Week 5 - Deprescribing Flashcards
What is deprescribing and why is it important
Process of stopping or reducing medicines, AIM to eliminate inappropriate polypharmacy
- polypharmacy = multiple medicines
NOTE:
- Shared decision making must take place
- Need to involve pt in the deprescribing decisions
- Would deprescribe if: medicine is causing harm to pt, benefits don’t outweigh risk, no longer clinically required
What are the challenges with deprescribing
- Fear of being sued (by pt)
- Poor communication between HCP and private prescribers
- Poor medication review
- Poor evidence for stopping therapy
- Non-pharmacological option isn’t as readily available
What tools are available to support deprescribing
- NHS, NICE, BNF
- ACB (anticholinergic) calculator and risk scales
- Opioid calculators, reduction templates
How to deprescribe:
(use “NO TEARS” abbreviation)
N - need / indication
O - open questions
T - tests + monitoring
E - evidence + guidelines
A - adverse events
R - risk reduction / prevention
S - simplification
What is the anticholinergic burden (ACB)
Anticholinergics block acetycholine = smooth muscle function is affected
= high risk of falls
Anticholinergics can induce cognitve impairment and early dementia
ACB calculators aim to lower burden
- drugs with possible ACB = score of 1
- drugs with definite ACB = score 2-3
- if on multiple score 2-3 drugs = risk of dementia is high
SYMPTOMS:
- Blurred vision
- Urinary retention
- Constipation
- Dry mouth
ADRs:
- Dry eyes
- Dry mouth
- Drowsiness / Dizziness
- Dilated pupils
- Delirium
- Difficulty urinating
- Decreased sweating
- Falls
- Cognitive impairment
Explain STOMP
Used in autism and learning disabilites
Used to stop psychotropic medication in people with autism / learning disabilites
- usually they are prescribed more antipsychotics than required
- prescribed high doses to sedate / supress their behaviour
- antipsychotics often have bad SE
