Polypharmacy and Medicine Management Flashcards
how does increase in body fat mass significant for drug use
increase time to onset of action
prolonged t 1/2 for fat soluble drugs
give examples of drugs that are influenced by increased body fat mass
diazepam
verapmil
how does decrease in lean body mass and decrease total body water significant for drug use
higher than expected plasma levels of water soluble drugs
list drugs affected by decreased in lean body mass and decrease total body water
aspirin
lithium
alcohol
how does decrease in renal function water significant for drug use
reduce creatinine clearance and potential accumulation of renally excreted drugs
list drugs affected by decrease in renal function
lithium
digoxin
how does decrease in liver blood flow and decrease liver function significance for drug use
may lead to decrease metabolism of drugs via Phase I and II metabolic systems
increase bioavailability of first pass effect drugs
list drugs affected by decrease in liver blood flow and decrease liver function
warfarin
amiodarone
fentanyl
nitrates
nifedipine
tricyclic antidepressants
list the 3 domains potentially inappropriate prescribing
overprescribing
misprescribing
underprescribing
age related issued with prescribing in elderly
increased susceptibility to adverse dug effects
cognitive state, nutritional state
number of additional prescribing physicians
unrecorder concomitant use of over the counter medicines
what is overprescribing
: the use of drugs where no
clinical indication exists
give examples of overprescription
Aspirin with no history of coronary, cerebral or peripheral arterial symptoms or occlusive arterial event
* Loop diuretic as first line for ankle oedema only
what is misprescribing
the use of an indicated drug where the risks outweigh the benefits
what is underprescribing
the omission of clinically
indicated medicines
examples of underprescribing
Omission of:
* Primary treatment e.g. Metformin in diabetes
* Preventative treatment e.g. Bisphosphonate
in chronic steroid use
* Symptomatic treatment e.g. Laxative for
patients taking opioids
what is polypharmacy
Polypharmacy usually defined as taking 5 or
more regular medicines
how is potentially inappropriate prescribing determined
Explicitly: criteria/indicator-based
* Beers’ criteria
* Screening Tool for Older Persons’
Prescriptions (STOPP)
* Screening Tool to Alert doctors to Right
Treatment (START)
what FACTORS must be considered to appropriately prescribe
Medicine factors - adverse effects, dosage, frequency, duration, alternative, dosage form
Patient factors - age, conditions, other medicines, smoker, diet, dysphagia, mobility
Environment factors - setting, medication monitoring, administration
what is the definition of medicine management
“The clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimising potential harm”
MUST BE
* Safe, (cost-)effective, clinically indicated,
evidence-based medicines use
Components of medicines management
- Effective communication, transcription,
medicines reconciliation - Prescribing (+ deprescribing)
- Dispensing
- Medicines storage
- Administration
- Monitoring
- Review
- Medicines disposal
checklist for appropriately prescribing an elderly patient
is there a need for pharmacotherapy
is this optimal medicine for the specific clinical diagnosis
will the medicine introduce unnecessary duplication with existing medicines
correct dosage
suitable formulation
acceptable duration of therapy
new medication likely to interact with existing medication
will medicine likely affect concurrent disease
are directions for use correct and feasible
what is deprescribing
The planned and supervised process of dose reduction or stopping of medications that may cause harm or are no longer providing benefit
when a medical practitioner reviews the medication list every 3 months what medications are especially considered
antipsychotic medication
sleeping tablets and other sedating medication
antiplatelet and anticoagulant medication
non-steroidal anti-inflammatory drugs
what are the risks associated with anti psychotic medication
Provide limited benefit to such symptoms,
high potential for harm (stroke, death
what are the risks associated with sleeping tablets
Risks of prolonged sedation, confusion,
impaired balance and falls
what are the risks associated with antiplatelet/anti-coagulant
Main risk is bleeding/bruising – dose too high?
when are NSAIDS contraindicated
Peptic ulcer disease
* Hypertension
* Heart failure
* Renal failure
