or other caregiver enlisted to help make sure prescribing directions are followed, the suggestion should be emphatically made. If you suspect cognitive deficit of some kind and that it may be contributing to improper use of medication, screening for memory loss may be appropriate. [...]

4. Appreciate how the high cost of some medications may affect patient use of prescribed agents. Older adults, many of whom are on fixed incomes, may not be able to afford prescription medications, especially brand-name agents. [...]

5. Approach use of specific medications or drug classes with extreme caution. Certain medications for a variety of reasons may be inappropriate for routine use in older adults. Included in this group are long-acting benzodiazepines, certain NSAIDs, digoxin, and pherosulphate. In addition, routine use of tricyclic antidepressants, certain types of antihistamines, GI antispasmodics, and muscle relaxants may be potentially dangerous in older adults. I recommend that when any of these medications are prescribed, the prescriber reevaluate periodically the need for the drug and to discontinue it at the earliest possible time. The longer they are used, the more likely adverse outcomes will result. (See http://www.fmda.org/beers.pdf  for a list of medications that are potentially harmful in older adults.)

[...]

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WG
WGr common medications or medication classes were implicated alone or in combination in 67.0% of emergency hospitalizations: (33.3%), warfarin (Drug information on warfarin), insulins (Drug information on (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%). High-risk insulin medications were associated with only 1.2% of hospitalizations.  Adverse drug events are also common among long-term–care and nursing home residents and contribute significantly to the morbidity, mortality, and health care costs in those populations. Living in a supervised and structured setting, therefore, does not guarantee protection for older adults from potential adverse drug events. Changes associated with aging, including loss of physiologic reserve, decline in hepatic and renal blood flow, and related metabolism, may render this population more vulnerable to adverse drug events. Long-term use of multiple drugs, or polypharmacy, is also common in older adults and poses a significant risk for untoward drug interactions