POLIPHARMACY Flashcards
Multi-morbidity definition?
The presence of 2 or more long term condition which includes:
-physical and mental long term condition
-sensory impairment
-symptom complexes (frailty, chronic pain)
-ongoing conditions (learning disabilities)
-alcohol and substance misuse
Polipharmacy definition
The use of multiple medication, common in elder population with co-morbidities, as one or more medication are used to treat each condition
Appropriate polipharmacy definition
Prescribing of multiple medication for complex conditions or multiple condition where the use of the medication has been optimised and based on best clinical evidence.
Inappropriate polipharmacy
The prescribing of multiple medication inappropriately where the intended benefit is not been achieved
What prescribers should consider in polipharmacy? 6
-select appropriate medication
-consider co-morbidities
-be aware I’m of implication of polipharmacy
-involve pt in the decision
-understand why and how the pt should take the medication
-relay knowledge of the medication upon reviewing the patient
ADR definition
Unwanted and harmful reaction experienced by the pt when taking a medication/following a treatment
Drug induced adr examples?
-NSAIDS
-METOCLOPRAMIDE
-Thiazide diuretic (bendruflumethiaziade, indapamide, HCT)
Contraindication definition
It is a factor or condition that serves as a reason to withdraw a medical treatment
Relative contraindication explained
Caution should be used when recommending the drugs/treatment. Benefit > risks
Absolute contraindication explained
When medication/treatment can cause a life threatening situation. Use should be avoided
Glomerular filtration formula
Cl(creatine)= F(140-age) x ideal body weigh : serum creatine
Predisposing factors for ADR? 7
-age
-gender
-polipharmacy
-previous ADR or allergies
-renal impairment
-hepatic impairment
-heart failure
NSAIDS benefit ? 7
-more 20 option available
-different dose, ADR, interaction
-analgesic, antipyretic and anti inflammatory properties
-used for symptoms relief
-used for both acute and chronic pain
-reduce the requirement of opioids
-short to moderate acting NSAIDS are well tolerated across population
NAAIDS risks ? 4
-age and dose related risk of gastropathy
-can cause/worsen renal impairment
-safety concern for use in pt with thrombotic event or CVD
-non selective NSAIDS inhibit the platelet functioning , this reduce the cardio protective properties of aspirin
NSAIDS contraindication examples ? 4
-anticoagulant
-loop diuretics (furosemide)
-lithium
-systemic glucocorticoid
GI toxicity risks ranked?
-piroxicam, ketoprofen (high)
-indometacin, diclofenac, naproxen (medium)
-diclofenac and ibuprofen low dose (low)
General recommendation when prescribing NSAIDS? 3
-select the NSAID with low GI toxicity risks
-select lowest effective dose for the shortest period
-prescribe a gastro-protector whilst pt is on NSAIDs
Induce AKI explained
Inhibition cox enzyme, ⬇️ prostaglandins synthesis, ⬇️ glomerular filtration rate, causes reversible renal ischemia, ⬇️ glomerular hydraulic pressure, which causes AKI
Deprescribing definition?
Aim? 2
It is the process of withdrawing inappropriate medication by the HCP with the agreement of the pt with the aim to:
-improve pt quality of life
-maintaining control of the chronic condition
5 stages of deprescribing
1) ascertain all Medication and identify the reason to each one
2)assess the intensity of the deprescribing process by evaluating the risks that each medication carries versus the benefit
3)Assess eligibility to drug discontinuation (e.g. no valid indication, part of a prescribing cascade, risks>benefit)
4)prioritise drug for discontinuation (easy to stop by the pt, risks>benefit, lowest symptoms withdrawal or disease rebound)
5)monitor and evaluate
7 principles of deprescribing?
1)establish collaborative relationship wi to pt/carer
2)review all medication
3)identify medication of concern
4)agree with pt a deprescribing regimen
5)aim for a simplified regimen
6)Monitor and review
7)inform of ADR
Pt centred approach to deprescribing? 7
1)assess the pt
2)define goals
3)review medication of concern
4)agree a review date with pt
5)agree with pt which medication to stop, substitute or lower the dose)
6)inform every party involved
7)monitor and review
Areas of focus for a prescriber?
1)safety
2)efficacy
3)quality of life: is it beneficial to the pt?
4)economy: is this treatment affordable?
When reviewing a pt. A good prescriber should? 8
1)be aware of external pressures
2)be aware of the prescribing responsibility, consequences and how to manage it;
3)be aware of their own limitation
4)understand ethic of prescribing
5)be aware of non-medical suitable alternative
6) develop appropriate communication skills (with pt, relatives, carers or colleagues)
7)put the safety of it first
8) consider deprescribing
Medicines optimisation definition
Ensuring the right patient has access to the right choice of medicine at the right time. Medicine optimisation involve review current medication, consider to stop/reduce/substitute or look into non medical options available. Ultimately encourages the pt to take ownership to their treatment and obtain the best outcomes out of their medication.
Medicine optimisation goal? 4
-pt taking medication correctly
-reduce use of unnecessary medication
-reduce wastage
-increase medicine safety
4 principles of medicine optimisation?
1)aim to understand the pt experience
2)right choice of medicine
3) safe use of medicine
4)incorporate medicine optimisation as part of prescribing routine
aim to understand the pt experience explained
Understand pt experience in relation to their treatment and the management of their long term condition.
Goal: fully understand pt beliefs around the treatment and address possible concerns regarding possible side effect. This will increase the pt adherence to treatment
right choice of medicine Explained
Select the right choice of clinically and cost effective medication that satisfy the needs of the pt.
Goal: optimal outcome is achieved
safe use of medicine
Consider:
-drug interaction
-drug usage
-ADR
goal: pt more confident taking the medication
incorporate medicine optimisation as part of prescribing routine
pt is able to address concerns in relation to their medication.
Goal: optimal pt outcome achieved
