Polypharmacy and Med optimisation

Question 1

Sick day rule

Answer 1

Stop medicines if patient experience fever, sweats and shaking, vomiting / diarrhoea and restart after 24-48 hrs

Question 2

Sick day rule medicines (SADMAN)

Answer 2

Sulphonylureas - Gliclazide, Tolbutamide, Glipzide
SGLT-2 inhibitors - Canagliflozin, Dapagliflozin, Empagliflozin
ARB - Losartan, Valsartan, Candesartan, Irbesartan
Diuretics - Furosemide, Bumetanide, Bendroflumethiazide
Metformin
ACE - Ramipril, Perindopril, Enalapril, Lisinopril
NSAIDs - Ibuprofen, Naproxen, Diclofenac

Question 3

High risk medicines (APINCH)

Answer 3

Antimicrobials
Potassium and other electrolytes
Insulin
Narcotics (opioids) and other sedatives
Chemotherapeutic agents
Heparing and other anticoagulants

Question 4

High risk medicine combinations - NSAID

Answer 4

ACE / ARB + Diuretics
Warfarin / DOAC
eGFR less than 60ml/min
HF diagnosed
Elderly >75 years w/out PPI

Question 5

High risk medicine combinations - HF diagnosed

Answer 5

Gliclazide
TCA
NSAID

Question 6

High risk medicine combination - Warfarin

Answer 6

NSAID
Macrolide and other Quinolone abx
Azole - Metronidazole
DOAC
Other antiplatelet

Question 7

Medicines needed specialist advice before altering

Answer 7

Anticonvulsants - epilepsy
Antidepressants - initiated in secondary care
Antipsychotics and mood stabilising medicines - lithium
PD management medicines
Amiodarone
DMARDs
Prescribed by specilist team

Question 8

Anticholinergic Effect on Cognition (AEC)

Answer 8

Long-term use of anticholinergic drugs in older people.
Associated with cognitive decline, dementia and cause mortality.
AE includes constipation, urinary retention, sedation and falls