Week 7: Polypharmacy

Question 1

What are older populations at risk of with greater medication prescriptions?

Answer 1

Medication interactions
Adverse reactions
Misuse of medications

Question 2

What factors play into misuse of medications?

Answer 2

Lack of skills or foresight on behalf of the nurse of physician, misunderstanding of instructions, inadequate funds to purchase prescriptions

Question 3

What can prescription medications interact with?

Answer 3

Other meds, nutritional supplements, food or alcohol

Question 4

What term refers to the alterations in absorption, distribution, metabolism or excretion of medications that older populations are at higher risk of?

Answer 4

Altered pharmacokinetic activity

Question 5

Alteration due to aging of which organ would greatly affect metabolism of medications?

Answer 5

Liver

Question 6

What organ is greatly responsible for excretion of meds?
How does it change with age?

Answer 6

Kidney
Decreased GFR, decreased cortical volume, decreased tubular secretory function

Question 7

How are pharmacodynamics (interaction between drug and body) affected by age?

Answer 7

Older age increases risk for alteration or unreliable response to medication

Question 8

What is chronopharmacology?

Answer 8

Relationship between biological rhythms and variations in the body’s response to medications
Ex. certain drugs are better absorbed at different times in the day

Question 9

What is the definition of multi morbidity?

Answer 9

the presence of two or more long-term conditions, which are those that cannot currently be cured but can be controlled through medications or other treatments.

Question 10

What complications are linked to multi morbidity?

Answer 10

Functional decline, poorer quality of life, greater hospitalization, increased mortality, cognitive impairment

Question 11

Define polypharmacy

Answer 11

concomitant use of 5 or more medications. Ranges in prevalence, but prevalence is shown to increase in older adults. Also defined as the use of more drugs than clinically indicated.

Question 12

What clinical outcomes are associated with polypharmacy?

Answer 12

Frailty, death, hospitalization, falls, cognitive impairment, physical impairment

Question 13

What is a prescription cascade?

Answer 13

When an adverse drug reaction is misinterpreted as a new medical condition leading to additional medication prescriptions to treat it

Question 14

What is deprescribing?

Answer 14

Process of medication removal or reduction

Question 15

What are some triggers for deprescribing?

Answer 15

Polypharmacy, adverse drug reactions, at end of life/palliative care, prescription cascades

Question 16

What tool can be used to assess for potentially problematic medications for older adults?

Answer 16

Beers Criteria - evidence-based, expert consensus list of medications that are often inappropriate in older adults due to excess risk of harms and/or limited benefits in this population

Question 17

What are the nursing implications for pt teaching regarding prescriptions with older adults?

Answer 17

Exercise pts right to question/pt control
Know medication effects and alternatives available
Supply pamphlets in lay terms in readable print
Evaluate teaching (teach back, ask questions)

Question 18

What should the nurse question when assessing medication adherence?

Answer 18

Ask the person how they actually take the medicine instead of relying on label/prescription

Question 19

What are some high risk medications outlined by BEERS criteria?

Answer 19

Opioids, diuretics, anticholinergics, CNS depressants, anti diabetics