Medication review process

Question 1

Goals of Medication Review

Answer 1

Optimizing Medication Use:
Improving Patient Outcomes:
Enhancing Patient
Reducing Healthcare Costs:

Question 2

In contrast to counseling or the validation of a prescription, a medication review is

Answer 2

a structured activity or a method in patient care

Question 3

Medication review as a cognitive service requires the-

Answer 3

implementation of a comprehensive process

Question 4

Process of Medication Review

Answer 4

1.Data collection
2.Detection and evaluation of DRPs
3.Agreement on interventions
4.Documentation
5.Follow-up

Question 5

data collection

Answer 5

-identification of available data
sources.
-patient’s basic demographics and the medication history.

Question 6

▪ document the drug name, dosage form, the dose and/or strength (as required), the route, and the frequency for each

Answer 6

1. data collection
   MEDICATION HISTORY

Question 7

1. data collection
   Sources of medication information:

Answer 7

✓ Electronic medication records
✓ Community pharmacy records
✓ Patient own medication lists or medication plans
✓ Prescriber referrals
✓ Previous admission records/discharge medication information

Question 8

review of medications that encourages
patients to bring all of their medications to the patient interview.
Including prescription drugs, over-the-counter products, supplements, and herbal remedies.

Answer 8

Brown Bag Review

Question 9

Conducting can help to get a better
impression of the patient’s medication experience and
helps to speak with the patient about his medication in a systematic way.

Answer 9

brown bag reviews

Question 10

This is a well-known tool used to evaluate medication
appropriateness, particularly in older adults over age 65.
* It is essentially a “drugs-to-avoid” list that outlines medications considered risky for elderly patients, due to their higher susceptibility to side effects and adverse drug events

Answer 10

2. Detection and Evaluation of Drug-related Problems
   BEERS CRITERIA

Question 11

helps clinicians avoid prescribing medications
that are potentially inappropriate, and it offers specific
guidance on:
* Which medications should be avoided in older adults in General.
* Medications that should be avoided in patients with
certain diseases or conditions.
* Drugs that require reduced dosing, cautious use, or close monitoring in older adults to prevent harm.

Answer 11

2. Detection and Evaluation of Drug-related Problems
   BEERS CRITERIA

Question 12

There are close to 100 medications or medication classes on the Beers Criteria list. The following list isn’t comprehensive, but it gives an example of a drug in each category and the reason why it’s harmful:

Answer 12

*Analgesics (meperidine):
*Antibiotics (ciprofloxacin with warfarin):
*Antiseizure medications (carbamazepine):
*Antihistamines (brompheniramine):
Antihypertensives (alpha-blockers):
.Antiplatelets or anticoagulants (edoxaban):
*Antipsychotics (any):
*Anxiolytics (benzodiazepines):
*Cardiac medications (disopyramide):
*Central nervous system agents (dimenhydrinate):

Question 13

Neurotoxicity, delirium.

Answer 13

*Analgesics (meperidine):

Question 14

Increased bleeding.

Answer 14

*Antibiotics (ciprofloxacin with warfarin):

Question 15

Syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Answer 15

*Antiseizure medications (carbamazepine):

Question 16

Confusion, cognitive impairment,
delirium.

Answer 16

*Antihistamines (brompheniramine):

Question 17

Hypotension.

Answer 17

*Antihypertensives (alpha-blockers):

Question 18

Renal impairment

Answer 18

.*Antiplatelets or anticoagulants (edoxaban):

Question 19

Stroke, cognitive decline, delirium.

Answer 19

*Antipsychotics (any):

Question 20

Impaired metabolism, cognitive
impairment, unsteady gait.

Answer 20

*Anxiolytics (benzodiazepines):

Question 21

Heart failure.

Answer 21

*Cardiac medications (disopyramide):

Question 22

Confusion, cognitive
impairment, delirium

Answer 22

*Central nervous system agents (dimenhydrinate):

Question 23

Hypoglycemia.

Answer 23

*Diabetes medications (chlorpropamide):

Question 24

Judgment-based, flexible, and require clinical
expertise (e.g., Medication Appropriateness Index); focus on
personalized, case-by-case medication evaluations.

Answer 24

2. Implicit instruments

Question 25

Standardized, rule-based, and easy to apply
(e.g., Beers Criteria); focus on specific medications or conditions.

Answer 25

2. Implicit instruments

Question 26

establishes appropriateness
per drug. It helps healthcare professionals, particularly clinical
pharmacists, evaluate and improve the quality of prescribing.

Answer 26

Medication Appropriateness Index (MAI)

Question 27

2. Detection and Evaluation of Drug-related Problems
   The MAI evaluates medications based on 10 specific criteria, Including:

Answer 27

1. indication
   (Is there a clear reason for the drug?)
2. Effectiveness
   (Is the drug effective for the condition being treated?)
3. Dosage
   (Is the dose appropriate for the patient?)
4. Correct directions
   (Are the instructions for use clear, and correct?)
5. Practicality
   (Is the medication easy for the patient to take?)
6. Drug-drug interactions
7. Drug-disease interactions
8. Duration
   (Is the medication prescribed for the appropriate
   duration?)
9. Duplication
   (Is the patient taking multiple medications with similar effects?)
10. Expense
    (Is the medication cost-effective, compared to
    alternatives?)

Question 28

▪ Requires a coordinated collaboration with the other health professionals such as physician and nurses
▪ The physician discusses therapeutic interventions with the patient, while the pharmacist discusses pharmaceutical
interventions and DRPs related to self-medication/nonprescription drugs (OTC use).

Answer 28

process on medication review
3. AGREEMENT ON INTERVENTIONS

Question 29

▪ A record should be kept of all DRPs identified and of all recommended interventions, including the date and time they were made/taken and whether they were verbal or written. The names of members of the health care who were contacted, and the dates of contacts should also be documented

Answer 29

process on medication review
4. DOCUMENTATION

Question 30

▪ Depending on the medication review service, the following
data are part of the documentation:

Answer 30

✓ Basic patient demographics,
✓ Medication history,
✓ Medical history/clinical data,
✓ Data obtained in the patient interview,
✓ Detected DRPs and suggested interventions, what action was taken and by whom.

Question 31

If the reviewer is not a prescriber, then any urgent recommendation for change must be _____ ______ within 48 hours by the patients GP.

Answer 31

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