Polypharmacy

Question 1

What steps of pharm are important in Y3?

Answer 1

Discuss choice of medication with patient (and carer) and make a shared decision about treatment

Make appropriate arrangements for follow up

Question 2

What is problematic polypharmacy?

Answer 2

Multiple medicine inappropriately prescribed, or where the intended benefits from the medicine are not realised

Question 3

Explain the mechanism of action of apixaban

Answer 3

Target - Factor Xa enzyme released in the liver
Location - platelet cell surface
Effect - Factor Xa inhibitor. Prevents thrombin activation and subsequent clot formation

Question 4

What symptoms can be brought on by apixaban?

Answer 4

Nausea

Question 5

In general, what drugs should never be stopped?

Answer 5

Replacing something vital e.g. Insulin
Drugs that may cause rapid symptomatic decline or loss of disease control if stopped
Drugs with a strong evidence base for primary or secondary prevention

Question 6

What is Chads-Vasc risk?

Answer 6

Stroke risk in those with AF

Apixiban reduces risk

Question 7

When should you consider stopping a drug?

Answer 7

Indication of drug has expired
Risk/benefit no longer appropriate
Medicine combinations is hazardous due to interactions

Question 8

What are the pros and cons of amlodipine?

Answer 8

Pros: 1x a day so easier to remember than other drugs

Cons: Swollen ankles, dizziness

Question 9

What are the pros and cons of statins?

Answer 9

Cons: Dizziness, wants to drink grapefruit juice, side effects on muscles and liver/kidney

Question 10

What are the pros and cons of metformin?

Answer 10

Pros: Pts. think it keeps weight down, supposedly protective against cancer

Cons: GI side effects

Question 11

Why is polypharmacy a problem?

Answer 11

Ageing pop leads to increasing multiple morbidity

Increased medicalisation and development of novel therapeutics

Guidelines do not always consider risks of polypharmacy

Prescribing cascade