Polypharmacy

Question 1

What is the definition of polypharmacy

Answer 1

> 4 medications

Question 2

What does polypharmacy increase the risk of

Answer 2

non-compliance
ADRs
Decline in health

Question 3

What does the prescribing cascade refer to

Answer 3

ADR is inappropriately diagnosed as a new condition + treated w/ further medication

Question 4

What drugs are the elderly more sensitive to than the regular population

Answer 4

Opioids
Benzodiazepines
Neuroleptics/Antipsychotics

Question 5

What drugs are the elderly less sensitive to than the regular population

Answer 5

Beta-Blockers (↓ cAMP)
Beta-Agonists
Furosemide

Question 6

What altered pharmacokinetics do the elderly have + why

Answer 6

↓ Metabolism (↓ kidney/liver function)
↓ Absorption (GI changes)
↓ Distribution for water-soluble drugs (↑ Total body fat %)
↓ Albumin (↓ albumin-bound drug distribution)
↓ Excretion
↓ Saliva/acid/SA/motility in gut
↑ Distribution for fat-soluble drugs (↑ total body fat)
↑ Gastric pH
↑ Gastric emptying

Question 7

What are some good prescribing principles for avoiding polypharmacy in the elderly

Answer 7

1. Avoid prescribing CI’d drugs
2. Avoid prescribing outside the recommended dose/duration
3. Avoid prescribing a drug that adversely affects the prognosis
4. Avoid failing to use a drug to improve outcomes

Question 8

Why are older people at increased risk of ADRs

Answer 8

Impaired cognition
Multiple co-morbidities 
Dependent living functions
Impaired renal function
Non-adherence
Polypharmacy