Polypharmacy Flashcards
Polypharmacy is the use of multiple drugs. Using how many drugs defines polypharmacy?
1 - >2
2 - >4
3 - >5
4 - >8
3 - >5
How many people >65 y/o are routinely taking >8 medications each week?
1 - 1 in 10
2 - 1 in 100
3 - 1 in 1000
4 - 1 in 10,000
1 - 1 in 10
What % of patients >85 fulfil the definition of polypharmacy?
1 - 5%
2 - 25%
3 - 50%
4 - 75%
3 - 50%
Which of the following has a key impact upon pharmacokinetics in ageing patients and thus could increase the risk of adverse events?
1 - reduced muscle mass
2 - reduced sweat glands in skin
3 - reduced fat and muscle mass
4 - reduced number of Langerhans cells
3 - reduced fat and muscle mass
Polypharmacy has been shown to increase the risk of all the following EXCEPT which one?
1 - Immobilisation
2 - Adverse drug reactions (ADRs)
3 - Poorcompliance
4 - Falls leading to Hospital admissions
1 - Immobilisation
There are lots of adverse events that can be caused by polypharmacy in ageing populations. Which of the following os NOT a common adverse event?
1 - Nausea
2 - Weight Loss
3 - Arrhythmias
4 - Dizziness
5 - Muscle weakness
6 - Loss of appetite
7 - Delirium
8 - Low mood
3 - Arrhythmias
On average over a 6 month period 75% of people aged >70 will have an adverse drug reaction. Which of the following is NOT a factor that influences drug-drug interactions andage-related changes in pharmacokinetics and pharmacodynamics?
1 - Reduced hepatic/renal function
2 - Prolonged elimination half-life
3 - Increased sensitivity to drugs
4 - Low fibre and iron intake
4 - Low fibre and iron intake
There are some key drug classes that are commonly associated with adverse events including Hypnotics, Diuretics, NSAIDS (including Aspirin), Antiparkinsonian drugs, Psychotropic medication and Digoxin. One key class is hypnotics, which 2 of the following are drugs within the hypnotic class?
1 - zopiclone
2 - diazepam
3 - solifenacin
4 - amitriptyline
1 - zopiclone
2 - diazepam
Which of the following are key adverse events older patients can experience when taking hypnotics such as zopiclone and diazepam?
1 - drowsiness
2 - unsteady gait
3 - slurred speech
4 - confusion
5 - all of the above
5 - all of the above
- always prescribe in low doses to avoid dependence
There are some key drug classes that are commonly associated with adverse events including Hypnotics, Diuretics, NSAIDS (including Aspirin), Antiparkinsonian drugs, Psychotropic medication and Digoxin. One key class is NSAIDs, which of the following are drugs would NOT come under the NSAIDs class?
1 - paracetamol
2 - naproxen
3 - aspirin
4 - ibuprofen
1 - paracetamol
Which of the following are key adverse events older patients can experience when taking NSAIDs such as naproxen, aspirin and ibuprofen?
1 - peptic ulcer disease
2 - kidney injury
3 - worsening of cardiac disease
4 - all of the above
4 - all of the above
- worsening of cardiac disease = damaged kidneys do not filter properly and can result in electrolyte imbalance
- prescribe PPI alongside NSAIDs such as Omeprazole/Lansoprazole
There are some key drug classes that are commonly associated with adverse events including Hypnotics, Diuretics, NSAIDS (including Aspirin), Antiparkinsonian drugs, Psychotropic medication and Digoxin. One key class is diuretics, which 2 of the following are drugs comes under the diuretics class?
1 - lasartan
2 - ramipril
3 - furosemide
4 - spironolactone
3 - furosemide
4 - spironolactone
Which of the following are key adverse events older patients can experience when taking diuretics such as furosemide and spironolactone?
1 - hypotension
2 - kidney injury
3 - electrolyte disturbance
4 - all of the above
4 - all of the above
- prescribe short does and check for oedema
- use non-pharmacological as well (stockings, mobilisation)
In polypharmacy patients may be unable to open containers, have difficulty swallowingand lose track of what they’ve taken. This can lead to poor compliance which then leads to what?
1 - increased dosages of medications
2 - increased number of medications
3 - increased hospital and doctors appointment
4 - all of the above
4 - all of the above
All of the following are causes of postural hypotension and can increase the risk of falls in older patients, but which is the most common cause?
1 - impaired renal function
2 - drug related
3 - autonomic nervous system
4 - muscle atrophy
2 - drug related
- antihypertensivemedication
- drugs with a high anticholinergic burden
- always check Lying/Standing BP and review medications
All prescribed medication can have adverse events. These adverse events can be seen as a new medical condition and further medications can be given called the prescribing cascade. For example a patient is given a medication that leads to constipation, which subsequently is treated with using laxatives. Which medication is most likely to gave caused the constipation and should have been reviewed before prescribing laxatives?
1 - ramipril
2 - codeine
3 - paracetamol
4 - larsartan
2 - codeine
- often drugs for pain get put on repeat prescriptions
