medicines optimisation

Question 1

what are the risk domains in medical optimisation

Answer 1

clinical risk, medicines related risks, and social risks

Question 2

what is the COMB framework

Answer 2

capability, opportunity and motivation- people need these 3 elements to be able to perform particular behaviour eg take medicines

Question 3

what are the two aspects of capability in the COM B framework

Answer 3

psychological and physical

Question 4

what are the two aspects of opportunity in the COMB framework

Answer 4

social and physical

Question 5

what are the two aspects of motivation in the COMB framework

Answer 5

automatic and reflective

Question 6

why is poly pharmacy a concern

Answer 6

• elderly- lose weight and muscle mass –> renal impairment
• drug drug interactions
• drug disease interaction
• adverse events can lead to hospital admissions
• link between poly pharmacy and frailty
• increased risk of falls
• adherence problems
• increased cost of medicines

Question 7

what are the principles of prescribing in the elderly

Answer 7

avoid prescribing prior to diagnosis
start low dose and titrate slowly
avoid starting 2 agents at the same time
reach therapeutic doses before switching or adding
consider non-pharmacological agents

Question 8

pros of MDS tray

Answer 8

save time

Question 9

cons of MDS tray

Answer 9

not all oral doses can be packaged in here
PRN drugs- all or nothing so drugs will have to be packaged in here when they’re not needed
antibiotics won’t be in the tray as it is an emergency med
stability of meds stored outside original packs
risk of not accommodating all dosing instructions
understanding of medicines may be misleading if all mixed together- more challenging

Question 10

current roles of pharmacists in care homes

Answer 10

supply, med reviews, waste reduction, storage, training, info and advice, MDT working, prescribing, PRN directions, patient/ family discussions, keeping patients safe when they transfer between care providers

Question 11

what can go wrong with discharge information

Answer 11

unintentional changes, intentional changes, misunderstandings, inaccurate information, unclear info or wrong info