Therapeutics and polypharmacy (1) Flashcards
(2) types of contraindications for the drug use (in general)
- Relative contraindication → caution should be used when two drugs or procedures are used together. (It is acceptable to do so if the benefits outweigh the risk.)
- Absolute contraindication → event or substance could cause a life-threatening situation
What’s ‘Shared Care Agreement’?
Shared care → where a GP supports and prescribes treatment for a patient which was initiated by a specialist.
- patient continues to be followed-up in reviews by the specialist
- a clear plan of care and defined protocol, medication specific, with a statement of monitoring arrangements, and responsibilities of the specialist, GP and patient
- GP can decide not to share care if they feel they can’t accept the responsibility, are not competent etc
What’s polypharmacy?
- taking multiple medications concurrently to manage co-existing health problems
- use of >4-5 medications per day or taking more medications than clinically required
How often should we review meds of 75 y old patient?
- at least annually
- 6/12 if taking ≥4 meds
Who can perform meds review?
Clinical pharmacist, doctor, PA, (for some drugs) nurse practitioner/nurse prescribers
What’s NO TEARS?
NO TEARS – mnemonic to maximise 10 minute consultations for med review
What’s ‘N’ in NO TEARS?
Need and indication
- Does the patient know why they take each drug?
- Is each drug still needed? Was long term therapy intended?
- Is the diagnosis refuted? (cancelled/changed)
- Is the dose appropriate? Would non-pharmacological treatments be better?
What’s ‘O’ in NO TEARS?
Open questions
- Allows patients to express views
- Helps to reveal any problems they may have
What’s ‘T’ in NO TEARS?
Test and Monitoring
- Assess disease control. Any conditions under-treated?
- Use appropriate reference for monitoring advice e.g. BNF, Shared care
- protocols, NPHS Wales monitoring guidelines
What’s ‘E’ in NO TEARS?
Evidence and Guidelines
- Has the evidence base changed since initiating drug?
- Are any drugs now deemed ‘less suitable’?
- Is dose appropriate? (Over or under-treatment, extreme old age)
- Are other investigations now advised e.g. echocardiography?
What’s ‘A’ in NO TEARS ?
Adverse Events
- Any side effects?
- Any OTC or complementary medicines?
- Check interaction, duplications or contra-indications.
Don’t misinterpret an adverse reaction as a new medical condition
What’s ‘R’ in NO TEARS?
Risk Reduction or Prevention
•Opportunistic screening and risk reduction – are drugs optimized to reduce the risks?
What’s ‘S’ in NO TEARS?
Simplification and Switches
Can treatment be simplified?
Explain any cost effective switches
What should we think of (during meds review) if pt uses PPI? (2)
Can they be stopped/reduced?
- increased risk of GI infection
- risk of fractures in high dose/prolonged use
What should we think of (during meds review) if pt uses quinine?
Can this be stopped? MHRA advice
Adverse effects: retinopathy, thrombocytopenia, tinnitus, lichen planus etc.
