Polypharmacy and de-prescribing Flashcards
Polypharmacy
Simultaneous use of multiple medicines by a patient for their conditions. >5 medications
Deprescribing
Stop/swap medication OR reducing dose after review
Aim to reduce .inappropriate polypharmacy
Shared decision making to improve patient quality of life
Results of polypharmacy
Increased mortality, risk of falls, more ADRs, increased length hospital stay, economic cost, patient safety incidents
Appropriate Polypharmacy
optimum minimum number of medications for complex patient
Problematic polypharmacy
unbalanced / inappropriate use of multiple medications increasing risk of drug-drug interactions and ADRs
How to reduce ADRs?
- Follow guidelines / evidence to use most appropriate drug
- Consider co-morbidities
- Ensure shared patient care with other HCPs
- Awareness of polypharmacy
- Medication optimisation and review
- Patient involvement and education, improve adherence
Example of polypharmacy
chronic pain –> depression Rx morphine + benzodiazepine = respiratory depression
oxycodone –> consitpation –> senna –> electrolyte imbalance / dehydration
NSAID –> increase BP –> amlodipine –> hypotension
Causes of polypharmacy in opioid patients
multimorbidities (CNS)
multi-prescribers (opioid tourism)
Dependence / addiction
Multimorbidity
> 2 long-term health conditions (physical, mental, learning disability, misuse, chronic pain, frailty, hearing loss)
RFs: age, economic, physical/mental
Relative Contraindication
Use with caution
Benefit vs. Risk
Absolute Contraindication
AVOID!
Life-threatening
Find alternative
Factors affecting contra-indications
Age
Gender
Previous ADRs
Allergy
Multi-drugs (interactions)
Hepatic impairment
Renal impairment
HF
Drug-disease interactions
Altered pharmacokinetics
PIMS
Potential Inappropriate Medications
Guidelines
Medication Review and Tools
Beets Criteria
STOP/START
ImPE project
STOP-IT: high risk polypharmacy, stop/swap dependent on admission reason
Example of STOP/SWAP
Metabolic disturbance from diuretics, ACEi, ARBs, NSAIDs, SSRIs
Falls from Benzo’s, Z-drugs, opioids
Patient Centred Care
assess pt, define pt goals, identify meds of concern, agree priorities for review, adgree to stop/reduce dose, communicate actions with all relevant people
Medicines optimisation RPS 2013
patient-focused
holistic
partnership with patient
MDT
monitor and review
Right patient get the right medicine at the
Patient takes ownership (take medicines correctly, avoid taking unnecessary medicines, reduce wastage of medicines and improve medicines safety)
x4 principles of medication optimisation
RPS guidelines 2013
1. Aim to understand patient experience - open Qs, engagement, might change over time, improves pt confidence
2. Evidence based choice of medication - NICE guidelines, regular review, optimal pt outcome,
3. Ensure medicine use safe - ADRs, interactions, safe processes and systems, effective communication MTD, avoid harm, reduced hospital admissions, MRHA reporting
4. Make medicine optimisation part of routine practice - how to get best out of medication, signposting, interprofessional, reduce waste
