Geriatrics - Safe Med Prescribing, Deprescribing & Fall Risk Flashcards
What are tools to identify PIMs?
American Geriatrics Society (AGS) Beers Criteria, START/STOPP Criteria, Medication Appropriateness Index (MAI), Anticholinergic Risk Scale (ARS), VIONE, deprescribing.org
What are the most prevalent PIM classes? (4)
anticholinergics, benzodiazepines, antidepressants, NSAIDs
List examples of anticholinergic classes? (4)
muscle relaxants (cyclobenzaprine, carisoprodol), TCAs (amitriptyline, doxepin), antispasmodics (dicyclomine, hyoscyamine), antihistamines (cyproheptadine, promethazine)
What are anticholinergic drugs associated with in elderly?
worse memory and executive/cognitive functions
What are benzodiazepines associated with in elderly?
cognitive impairment, delirium, falls/fractures
When may benzodiazepines be appropriate for use in elderly?
seizure disorders, rapid-eye movement sleep behavior disorder, benzodiazepine/ethanol withdrawal, severe generalized anxiety disorder, periprocedural anesthesia
What are antidepressants associated with in elderly?
falls, anticholinergic ADRs
What are NSAIDs associated with in elderly?
gastrointestinal toxicity, cardiovascular risks, renal considerations
What can be used for NSAID-induced injury prevention? (3)
misoprostol, H2RAs, PPIs
By what mechanism do NSAIDs affect the kidneys in elderly? (2)
reduced blood flow/perfusion, sodium and water retention (fluid overload)
List consequences of polypharmacy in elderly?
ADEs, DDIs, cognitive impairment/functional decline, medication non-adherence, increased healthcare cost, FALLS
Define deprescribing?
systematic process of identifying and discontinuing drugs where potential harms outweigh benefits in context of a patient’s care
List barriers/facilitators to deprescribing? (4)
sociocultural, relational, organizational, individual
What are the key steps to deprescribing? (5)
obtain comprehensive medication history, identify PIM(s), determine eligibility for deprescribing and prioritize, plan and initiate withdrawal, monitor/support/document
What are reasons a medication would be a good candidate for discontinuation?
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
List drug “factors” for potential drug induced harm?
number of medications prescribed, use of potentially inappropriate or “high risk” medications, past or current toxicity
List patient “factors” for potential drug induced harm?
age >80 years, cognitive impairment, multiple comorbidities, multiple prescribers
List the factors that influence prioritization for drug deprescribing? (3)
harm outweighs benefit, easiest to discontinue, patient willingness to discontinue
The number needed to treat (NNT) is the inverse of what parameter? (2)
absolute risk reduction (ARR), life expectancy
If the life expectancy is less than the time to benefit…?
medication not recommended, consider discontinuation
If the life expectancy is equal to the time to benefit…?
defer to patient’s values and preferences, shared decision making
If the life expectancy is greater than the time to benefit…?
medication may have benefit and can be continued
What medications have been associated with an increased fall risk in elderly?
any psychotropic drug, antidepressants, benzodiazepines, antipsychotics, sedatives/hypnotics, tranquilizers
What medications have been associated with a non-significant increase in fall risk in elderly?
antihypertensives, diuretics, beta-blockers, opioids, NSAIDs
What is the consensus regarding multifactorial interventions in elderly?
risk reduction for preventing falls in small
What is Goal A for elderly medication management?
older adults should become aware that falling is a common AE of medications and should discuss this phenomenon with health care providers
What is strategy 1 of Goal A?
increase number of adults who have a medication review, focusing on falls and related injury prevention
What is strategy 2 of Goal A?
conduct a consumer education campaign to increase awareness of fall risk associated with medications
What is strategy 3 of Goal A?
assure that falls self-management programs include a component on medication-use related falls
What is strategy 4 of Goal A?
develop strategies to empower elderly to take responsibility for medication management
What is Goal B for elderly medication management?
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
What is strategy 1 of Goal B?
support health care provider efforts in implementation of periodic medication review in elderly
What is strategy 2 of Goal B?
develop systematic method for predicting medication-related fall risk
What is strategy 3 of Goal B?
improve education of healthcare professionals in relation to medication related fall risk
What is strategy 4 of Goal B?
maximize the opportunity to address fall issues ad part of medication therapy management services (Medicare Part D)
What score is indicative of a higher fall risk according to the AHRQ tool?
6 or greater
