Lecture 27- Reviewing medication STOPP-START Flashcards
1
Q
Medicines optimisation
A
- Many facets and not universally defined
- There are generally different levels to approaching this from checking repeat prescriptions and what is on a script to a full clinical medication review which involves discussing medicines and condition with the patient
- Ensuring right patient receives right medication at the right time improving clinical outcomes
improving economy – best investment for each pound spent - Useful because of polypharmacy – loosely agreed term for a patient who is taking 4-6+ medicines
- Remember every drug may be necessary
2
Q
Who should be targeted for review
A
- Taking lots of medications!
- Complex medication regimens
- E.g. how to take inhaler
- Recently discharged (or admitted)
- Frequent admissions to hospital
- Comorbidities
- Medications prescribed from multiple sources
- High risk medications – narrow therapeutic window, known and serious side effect profile
3
Q
Some pharmacokinetic and dynamic changes in older people to think about
A
- Body composition – increased fat, decreased body water and lean mass
- Renal mass and function reduced
- Hepatic function and blood flow
- GI absorption, GI bleed risk
- Baroreceptor sensitivity reduced
- Reduced first pass metabolism
- Protein binding?
- Receptor expression level changes
- Psychotropic drugs and extra pyramidal effects
4
Q
Things to think about during review
A
- Can be carried about by different healthcare professionals
- Is the medication right for the patient – seems obvious and part of initial prescribing responsibility but things change
- Time limited medications
- medications that may have been considered during admission but not on discharge
- Age – life expectancy and risk/benefit
- Is the medication effective – measurable outcome – HbA1c, BP, cholesterol
- Symptomatic relief in some patient groups or prevent symptoms worsening
- Cost – suitable generics
- Reduce waste
- Appropriate tests to support decisions
- May explain an admission to hospital – ADRs and DDIs common reason for admission
5
Q
STOPP- START tool to support medication review
A
Old people are known to have increased risk of adverse effects with medication due to age related alteration in pharmacokinetics and pharmacodynamics
- When to stop and start drugs
- Screening tool first introduced and validated in 2008
- Brought together expertise including geriatricians and clinical pharmacists
- For use in older patients ≥65 (use some judgment)
- Many trusts/ regions have their own adapted documents which may have local nuances
- In conjunction with your clinical judgement
6
Q
what does STOPP-START tool stand for
A
Screening
Tool
of
Older
People
Prescriptions
Screening
Tool
to
Alert
to
Right
Treatment
7
Q
aim of STOPP-START
A
- Aim to highlight and prevent inappropriate prescribing → reduction in DDIs and or ADRs
- New categories include antiplatelet/anticoagulant agents, vaccines, drugs that increase anticholinergic burden
8
Q
example STOPP
A
9
Q
example START
A
