Multimorbidity and polypharmacy

Question 1

Define multimorbidity

Answer 1

2 or more long-term health conditions in one individual

Question 2

Define polypharmacy

Answer 2

Taking more than 4 medications daily

Question 3

What might the negative impact be on a patient due to polypharmacy?

Answer 3

• side effects and interaction with medication
• poor quality of life
• cost of medication
• monitoring of medications and appointment burden
• compliance difficulties due to health literacy, language barriers, forgetting

Question 4

What are the advantages of appropriate polypharmacy?

Answer 4

• optimum management of condition
• reduced complications
• primary and secondary prevention
• reduced hospitalisation, morbidity and mortality
• improved quality of life
• reduced harm from medications

Question 5

What is polypharamcy called when it is optimised?

Answer 5

Appropriate polypharmacy

Question 6

What is polypharamcy called when it is not optimised?

Answer 6

Inappropriate polypharmacy

Question 7

Define appropriate polypharmacy

Answer 7

Prescribing multiple medications for either a complex condition or multiple concurrent conditions where medicine use has been OPTIMISED (buzz word)

Question 8

Define problematic polypharmacy

Answer 8

When multiple medications are prescribed inappropriately, increasing risk of side effects

Question 9

What is the strongest risk factor for multimorbidity out of physical activity, eating fruits and veg, alcohol, smoking and BMI?

Answer 9

BMI

Question 10

What are the barriers for getting patients to self-manage obesity?

Answer 10

• cost of nutrition
• time pressure for exercise
• cost of exercise
• educational level and health literacy

Question 11

Is the BP target of a patient without diabetes the same for a pt with diabetes?

Answer 11

No - BP target is 130/80 for pts with diabetes

Question 12

Define long term condition

Answer 12

Any medical condition that cannot currently be cured but can be managed with the use of medication and/or other therapies

Question 13

Which health conditions predispose to orthostatic hypotension?

Answer 13

Diabetes
Parkinson’s disease
Pure autonomic failure
Multisystem atrophy

Question 14

Which health conditions predispose to orthostatic hypotension?

Answer 14

Diabetes (type 1 and type 2)
Parkinson’s disease
Pure autonomic failure
Multisystem atrophy

Question 15

Which medications for hypertension and heart failure can cause reduced eGFR?

Answer 15

Bumetenide

Ramipril

Question 16

What is the advantage of ACE inhibitors?

Answer 16

Increase life expectancy

Question 17

If you had to choose which of bumetenide and ramipril to remove in sb with kidney problems and heart failure, which would you choose?

Answer 17

ramipril, as bumetenide (a diuretic) can help with SOB in heart failure but ramipril mainly works by prolonging

Question 18

What is the blood pressure target for pts over the age of 80?

Answer 18

150/90

Question 19

What safety issues are there in polypharmacy?

Answer 19

• poor medication adherence and adverse drug events
• Complex management regimens
• appointment burden
• Greater susceptibility to failures of care delivery and coordination
• Demanding self-management regimens and competing priorities
• diagnostic overshadowing - where all new symptoms are assumed to be related to the pre-existing condition, rather than fully exploring the symptoms