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Year 4 - MFE > Polypharmacy and prescribing > Flashcards

Polypharmacy and prescribing Flashcards

1
Q

What do you use to help you prescribe analgesia

A

WHO analgesic ladder

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2
Q

What scale can you use to assess pain in patients with delirium/dementia

A

Abbey pain scale

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3
Q

Side effects of PPIs

A

hyponatraemia
hypomagnesaemia
C.diff risk

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4
Q

what drugs are avoided in the elderly

A 
NSAIDs
Antipsychotics 
unnecessary antibiotics 
diuretics
tramadol / dihydrocodeine
PPIs
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5
Q

define polypharmacy

A

patient is on >=5 medications

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6
Q

what are the 7 steps for conducting a polypharmacy review

A
  1. identify aims and objectives of treatment
  2. identify essential drug treatment
  3. identify potentially unnecessary drugs
  4. are the drugs effective
  5. are there ADRs - un/acceptable
  6. cost effective treatment
  7. patient willing to take treatment
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7
Q

what tool can be used to review drugs in palliative medicine

A

SPICT

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8
Q

side effects of anticholinergics

ABCDS

A 
A - agitation 
B - blurred vision 
C - constipation / confusion 
D - dry mouth / dizziness 
S - stasis of urine / sweating
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9
Q

what are some scoring systems / scales for anticholinergic drug burdens

A

anticholinergic burden scale ACB scale

modified anticholinergic risk scale mARS

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10
Q

what drugs display anticholinergic activity

A 
antimuscarinics 
tricyclic antidepressants 
anti emetics 
anti psychotics
anti histamines 
anti parkinsons
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11
Q

what CVS drugs can cause falls

A 
antihypertensives 
nitrates 
B blockers 
digoxin 
diuretics
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12
Q

what analgesic drugs can cause falls

A

opioids
gabapentin
pregabalin

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13
Q

what urinary drugs can cause falls

A

tamsulozin

antimuscarinics - oxybutynin, tolterodine, solifenacin

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14
Q

what psychiatric drugs can cause falls

A

antipsychotics
tricyclic antidepressants
BZDs
anti dementia drugs

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15
Q

what neurological drugs can cause falls

A

anti Parkinsons

anti convulsants

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16
Q

side effects of tramadol

A

nausea
lowers seizure threshold
generally avoided in the elderly

17
Q

list drugs that can cause acute confusion (ie that cross the BBB)

A

lithium
H2 receptor antagonists
theophylline
corticosteroids

18
Q

what time is best to give steroids and why

A

in the morning because they can make you alert and therefore unable to sleep

19
Q

what time is best to give diuretics and why

A

in the morning so that they dont need to go pee in the middle of the night

20
Q

what are the 3 basic steps to approaching polypharmacy

A
  1. what can be stopped immediately
  2. what can be withheld pending further investigations
  3. what needs more info / discussion with GP / follow up
21
Q

what is a more reliable way of assessing an elderly person’s renal function and why

A

creatinine clearance

doesnt rely on patients weight

Year 4 - MFE (8 decks)

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