Polypharmacy and prescribing Flashcards
What do you use to help you prescribe analgesia
WHO analgesic ladder
What scale can you use to assess pain in patients with delirium/dementia
Abbey pain scale
Side effects of PPIs
hyponatraemia
hypomagnesaemia
C.diff risk
what drugs are avoided in the elderly
NSAIDs Antipsychotics unnecessary antibiotics diuretics tramadol / dihydrocodeine PPIs
define polypharmacy
patient is on >=5 medications
what are the 7 steps for conducting a polypharmacy review
- identify aims and objectives of treatment
- identify essential drug treatment
- identify potentially unnecessary drugs
- are the drugs effective
- are there ADRs - un/acceptable
- cost effective treatment
- patient willing to take treatment
what tool can be used to review drugs in palliative medicine
SPICT
side effects of anticholinergics
ABCDS
A - agitation B - blurred vision C - constipation / confusion D - dry mouth / dizziness S - stasis of urine / sweating
what are some scoring systems / scales for anticholinergic drug burdens
anticholinergic burden scale ACB scale
modified anticholinergic risk scale mARS
what drugs display anticholinergic activity
antimuscarinics tricyclic antidepressants anti emetics anti psychotics anti histamines anti parkinsons
what CVS drugs can cause falls
antihypertensives nitrates B blockers digoxin diuretics
what analgesic drugs can cause falls
opioids
gabapentin
pregabalin
what urinary drugs can cause falls
tamsulozin
antimuscarinics - oxybutynin, tolterodine, solifenacin
what psychiatric drugs can cause falls
antipsychotics
tricyclic antidepressants
BZDs
anti dementia drugs
what neurological drugs can cause falls
anti Parkinsons
anti convulsants
side effects of tramadol
nausea
lowers seizure threshold
generally avoided in the elderly
list drugs that can cause acute confusion (ie that cross the BBB)
lithium
H2 receptor antagonists
theophylline
corticosteroids
what time is best to give steroids and why
in the morning because they can make you alert and therefore unable to sleep
what time is best to give diuretics and why
in the morning so that they dont need to go pee in the middle of the night
what are the 3 basic steps to approaching polypharmacy
- what can be stopped immediately
- what can be withheld pending further investigations
- what needs more info / discussion with GP / follow up
what is a more reliable way of assessing an elderly person’s renal function and why
creatinine clearance
doesnt rely on patients weight
