Polypharmacy Flashcards
What is polypharmacy?
Many medications
What is meant by appropriate polypharmacy?
When all prescribed medications are required, optimised and aggreed upon by the patient
What are some challenges that can cause polypharmacy?
- Advances in medical
- Ageing population
- Multi-morbidities
- Complex care needs
How common are preventable adverse drug reactions?
Adverse drug reactions cause 8.6 million admissions in Europe every year, with 50% of these being preventable
Why is polypharmacy more risky in older people?
Polypharmacy can have a greater effect on people in older age due to age-related phsyiological changes to pharmacokinetics and pharmacodynamics, as well as cognitive changes leading to lower medication adherence
What are some high fall risk medications?
- Antidepressants
- Antipsychotics
- Anticholinergics
- Benzodiazepines and hypnotics
- Dopaminergics in PD
What are some moderate fall risk medications?
- Anti-arrhythmic
- AEDs
- Opiate analgesia
- Antihistamines
- Alpha-blockers
- ACEi or ARB
- Diuretics
- ß-Blockers
What are some lower fall risk medications?
- Ca2+ channel blockers
- Nitrates
- Anti-diabetic medications
What is meant by anti-cholinergic burden?
This is the effects of taking too many anti-cholinergic medications
What are some symptoms of anti-cholinergic burden?
- Blurred vision and dry eyes
- Dry mouth
- Constipation
- Skin-flushing, anhydrosis, overheating
- Drowsiness, dizziness, confusion and hallucination
- Rapid heart rate
- Urinary retention
What are some medications with high anti-cholinergic activity?
- Tricyclic antidepressants
- Antipsychotics - Chlorpromazine, Clozapine
- Urinary antispasmodics - Oxybutinin, Tolterodine, Solifenacin
- Anti-histamines - Chlorphenamine, Hydroxyzine
- H2 receptor antagonists - Ranitidine, Cimetidine
- Spasticity agents - Tizanidine, Baclofen, Diazepam
What are some long-term risks of anticholinergics?
Increased dementia risk
Reduced physical function
How is anti-cholinergic burden calculated?
ACB calculator
What ACB score is associated with increased risk of mortality and cognitive impairment?
≥3
What are some common risks of polypharmacy in older age?
- Increased risk of delirium
- Bowel dysfunction, especially constipation
- Dizziness and balance issues (Postural hypotension and Parkinsonism)
What is meant by polypharmacy cascade?
When 1 drug is started to counteract the side effects of another, and so on
What are the 7 steps to appropriate polypharmacy (Medication review)
- What matters to the patient?
- Identify essential drug therapy
- Does the patient take unecessary drug therapy?
- Are therapeutic objectives being achieved?
- Does the patient have ADR or side effects, or is at risk of this
- Is drug-therapy cost effective
- Is the patient willing to take the drug?
