Polypharmacy Workshop Flashcards
SBAR communication tool used for hx taking and consultations, what does it stand for
situation
background
assessment
recommendation
s in sbar involves what
identify urself and location
identify px by name and reason for ur call
explain ur concerns
b in sbar involves what
give px reason for admission
explain pastmed hx, emds, allergies
relevant investigations
a in sbar involves what
most recent obs (vital signs)
clinical impressions and concerns
r in sbar involves explaining what
what u need
recommendations
what 3 things to check/ assess as part of med review
any presc errors?
are meds prescribed appropriate in view of hx?
any meds u think should be stopped/ started?
nitrofurantoin antibiotic avoid if egfr less than what
45
can u use nitrofurantoin in egfr 30-44?
yes w caution as a short course only 3-7 days
alternative for presc nitrofurantoin for uti
check microbiology results!
trimethoprim 200mg bd 3/7
avoid cephalosporins: risk of antibiotic assoc colitis
what should be assessed w fall risk px
hx of falls
- gait, balance, mobility, muscle weakness
- risk of osteoporosis
- perceived func ability/ falling fear
- vision
- cognitive func/ neurological review
- urinary incontinence?
- home hazards
- do CV exam and med review
mechanisms by which meds increase fall risk? what ses may increase risk
postural hypotension
sedation/ drowsiness
dizziness
bradycardia, tachycardia
how does codeine phosphate inc risk of falls
causes drowsiness which increases risk
can cause constipation
what to do in fall risk px on codeine
stop
start paracetamol 500mg qds prn - do not exceed 2g/ 24hrs in px <50kg
avoid nsaids why?
cause kidney injury
why are antipsychotics other than risperidone contraindicated in dementia px?
increase risk of stroke
how can antipsychotics (prochlorperazine, haloperidol) inc risk of falls
can cause sedation
also postural hypotension
typical antipsychotics exacerbate what symptoms
parkinsons
temazepan has t1/2 5-12hrs, up to 15 hrs in older adults. what can it cause which inc risk of falls
sedation
what to consider when stopping benzos eg temazepam due to stroke risk
withdrawal symptoms
bisphosph tx for osteoporosis should be re-evaluated periodically based on risk benefit, particularly after X yrs of use
5 or more
amitryptyline
haloperidol
prochlorperazine
temazepam
all cause sedation, which ones also cause postural hypo
haloperidol and prochlorperazine
drugs with withdrawal potential 5
benzos
bb
centrally acting antihypertensives
clonidine
barbiturates
all prescs that are stopped should be X and Y
dated and signed
likewise changes should not be made after first admin - strike out and reqwrite to avoid confusion
what things DECREASE with increasing age
… all of which affect pk and pd of meds eg reduce dose of paracetamol, enoxaparin
lean body mass
body water
bone mass
liver enz activity
hepatic blood flow
gfr
what increases with inc age, in relation to total body weight
body fat
amlodipine and indapamide are what step in antihypertensive tx for over 55
2
temazepam cd drug class
cd3
what to do about nitrofurantoin if egfr 44?
<45 so switch to alt: trimethoprim or dec dose
why would you dec amitryptyline (TCA)
anticholinergic burden
titrate, does have withdrawal effects
t/f haloperidol and prochlorperazine inc stroke risk by 3x
true
both have anticholinergic burden
cause sedation, give for anxiety?
2 SE risks w alendronic acid
ONJ
atypical femoral fractures
