Polypharmacy

Question 1

How is polypharmacy defined?

Answer 1

Patient on over 4 medications

Question 2

What is the main risk with alpha blockers in the elderly?

Answer 2

(used for BPH and resistant hypertension)

–> causes postural hypotension, especially if used with other antihypertensives

Question 3

What is the risk of prescribing antibiotics along with ACE inhibitors?

Answer 3

–> deterioration in renal function

Question 4

What are the anticholinergic side effects?

Answer 4

Confusion + hallucinations 
Tachycardia
Blurred vision
Urinary retention
Constipation
Dizziness
Falls
Dry mouth

Question 5

Give some examples of drugs with anticholinergic potential?

Answer 5

Oxybutynin + tolterodine (used to treat urinary incontinence)
PD drugs
Antidepressants
Antiemetics
Opiates
Antipsychotics
Antihistamines
... lots more

Question 6

Which things should you consider when reviewing a mediation list for someone with polypharmacy?

Answer 6

Are any harmful?
Are any futile? e.g. a statin in someone with advanced malignancy
Risks vs benefits e.g. anti-cholinergic for urinary incontinence

Question 7

Give some examples of common drugs which cause problems in the elderly?

Answer 7

Warfarin
Digoxin
Insulin
Benzodiazepines
Diuretics
NSAIDs
Corticosteroids
Antihypertensives
Opioids
Theophylline

Question 8

What is the adverse risk with benzos in the elderly?

Answer 8

Confusion and falls risk

Question 9

What are some of the adverse risks with NSAIDs?

Answer 9

GI bleeding
Reduced renal function
Reduce the effects of diuretics and antihypertensives

Question 10

What are some of the risks with opioids in the elderly?

Answer 10

Falls/confusion

Constipation –> give prophylactic laxatives