Detailed medication history Flashcards
Each medication we prescribe is basically a calculated _____
“poison.”
When is it important to obtain a detailed medication history?
At every single visit
The 5 Primary Goals of Drug Therapy
○ Alleviate pain, suffering, and disability
○ Improve functional capacity
○ Promote quality of life
○ Prolong life
○ Prevent iatrogenic (caused by medicine) disease
Drug ____ should always be on the list of differential diagnoses
adverse effects
Things about currently prescribed drugs to ask patients about
■ Formulations (ie. extended-release)
■ Doses
■ Routes of administration (oral, transdermal, PR, etc)
■ Frequencies
■ Duration of treatment
When interviewing the patient, be
sure to find out about
○ Currently prescribed drugs
○ Other medications (ie. OTC, herbal)
○ Drugs that have been taken in the recent past.
○ Previous drug hypersensitivity reactions
○ Previous adverse drug reactions
○ Adherence to therapy
What do we mean when we say “Polypharmacy”?
The use of 5 or more medications
Risk factors for polypharmacy
- Presence of certain disorders (psychiatric, neurologic, medical)
Age, race, and gender variables that increase risk of polypharmacy
■ Patients age 65 and older
■ Caucasians
■ African-Americans
■ Females
Psychosocial variables that increase risk of polypharmacy
■ Lower socioeconomic class
■ Inner-city residence
■ Lower level of education
■ Unemployment
■ Concealed drug use
Risk Factors for Polypharmacy Associated with Aging
○ Multiple medical conditions
○ Multiple medications taken
○ Suboptimal social situation
○ Inability to pay for medication
○ Inability to comply with medication instructions or understand the treatment regimen
○ Cognitive impairment
○ Lack of a primary caregiver
○ Problems with vision or hearing
○ Underrepresentation in studies of new medications
○ Physiologic changes (reduced ability to eliminate medications
Causes of polypharmacy
○ Multiple chronic medical problems and vague symptoms.
○ Patient pressure to prescribe (“a pill for every ill”).
○ Susceptibility to product advertisements.
○ Multiple providers of care and lack of coordination.
○ Addition of medications to treat drug related complaints in a “cascading” fashion.
○ Availability of OTC medications and supplements
Several factors are associated with increased incident ofMedication-Related Problems
○ Presence of > 6 chronic medical problems
○ > 12 doses of medication/day
○ Use of 9 or more medications
○ Prior adverse reactions
○ Low body weight or body mass index
○ Creatinine clearance < 50 mL/min
What is an economic consequence of polypharmacy?
For individuals living on a fixed income or who lack adequate health coverage, the burden of purchasing medications may be significant.
Physiologic Consequences of Polypharmacy
○ Loss of functional ability and memory impairment.
○ Drowsiness, loss of coordination, and confusion can lead to falls or automobile accidents.
○ 17% of hospitalizations among seniors are due to adverse medication reactions (a rate that
is 6x that of the general population)
What is therapeutic planning?
○ Begins with identification of the actual diagnosis.
○ Consider non-drug treatments instead.
○ Establish a therapeutic goal and a timeline for assessing progress towards that goal.
○ A drug that is not effective should be discontinued promptly
Factors to consider when choosing an initial drug
Efficacy, cost, ease of administration, patient’s risk profile, possibility of treating several conditions with one drug
Steps to follow once initial drug is chosen
■ “Start low and go slow.”
■ Monitor drug therapy (history, PE, lab tests)
■ Determine if therapeutic goal has been reached.
■ Determine appropriate duration for each medication therapy
When prescribing, we should strive for _____
We should strive for “one disease, one drug, once a day.”
Importance of OTC medications
OTC supplements are potent drugs that affect prescription therapies and PCP should be consulted before self-prescribing
Types of drug non-compliance
○ Omitting doses
○ Adding doses
○ Taking doses at the wrong time
○ Incorrectly administering the medication
Ways to maximize comliance
● Simplify the number of medications and doses per day.
● Discuss with the patient whether they can open child-resistant caps.
● Prescribe generics when available. Know the differences in costs between drugs in the same class.
● Provide the patient and family/caregiver with written information/instructions.
