POLIPHARMACY

Question 1

Multi-morbidity definition?

Answer 1

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

Question 2

Polipharmacy definition

Answer 2

The use of multiple medication, common in elder population with co-morbidities, as one or more medication are used to treat each condition

Question 3

Appropriate polipharmacy definition

Answer 3

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.

Question 4

Inappropriate polipharmacy

Answer 4

The prescribing of multiple medication inappropriately where the intended benefit is not been achieved

Question 5

What prescribers should consider in polipharmacy? 6

Answer 5

-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

Question 6

ADR definition

Answer 6

Unwanted and harmful reaction experienced by the pt when taking a medication/following a treatment

Question 7

Drug induced adr examples?

Answer 7

-NSAIDS
-METOCLOPRAMIDE
-Thiazide diuretic (bendruflumethiaziade, indapamide, HCT)

Question 8

Contraindication definition

Answer 8

It is a factor or condition that serves as a reason to withdraw a medical treatment

Question 9

Relative contraindication explained

Answer 9

Caution should be used when recommending the drugs/treatment. Benefit > risks

Question 10

Absolute contraindication explained

Answer 10

When medication/treatment can cause a life threatening situation. Use should be avoided

Question 11

Glomerular filtration formula

Answer 11

Cl(creatine)= F(140-age) x ideal body weigh : serum creatine

Question 12

Predisposing factors for ADR? 7

Answer 12

-age
-gender
-polipharmacy
-previous ADR or allergies
-renal impairment
-hepatic impairment
-heart failure

Question 13

NSAIDS benefit ? 7

Answer 13

-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

Question 14

NAAIDS risks ? 4

Answer 14

-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

Question 15

NSAIDS contraindication examples ? 4

Answer 15

-anticoagulant
-loop diuretics (furosemide)
-lithium
-systemic glucocorticoid

Question 16

GI toxicity risks ranked?

Answer 16

-piroxicam, ketoprofen (high)
-indometacin, diclofenac, naproxen (medium)
-diclofenac and ibuprofen low dose (low)

Question 17

General recommendation when prescribing NSAIDS? 3

Answer 17

-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

Question 18

Induce AKI explained

Answer 18

Inhibition cox enzyme, ⬇️ prostaglandins synthesis, ⬇️ glomerular filtration rate, causes reversible renal ischemia, ⬇️ glomerular hydraulic pressure, which causes AKI

Question 19

Deprescribing definition?
Aim? 2

Answer 19

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

Question 20

5 stages of deprescribing

Answer 20

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

Question 21

7 principles of deprescribing?

Answer 21

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

Question 22

Pt centred approach to deprescribing? 7

Answer 22

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

Question 23

Areas of focus for a prescriber?

Answer 23

1)safety
2)efficacy
3)quality of life: is it beneficial to the pt?
4)economy: is this treatment affordable?

Question 24

When reviewing a pt. A good prescriber should? 8

Answer 24

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

Question 25

Medicines optimisation definition

Answer 25

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.

Question 26

Medicine optimisation goal? 4

Answer 26

-pt taking medication correctly
-reduce use of unnecessary medication
-reduce wastage
-increase medicine safety

Question 27

4 principles of medicine optimisation?

Answer 27

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

Question 28

aim to understand the pt experience explained

Answer 28

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

Question 29

right choice of medicine Explained

Answer 29

Select the right choice of clinically and cost effective medication that satisfy the needs of the pt.
Goal: optimal outcome is achieved

Question 30

safe use of medicine

Answer 30

Consider:
-drug interaction
-drug usage
-ADR

goal: pt more confident taking the medication

Question 31

incorporate medicine optimisation as part of prescribing routine

Answer 31

pt is able to address concerns in relation to their medication.
Goal: optimal pt outcome achieved