Polypharmacy

Question 1

What is polypharmacy?

Answer 1

Concept of inappropriate drug prescription(s) - eg. not indicated, poor interactions, wrong dosages, inappropriate for specific patient.
No cut-off number.

Question 2

What is the ‘prescribing cascade’?

Answer 2

One drug having an effect or side effect that is subsequently treated by prescribing other drug(s).

Question 3

With increasing age, do the follow increase or decrease: total body water, liver/renal blood flow & mass, fat stores.

Answer 3

Body water decreases; liver/renal blood flow & mass decrease; fat stores increase.

Question 4

What are 4 possible negative effects of polypharmacy?

Answer 4

Increased falls risk; over-sedation; coagulation disruption; incontinence; decline in ADLs; cost; failure to prescribe needed medication.

Question 5

Name an important/common side effect of the following drugs: digoxin, thiazide diuretics, loop diuretics, SSRIs.

Answer 5

Digoxin: renal insufficiency
Thiazide: gout
Loop diuretics: dependent ankle oedema
SSRIs: hyponatraemia.

Question 6

What are some important concerns of the following drugs in geriatrics: Tricyclics; benzodiazepines; antipsychotics.

Answer 6

Tricyclics: cognitive impairment, constipation, urinary retention.
Benzo: confusion, impaired balance, falls.
Antipsychotics: extra-pyramidal side effects, parkinsonism.

Question 7

What is Beer’s list/criteria?

Answer 7

List of potentially inappropriate drugs in the elderly / guideline for prescribing in elderly.