Polypharmacy

Question 1

What proportion of 65-74year olds take 3 or more prescribed medications?

Answer 1

1/2

Question 2

What proportion of >75 year olds take 3 or more prescribed medications?

Answer 2

> 70%

Question 3

What proportion of adults are hospitalised for medication related problems?

Answer 3

1 in 4

Question 4

What percentage of hospital admissions are due to ADRs?

Answer 4

6.5%

Question 5

What percentage of hospital admissions due to ADRS are avoidable?

Answer 5

55%

Question 6

Which drugs most commonly cause ADRS?

Answer 6

NSAIDS – ulcers, GI bleed, AKI, CKD, heart failure
Diuretics – hyponatraemia/hypokalaemia – falls
Warfarin
ACE inhibitors
Antidepressants – constipation, hyponatraemia, falls

Question 7

Which drugs increase falls risk?

Answer 7

Antipsychotics
Hypnotics
Antidepressants
To a lesser extent thiazides and NSAIDs

Question 8

Which drugs increase fracture risk?

Answer 8

SSRIs
Glitazones
Corticosteroids
PPIs

Question 9

Which drugs increase C.difficile risk?

Answer 9

Broad spectrum antibiotics
Cefuroxime 
Ciprofloxacin 
Coamoxiclav 
Clindamycin

Question 10

How should you monitor elderly patients?

especially with drugs that have a narrow TW

Answer 10

cant rely on eGFR in patients over 70 as creatinine levels don’t reflect renal function due to reduced muscle mass

check creatinine clearance instead

Question 11

What is Beer’s criteria?

Answer 11

a list of potentially harmful drugs

Question 12

What is the medication review tool - NO TEARS

Answer 12

Need/indication
Open questions

Tests
Evidence 
Adverse effects
Risk reduction 
Simplification/switches