Use of medications/Polypharmacy/Practicing safe prescribing

Question 1

What % of acute hospital admissions are due to prescribed meds

Answer 1

10%

Question 2

Reasons for increased risk of ADRs in older people (6)

Answer 2

Impaired cognition 
4 or > comorbidities 
Dependent on living situation 
Impaired renal function 
Non-compliance 
Polypharmacy 
Lack home support

Question 3

Physiological factors –> change in medication amount in gerries bodies (4)

Answer 3

Reduced mm:fat
Reduced hepatic blood flow
Reduced protein (–> incr free Dx)
Reduced renal fct

Question 4

due to changes in pharmacodynamics, which medications are gerries more sensitive to> (4)

Answer 4

Benzos
AntiHTN
TCAs
Warfarin

Question 5

Due to changes in pharmacodynamics, whic meds are gerries less sensitive to

Answer 5

B agonists/blockers

Question 6

How changes in 1st passs metabolism affect gerries

Answer 6

1st pass metabolism = reduced in gerries –> less lost before entering systemic circulation
Increased bioavilability of drug
(e.g. verapamil, propranolol)

Question 7

why should NSAIDs be avoided in gerries

Answer 7

Because can accelerate decline in renal fct

–> tubular ischaemia + retention of H2O + Na

Question 8

E.g.s of high risk NSAIDs in eldery (10)

Answer 8

NSAIDs
Warfarin 
Diuretics
Hypnotics
Anti-HTN
AntiD
AntiP
Digoxin 
Opiates 
vanc/genatmicin

Question 9

Def polypharmacy

Answer 9

Being prescribed > 4 meds

Question 10

What does polypharmacy result in? (4)

Answer 10

Increased risk SE
Increased risk Dx-Dx interactions
Therapeutic cascade
Increased risk of meds not being reviewed thoroughly

Question 11

Def IP (Inappropriate prescribing) (4)

Answer 11

Prescribing Dx = CI
Prescribing Dx w/ inapprop dose or duration
Prescribing Dx that = likely to adversly affect prognosis
Failure to use Dx that could improve pt outcomes

Question 12

Why are IP’s more common in the eldderly pop (3)

Answer 12

Higher prevalence of chronic disease
Higher level polypharmacies
Age-related physiological changes

Question 13

Consequences of inappropriate prescribing (4)

Answer 13

Incr morbidity + mortality
Incr hospital length of stay
Reduced compliance
Incr risk ADRs

Question 14

What are the 5 components of rehab

Answer 14

Physical 
Psychological
Environmental 
Social 
Functions

Question 15

Physical components of rehab

Answer 15

Tx of barriers, information giving and skills training

Question 16

Psychological components of rehab

Answer 16

Encouragement and behaviour changes

Question 17

Environmental components of rehab

Answer 17

Aids
Adaptations
Applications

Question 18

Social components of rehab

Answer 18

Participation + activities

Question 19

Functional components of rehab

Answer 19

Improve balance, mobility and ability to perform ADLs + continence

Question 20

Rehab assessment (5)

Answer 20

What do they want to achieve?
What can they not achieve?
What are the necessary conditions needed to achieve it
What needs to be done, by who and when
Assess –> plan –> do –> review –> reassess

Question 21

Barriers to rehab (10)

Answer 21

Inadequate assessment/planning
Lack resources
Inadequate disability Mx 
Depression 
Cardiac failure + angina
CHx infection/UTI
DVT/PE
Iatrogenic - need med review 
Pain 
Metabolic