14.1 Poisoning And STOPP-START Flashcards
What should be checked when thinking about medicine optimisation?
Checking repeat prescriptions
Full medication review - discussing each medicatio and condition with the patient
Ensure patient is taking the medications at the right time
Ensure they are taking medication in the intended way
Improving clinical outcomes - make sure it is the most beneficial and appropriate drug
Improve economy - best investment for each pound
Why is it useful to do medicine optimisation?
Because of polypharmacy - patients may be taking 4-6+ medicines a day
ADRs and DDIs are a common reason for admission to hospital in the elderly
What patients should be targeted for medication review?
- Taking lots of medications - polypharmacy. The more drugs a patient is taking, the less good their adherence is likely to be
- Complex medication regimens - taking drugs in a particular way at a particular time of day
- Recently discharged (or admitted)
- Frequent admissions to hospital - could be related to more management of their medications
- Comorbidities
- Medications prescribed from multiple sources
- High risk medications – narrow therapeutic window, known and serious side effect profile
What are some of the pharmokinetic and dynamic changes in older people to think about when reviewing medication?
- Body composition – increased fat, decreased body water and lean mass
- Renal mass and function reduced
- Hepatic function and blood flow decreased
- GI absorption decrease, GI bleed risk increase
- Baroreceptor sensitivity reduced - older patients tend to increase cardiac output instead of heart rate
- Reduced first pass metabolism
- Protein binding
- Receptor expression level changes
- Psychotropic drugs and extra pyramidal effects
Who might carry out a medication review?
GP
Hospital doctors
Specialist pharmacists
What things should we be thinking about when conducting a medication review?
Is the medication right for the patient Time limited medication Age - life expectancy and risk/benefit Measureable outcomes - able to tell whether or not the medication is effective Cost Appropriate tests to support decisions
What is the function of the STOPP-START tool?
To aid in medication reviews
screening tool of older people’s prescriptions and screening tool to alert to right treatment
What group of people is STOPP-START used for?
Polypharmacy patients over 65
What is the aim of the STOPP-START tool?
Aim to highlight and prevent inappropriate prescribing → reduction in DDIs and or ADRs
What is the difference between drug toxicity and adverse drug reaction?
ADRs are typical of a drug being used at therapeutic doses
Drug toxicity more commonly associated with effects that occur at supra therapeutic doses - giving doses of an agent well above what we know causes a therapeutic benefit
What causes pharmalogical toxicity?
Most often predictable extension of desired effect
Secondary effect not related to primary aim of the treatment
An effect normally only seen in large overdose - too much drug, narrow therapeutic window
What drugs can cause pharmalogical toxicity in overdose?
B-blocker - myocardial depression
Opioids - respiratory depression
Theophylline - convulsions, arrhythmia
Carbamazepine/phenobarbital - respiratory depression
What is meant by biochemical toxicity?
A drug or active metabolite which causes cellular damage - macromolecules inc. structural proteins and enzymes.
How does biochemical toxicity occur?
Potentially harmful metabolites build up. If they are not inactivated they can cause cytotoxicity.
Balance of elimination of a drug or metabolites will dictate the potential harm that may be caused
How do we overcome biological toxicity?
Development of suitable pharmacological treatment.
