polypharmacy Flashcards
The use of multiple medications which increase the likelihood of being administered an adverse drug which results in unwanted side effects that may include headaches, depression, memory impairment, cognitive decline, and/or death
Polypharmacy
The use of multiple medications which increase the likelihood of being administered an adverse drug which results in unwanted side effects that may include
headaches, depression, memory impairment, cognitive decline, and/or death
Nearly ___in every ___ older adults receive a medication that they should not have been prescribed
1 in 4
Adverse drugs account for up to ___of _______ ______and contribute to
25% of hospital admissions and contribute to prolonged hospital stays
1 in ___ older adults die from adverse drugs
14
Medication Management Challenges: • Increased ... • Lack of ... • Change in ... • Increased ... • The incidence...
Medication Management Challenges
• Increased pace of new drug development
• Lack of physician knowledge regarding polypharmacy5
• Change in drug metabolism with aging
• Increased longevity and likelihood of chronic conditions requiring medication
• The incidence of dementia,
incidence of dementia in continuing care facilities
50% in continuing care facilities
Commonly used to survey clinical medication use, and evaluate intervention studies to decrease medication problems in older adults
Beers Criteria
Beers Criteria
Commonly used to…,
and…to decrease medication problems in older adults
Commonly used to survey clinical medication use,
and evaluate intervention studies to decrease medication problems in older adults
Beers Criteria lists…
- medications not to be administered to older adults (e.g. lorazepam)
- inappropriate meds for particular conditions (e.g. cognitive impairment and anticholinergics)
Beers Criteria does not assess…
inappropriate dosages,
duration of administration or
adverse interactions of medications
Oddie’s study examined the relationships among adverse drugs prescribed to community-dwelling older adults…
their health status,
need for assistance with activities of daily living,
and cognitive status
Oldies participants were..
n=68, 69% women age 71+/- 9 years, 14 years of ed +/- 3years ed
Community procedure included…
Structured interviews, a brief …survey and cognitive assessments, conducted at participants’ residence or research office
The interview and survey examined …
…demographics, health status, need for assistance with daily living, and a medication inventory
cognitive assessments included
- Geriatric Depression Scale,
- RBANS,
- Backward Digit Span,
- Trails A and B,
- NAART,
- Verbal Fluency, and the
- MMSE.
RBANS stands for…
repeatable battery for the assessment of neuropsychological Status
Collectively, these assessments measured:
Collectively, these assessments
- visuoconstruction,
- attention,
- language, and
- immediate memory,
- delayed memory,
- executive functioning
- depression
Adverse Drug Inclusion Criteria included:
Inappropriate adverse meds prescribed…
- independent of condition
- due to condition
- dosage for older adults
- duration
- interactions
55% had interactions between drugs-the most prevalent potential adverse effect would be ____________( %) associated with the concomitant use of ______________ drugs or with _______ inhibitors
hyperkalaemia (38%) associated with the concomitant use of potassium-sparing drugs or with ACE inhibitors
RESULTS: Inappropriate Duration \_\_\_ Inappropriate Dosage \_\_\_ ADI by Condition \_\_ ADI by medication\_\_\_
Inappropriate Duration 21%
ADI by medication 13%
Inappropriate Dosage 9%
ADI by Condition 2%
What percentage was not identified by the Beers list
85%
Medication and Likelihood of ADE: 1-5 meds\_\_\_ 6-10 \_\_\_ 11-13 \_\_\_ 14-20 \_\_\_
1-5 meds +20%
6-10-60%
11-13 - 78%
14-20 - 80%
___ of participants were prescribed medication that met criteria, with an average of ___medications taken
54% of participants were prescribed medication that met criteria, with an average of 7.6 medications taken
__________ (GABA agonists) were most common adverse
drug identified
Benzodiazepines (GABA agonists) were most common adverse
drug identified
Benzodiazepines are _____ _______
GABA AGONISTS
Most polypharmacy effects your…
cognitive abilities & motor function
Alberta is ____ in quality of health care despite being one of the …
We are second last in quality of health care offered in Canada despite being one of the biggest spenders
When GABA inhibition is lost it contributes to …
a lot of motor issues.
Top 3 adverse drugs were:
33%
18%
14%
33% Benzodiazepines
18% NSAIDS
14%Diuretics, SSRI’s
Cognitive Decline is likely mediated by… of many adverse drugs primarily in …
GABA agonist effects of many adverse drugs primarily in cortex and hippocampus
____ of community-dwelling older adults were prescribed potentially adverse drugs
1/2
Beer’s Criteria identified only ____of adverse drug effects
15%
Declining scores on cognitive measures were associated with _______ _______ _________ and not health status of participants
adverse drug identification
Estimated that___ experienced ___________ cognitive decline likely preventable with …
25%, significant decline, likely preventable with intervention strategies
Scores on MMSE
did not correlate with adverse drugs suggesting it is not sensitive enough to measure cognitive decline
