July 20, 2016
PACE Case: Cipro + Cymbalta
An 86 year-old female participant with a history of diabetes, Alzheimer's/dementia, hypertension, tremors, and pulmonary fibrosis, presented with symptoms of a urinary tract infection (UTI). Her current medication regimen included: 
  • Duloxetine (Cymbalta) 60mg delayed release PO QD
  • Furosemide (Lasix) 20 mg PO QD
  • Hydrochlorothiazide-lisinopril (Zestoretic) 12.5mg-/10mg PO QD
  • Lorazepam (Ativan) 0.25mg PO BID
  • Topiramate (Topomax) 25mg PO BID
The physician e-prescribed ciprofloxacin 500mg PO Q12h for a 7-day UTI treatment course duration. Upon performing the targeted medication review, the Medication Risk Mitigation (MRM) Matrix indicated to the clinical pharmacist that other alternative therapeutic options should be considered.  Click here to read the full case.
Liquid Docusate Warning from CDC
( from MHA
The CDC and FDA are currently investigating a multi-state outbreak of Burkholderia cepacia infections. Preliminary information indicates that a contaminated liquid docusate product might be related to cases in one state.  Until more information is available, CDC recommends that facilities not use any liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed. Institutions with non-cystic fibrosis patients in whom there are B. cepacia infections should sequester all liquid docusate products. 

While CareKinesis pharmacy has not dispensed the particular medication in question to our participants, and is notifying clients for whom local pharmacy dispenses of such has occurred, PACE clinicians should be cognizant of this recall.  Visit the CDC announcement page here.
CE: Kidney Function & Dose Adjustments in the Elderly
CareKinesis is offering on-demand access to PACE population-specific medication management CE programs through Tabula Rasa HealthCare University (free for clients).  Our newest posted TRHCU webinar is  Kidney Function & Dose Adjustments in the Elderly Learning objectives for this webinar are:
  • Explain the epidemiology of renal impairment across the United States and the elderly population 
  • Identify complications and co-morbidities of impaired renal function
  • Describe the impact of renal impairment on medication dosages
  • Identify and discuss dose adjustment principles in renal impairment
  • Evaluate a clinically relevant case
Summer Medication Risks

With summer upon us, we must remember that many commonly used medications can cause a sensitivity reaction to the sun. These include:
  • Quinolone antibiotics (Cipro, Levaquin, etc.)
  • Tetracyclines
  • Sulfonamides (Bactrim, SMZ/TMP, etc.)
  • Amiodorone
  • Furosemide
  • Sulfonyureas
  • Phenothiazines
  • Tricyclic antidepressants
If you have any questions or suspect a problem, please contact your CareKinesis Pharmacist and please advise participants to  REMEMBER THEIR SUNSCREEN!
CMS PACE Conference Recap (July 7, 2016)
At the July CMS PACE Conference, updates to PACE Quality reporting and data measurement efforts were announced:
Level 1 Quality Indicator Additional Data Elements:
* Census
* Falls without Injury
* Medication Administration Error without Injury
* Burns 1st Degree

CareKinesis helps PACE mitigate these risks by monitoring the cumulative effects of each participant's anticholinergic and sedative medications. Participants with high cumulative scores are at higher risk for falls.  Contact us to learn how we can help improve PACE quality measures.
Other CareKinesis Happenings

EireneRx 101 
August 11 @ 1pm ET
September 8 @ 3pm ET


We are passionate about improving lives for PACE participants through medication risk mitigation. Email us to schedule a call and learn more, visit us on the web at  www.CareKinesis.com, or call 888-974-2763 for more information.