Geriatrics - Safe Med Prescribing, Deprescribing & Fall Risk

Question 1

What are tools to identify PIMs?

Answer 1

American Geriatrics Society (AGS) Beers Criteria, START/STOPP Criteria, Medication Appropriateness Index (MAI), Anticholinergic Risk Scale (ARS), VIONE, deprescribing.org

Question 2

What are the most prevalent PIM classes? (4)

Answer 2

anticholinergics, benzodiazepines, antidepressants, NSAIDs

Question 3

List examples of anticholinergic classes? (4)

Answer 3

muscle relaxants (cyclobenzaprine, carisoprodol), TCAs (amitriptyline, doxepin), antispasmodics (dicyclomine, hyoscyamine), antihistamines (cyproheptadine, promethazine)

Question 4

What are anticholinergic drugs associated with in elderly?

Answer 4

worse memory and executive/cognitive functions

Question 5

What are benzodiazepines associated with in elderly?

Answer 5

cognitive impairment, delirium, falls/fractures

Question 6

When may benzodiazepines be appropriate for use in elderly?

Answer 6

seizure disorders, rapid-eye movement sleep behavior disorder, benzodiazepine/ethanol withdrawal, severe generalized anxiety disorder, periprocedural anesthesia

Question 7

What are antidepressants associated with in elderly?

Answer 7

falls, anticholinergic ADRs

Question 8

What are NSAIDs associated with in elderly?

Answer 8

gastrointestinal toxicity, cardiovascular risks, renal considerations

Question 9

What can be used for NSAID-induced injury prevention? (3)

Answer 9

misoprostol, H2RAs, PPIs

Question 10

By what mechanism do NSAIDs affect the kidneys in elderly? (2)

Answer 10

reduced blood flow/perfusion, sodium and water retention (fluid overload)

Question 11

List consequences of polypharmacy in elderly?

Answer 11

ADEs, DDIs, cognitive impairment/functional decline, medication non-adherence, increased healthcare cost, FALLS

Question 12

Define deprescribing?

Answer 12

systematic process of identifying and discontinuing drugs where potential harms outweigh benefits in context of a patient’s care

Question 13

List barriers/facilitators to deprescribing? (4)

Answer 13

sociocultural, relational, organizational, individual

Question 14

What are the key steps to deprescribing? (5)

Answer 14

obtain comprehensive medication history, identify PIM(s), determine eligibility for deprescribing and prioritize, plan and initiate withdrawal, monitor/support/document

Question 15

What are reasons a medication would be a good candidate for discontinuation?

Answer 15

no indication, part of prescribing cascade, harm outweighs benefit, nature of medication with relation to disease state (i.e., preventative versus palliative), impose unacceptable treatment burden

Question 16

List drug “factors” for potential drug induced harm?

Answer 16

number of medications prescribed, use of potentially inappropriate or “high risk” medications, past or current toxicity

Question 17

List patient “factors” for potential drug induced harm?

Answer 17

age >80 years, cognitive impairment, multiple comorbidities, multiple prescribers

Question 18

List the factors that influence prioritization for drug deprescribing? (3)

Answer 18

harm outweighs benefit, easiest to discontinue, patient willingness to discontinue

Question 19

The number needed to treat (NNT) is the inverse of what parameter? (2)

Answer 19

absolute risk reduction (ARR), life expectancy

Question 20

If the life expectancy is less than the time to benefit…?

Answer 20

medication not recommended, consider discontinuation

Question 21

If the life expectancy is equal to the time to benefit…?

Answer 21

defer to patient’s values and preferences, shared decision making

Question 22

If the life expectancy is greater than the time to benefit…?

Answer 22

medication may have benefit and can be continued

Question 23

What medications have been associated with an increased fall risk in elderly?

Answer 23

any psychotropic drug, antidepressants, benzodiazepines, antipsychotics, sedatives/hypnotics, tranquilizers

Question 24

What medications have been associated with a non-significant increase in fall risk in elderly?

Answer 24

antihypertensives, diuretics, beta-blockers, opioids, NSAIDs

Question 25

What is the consensus regarding multifactorial interventions in elderly?

Answer 25

risk reduction for preventing falls in small

Question 26

What is Goal A for elderly medication management?

Answer 26

older adults should become aware that falling is a common AE of medications and should discuss this phenomenon with health care providers

Question 27

What is strategy 1 of Goal A?

Answer 27

increase number of adults who have a medication review, focusing on falls and related injury prevention

Question 28

What is strategy 2 of Goal A?

Answer 28

conduct a consumer education campaign to increase awareness of fall risk associated with medications

Question 29

What is strategy 3 of Goal A?

Answer 29

assure that falls self-management programs include a component on medication-use related falls

Question 30

What is strategy 4 of Goal A?

Answer 30

develop strategies to empower elderly to take responsibility for medication management

Question 31

What is Goal B for elderly medication management?

Answer 31

healthcare providers should be aware that falling is a common AE of medications and should adopt a standard of care that balances benefits/harms of use with these medications

Question 32

What is strategy 1 of Goal B?

Answer 32

support health care provider efforts in implementation of periodic medication review in elderly

Question 33

What is strategy 2 of Goal B?

Answer 33

develop systematic method for predicting medication-related fall risk

Question 34

What is strategy 3 of Goal B?

Answer 34

improve education of healthcare professionals in relation to medication related fall risk

Question 35

What is strategy 4 of Goal B?

Answer 35

maximize the opportunity to address fall issues ad part of medication therapy management services (Medicare Part D)

Question 36

What score is indicative of a higher fall risk according to the AHRQ tool?

Answer 36

6 or greater