Multimorbidity & Polypharmacy

Question 1

What is multimorbidity?

Answer 1

Patients with multiple health conditions - often long-term conditions which require complex and ongoing care.

Question 2

What is diagnostic overshadowing?

Answer 2

Symptoms of a new condition are attributed to a pre-existing condition.

Question 3

What is polypharmacy?

Answer 3

Concurrent use of multiple medications (5+) in an individual.

Question 4

What is appropriate polypharmacy?

Answer 4

Prescribing for complex / multiple conditions in circumstances where medication use has been optimised and medications are prescribed according to best practice.

Question 5

What is problematic polypharmacy?

Answer 5

Prescribing of multiple medications inappropriately, or where the intended benefit of the medication is not realised.

Question 6

What lifestyle factors are associated with increased risk of multimorbidity?

Answer 6

• smoking
• low fruit & veg consumption
• low physical activity
• excessive alcohol consumption
• high BMI

Question 7

What are anticholinergic side effects?

Answer 7

• blurred vision, dry eyes
• dry mouth
• constipation
• flushed skin, overheating
• urinary retention
• rapid heart rate
• drowsiness, dizziness, confusion, hallucinations

Question 8

What drugs might cause orthostatic hypotension?

Answer 8

• thiazide diuretics (hydrochlorothiazide)
• loop diuretics (furosemide)
• ACE inhibitors (lisinopril)
• anti-depressant (trazodone)
• alpha-blockers (terazosin, doxazosin)

Question 9

What health conditions are associated with orthostatic hypotension?

Answer 9

• diabetes
• Parkinson’s

Question 10

Negative impacts of multimorbidity?

Answer 10

• polypharmacy
• diagnostic overshadowing
• failures of care co-ordination and delivery
• complex management regimes

Question 11

Negative effects of polypharmacy?

Answer 11

• interactions
• high pill burden for patient
• difficult to achieve adherence