Polypharmacy

Question 1

Why are drugs less beneficial for the elderly?

Answer 1

They are more likely to come to harm (especially frail patients)
therefore the harms may actually outweigh the benefits

Question 2

What side effects of drugs are elderly people more susceptible to?

Answer 2

• Cognition/consciousness problems
• Increased risk of delirium
• Bowel function (constipation)
• Dizziness and balance i.e. postural hypotension and parkinsonism
• Risk of falls / immobility

Question 3

What anti-cholinergic side effects are more pronounced in the elderly?

Answer 3

• Confusion and Hallucinations
• Tachycardia
• Blurred vision
• Urinary retention
• Constipation
• Dizziness
• Falls

Question 4

What LONG TERM risk is present with use of anti-cholinergic drugs?

Answer 4

LONG TERM - Increased risk of developing dementia

Question 5

What types of drugs can cause anti-cholinergic side effects?

Answer 5

Parkinson’s drugs
Antidepressants
Anti-emetics
Opiates
Antipsychotics
Antihistamines

Question 6

Give an example of an interaction that may occur in the elderly and cause them to have a side effect?

Answer 6

Alpha blocker (prescribed independently for BPH) and anti-hypertensive may together cause postural hypotension

Question 7

Patients come to the doctors expecting a prescription. TRUE/FALSE?

Answer 7

TRUE
many patients expect doctors to always prescribe something to fix their given problem.

=> We need to challenge this and not always prescribe

Question 8

How do we categorise medication in order to think about removing them from a patients prescription list?

Answer 8

Are any:

• Harmful
• Futile
• Risk-benefit balance

Question 9

Give examples of situations where a drug would be stopped immediately as it is considered harmful

Answer 9

Bleeding ulcer – stop NSAID
Kidney failure – stop ACE inhibitor
Hyponatraemia – stop antidepressant

Question 10

Give an example of a drug which could be removed on the basis that it is “futile”

Answer 10

Paracetamol in OA back pain = no better than placebo

Statins in advanced malignancy not required if pt has short life expectancy

Question 11

What do we use to analyse Risk-benefit balance?

Answer 11

Number needed to treat

Number needed to harm

Question 12

Why should risk-benefit analysis be individualised?

Answer 12

Independent active 79 year old lady. Incontinence is keeping her housebound.
Anti-cholinergic might benefit

Residential home resident with mild dementia, poor dentition and falls
Stop anti-cholinergic!

Question 13

When and where should polypharmacy be managed?

Answer 13

In community:

• Routine
• Opportunistic

In hospital:

• Out patient clinics
• Admissions