Deprescribing

Question 1

Define Deprescribing. (1)

Answer 1

Inappropriate polypharmacy.
Process of tapering, withdrawing, discontinuing or stopping medicines to reduce polypharmacy, ADR and inappropriate/ineffective medicine use.

Question 2

What are the aims of deprescribing? (4)

Answer 2

Improved QofL
Avoid worsening of disease or causing withdrawal effects.
Effective in reducing pill burden
Maintain control of chronic conditions.

Question 3

What are the types of approaches to deprescribing? (5)

Answer 3

IMPACT
STOP/START
NO TEARS
7-steps approach
Beers criteria

Question 4

State the 7 steps for medication review. (7)

Answer 4

Aim
Need
Effectiveness
Safety
Efficiency
Patient-centred

Question 5

Give e.g. of drugs that is discussed with an expert before stopping. (4)

Answer 5

Diuretics/ ACEi in LVSD
Steroids
HR controlling drugs

Question 6

Give e.g. of drugs that is discussed with an expert before altering. (9)

Answer 6

Anti-epileptics
Antipsychotics
Mood stabilisers
Antidepressants
DMARDs
Thyroid hormones
Amiodarone
Antidiabetics
Insulin

Question 7

Give e.g. of drugs that needs to checked for expired indications. (15)

Answer 7

PPI
Laxatives
Antispasmodics
Oral Steroids
Hypnotics/anxiolytics
Metoclopramide
Antibacterial (o/topical)
Antifungals (o/t)
Na2+/K+/Fe2+, Vitamin supplements
Calcium/Vitamin D
Sip feeds
NSAIDs
Drops/ointments/sprays.

Question 8

Give e.g. of drugs that is checked for valid indication. (15)

Answer 8

Anticoagulants
Anticoagulants + aspirin
Aspirin
Dipyridamole
Diuretics
Quinine
Theophylline
Antipsychotics
TCA
Opioids
Nitrofurantoin
Finasteride
Antimuscarinics
Muscle relaxants.

Question 9

Give e.g. of drugs where you need to consider the +/-. (8)

Answer 9

Antianginals
BP control
Statins
CS
Dementia
Bisphosphonates
HbA1c control
DMARDs

Question 10

Give e.g. of drugs that is poorly tolerated in frail adults. (6)

Answer 10

Antipsychotics
NSAIDs
Digoxin
BZP
Anticholinergics
Combination analgesics

Question 11

Give e.g. of high risk clinical scenarios. (15)

Answer 11

Metformin/ACE/ARB/Diuretics/NSAIDs + dehydration.
NSAIDs + ACE + Diuretics
NSAIDs + CKD
NSAIDs + > 75 yrs
NSAIDs + Hx of peptic ulcer
NSAIDs + antithrombic
NSAIDs + CHF
Glitazone + CHF
TCA + CHF
Warfarin + Macroline/Quinolone
> 2 Anticholinergics.

Question 12

Give e.g. of drugs used in CHD. (6)

Answer 12

Antithrombics
Statins
ACEi/ARBs
BB

Question 13

Give e.g. of drugs used in previous stroke/TIA. (4)

Answer 13

Antithrombic
Statin
ACEi/ARB

Question 14

Give e.g. of drugs used in LVSD. (4)

Answer 14

Diuretics
ACEi/ARB
BB

Question 15

Give e.g. of drugs used in AF. (2)

Answer 15

Antithrombic.
Rate control

Question 16

Give e.g. of drugs used in high # risk. (1)

Answer 16

Bone protection