Polypharmacy Flashcards
What is Polypharmacy?
Polypharmacy describes the idea of taking many medications, usually in older patients with multiple conditions, which can lead to adverse drug reactions (ADRs).
What are adverse drug reactions (ADRs)?
ADRs are complications and side effects that occur due to the use of medications.
How does the number of drugs a patient takes relate to the risk of ADRs?
The risk of adverse drug reactions increases as you increase the number of drugs that a patient is taking.
What are common iatrogenic drug problems associated with anticholinergics?
- Confusion
- Dry mouth
- Constipation
- Blurred vision
- Urinary retention
- Orthostatic hypotension
What are the results of medication-related problems (ADRs) in older patients?
- Falls
- Cognitive loss
- Dehydration
- Incontinence
- Depression
What is the concept of prescribing cascade?
The adverse drug events from a medication are interpreted as a new medical condition and treated with another drug.
What are the four stages of pharmacokinetics?
- Absorption
- Distribution
- Metabolism
- Excretion
What physiological changes affect drug absorption in the elderly?
Physiological changes affect the rate but generally not the extent of absorption from the GI tract.
What happens to fat-soluble drugs in older adults?
Increased fat leads to an increase in half-life and duration of action of fat-soluble drugs.
What is the effect of aging on hepatic metabolism?
Decreased liver mass and liver blood flow can lead to toxicity due to reduced metabolism and excretion.
What are the principles of prescribing in the aging population?
- Be clear about the diagnosis
- Consider whether drug therapy is the best action
- Lower doses are required
- Think about potential problems caused by the drug
- Start low, go slow
- Review the drug’s aim
- Consider medication compliance
What are some prescribing tools and guides for polypharmacy awareness?
- Beers’ criteria
- START-STOPP criteria
- NHS Scotland Polypharmacy Guidance
What is deprescribing?
Deprescribing is a reduction, substitution, or discontinuation of a drug due to several factors including ADRs and inefficiency.
What did the systematic review of medication withdrawal trials conclude for those aged >65?
It showed some evidence that it is safe and/or beneficial to stop certain medications like antihypertensives and benzodiazepines.
What are the top 10 common drugs associated with admission due to ADR?
- NSAIDs
- Diuretics
- Warfarin
- ACEI
- Antidepressants
- Beta blockers
- Opiates
- Digoxin
- Prednisolone
- Clopidogrel
Which two medications cause the most ADRs?
- Anticholinergics
- Sedatives
What are the most common adverse effects associated with NSAIDs?
- Renal impairment
- GI bleeding
