deprescribing Flashcards
define deprescribing
Deprescribing is synergistic with inappropriate polypharmacy. It is the process of tapering, withdrawing, discontinuing or stopping medicines to reduce potentially problematic
polypharmacy, adverse drug effects and inappropriate or ineffective medicine use
what are the aims of deprescribing?
- Improve quality of life
- Avoid worsening of disease or causing withdrawal effects
- Be effective in reducing pill burden
- To maintain control of chronic conditions
how do you approach de-prescribing?
IMPACT tool
stop/start tool
no tears
7 step apprach
beers criteria
why should we focus on deprescribing?
Preventable hospital admissions
–Patients on 5 or more medications
–Patients over 65 years of age
–50% are preventable
what is the 7 steps medication review?
1- aim
2- need
3- need- does the patient take unncessary drug therapy
4- effectiveness- are the therapeutic objectives being achieved
5-safety
6efficiency
7-patient-centred
what drugs can be disucssed with the patient before stopping?
diuretics- in LVSD
ACEi in LVSD
steroids
hr controlling drugs
what drugs need to be discussed with an expert before altering?
anti-epileptics
antipyschotics
mood stablisers
antidepressants
DMARDs
thyroid hormones
amiodarone
antidiabetics
insulin
what drugs would you possibly check for expired indication?
PPI, Laxutives, antispasmodics, hypnotics, metoclopramide, antifungals, na/k+ supplements
iron supplements
vitamin supplements
calcium/ vit D
NSAIDs
what medication would you check for validation
anticoagulant
aspirin
diuretics
digoxin
quinine
theophylline
TCA
opioids
niturofuratonin
finasteroid
antimuscarinics
what do you take into account for the benefits vs risks?
BP control
statins
corticosteorids
dementia drugs
bisphosphonates
hBA1C control
DMARDs
what are drugs that are poorly tolerated in frail adults?
antipsychotics
NSAIDs
digoxin
anticholinergics
what are the high risk scenarious with drugs?
metformin+ dehydration
ACEI/ARB+DEHYDRATION
diuretics+ dehydration
NSAIDs+ dehydration
NSAID+ACEi+ diuretic
NSAID>75 YRS
NSAID+ history of peptic ulcer
NSAID+ antithrombotic
NSAID+ CHF
glitazone + CHF
TCA+ CHF
warfarin+ macroline/ quinolone
>2 anticholinergics
what is effective for CHD?
Antithrombotic, statins, ACEI/ARB, beta blocker
what is effective for previous stroke/ TIA?
Antithrombotic, statin, ACEI/ARB
what is effective for LVSD?
Diuretic, ACEI/ARB, beta blocker
