Polypharmacy and Deprescribing

Question 1

Polypharmacy is described as…

Answer 1

A high number of medications - no universally agreed-upon cutoff

May be associated with a lack of appropriateness of medications

Question 2

Under-utilization of indicated therapies is also common in older adults, such as…

Answer 2

Bisphosphonates for osteoporosis
Anticoagulation for AFib
Pain medications
COPD treatment

Question 3

The #1 risk factor for adverse drug reactions is…

Answer 3

The number of medications taken

Therefore, concern regarding polypharmacy is valid

Question 4

Older adults are particularly vulnerable to ADR’s due to…

Answer 4

Altered medication response (PK/PD)
More comorbidities
Altered homeostatic mechanisms
Limited EBM for frail/older adults

Question 5

The Beers criteria was developed to assist…

Answer 5

In identifying potentially inappropriate medications for older adults

65+: medications generally considered to have risks > benefits

Question 6

The 5 sections of the Beers Criteria includes…

Answer 6

1. Medications generally considered inappropriate for older adults
2. Medications inappropriate for older adults with certain medical conditions
3. Medications to be used with caution in older aduits
4. Clinically important drug-drug interactions to avoid
5. Medications to avoid/dose-adjust in renal impairment

Question 7

Absence of a Beers medication does not mean…

Answer 7

Optimization of an older adult’s medications

Question 8

Explicit prescribing tools refers to…

Answer 8

Consensus criteria - lists of medications to either use or avoid

Question 9

Pros and cons of explicit prescribing tools include…

Answer 9

Pros: Easy to use and implement
Cons: Miss other types of DTP’s

Question 10

Implicit prescribing tools refers to…

Answer 10

A process for the clinician to follow to identify DTP’s

Question 11

Pros and cons with implicit prescribing tools include…

Answer 11

Pros: Very comprehensive approach to identifying DTP’s
Cons: Requires clinical knowledge/expertise, is time-consuming

Question 12

Examples of implicit prescribing tools include…

Answer 12

Medication Appropriateness Index (research tool to evaluate patient’s medication regimen)

Good Palliative-Geriatric Practice Algorithm

Question 13

A stepwise approach to managing polypharmacy is…

5 Steps

Answer 13

1. Identify pt. at risk of experiencing polypharmacy/ADR’s
2. Obtain accurate medication hx
3. Evaluate if any sx’s or problems pt. is experiencing may be caused by a drug
4. Match medical conditions with medications
5. Align drug tx with patient goals and priorities (consider frailty)

Question 14

A prescribing cascade is…

Answer 14

When a patient is prescribed another medication to treat an ADR

Question 15

Time to benefit is harder to determine for…

Answer 15

Preventative therapies

Consider pt. individual risk and clinical trial data

Question 16

Factors that can increase success of deprescribing include…

Answer 16

1. Patient/caregiver buy-in
2. Taper/stop one medication at a time
3. Watch for/try to break up prescribing cascades

Question 17

Adverse drug withdrawal reactions (ADWRs) are…

Answer 17

Clinically significant signs or symptoms on discontinuing a drug (physiologic withdrawal, recurrence of underlying condition)

Question 18

When stopping a medication, we need to consider whether any drug interactions…

Answer 18

May be unmasked when stopping a medication

Anticipate + manage potential adverse drug withdrawal reactions

Question 19

To avoid ADWR’s, we can…

Answer 19

Taper a medication off slowly
Advice on how to manage unpleasant symptoms during the tapering process