6.1 - Clinical Correlate Week #6 Flashcards
Define Polypharmacy
polypharmacy (pŏl´´ē-făr´mă-sē) [´´ +pharmakon, drug]Concurrent use of a large number of drugs. It increases the likelihood of unwanted side effects and adverse drug-to-drug interactions.
What is a prescribing cascade?
The administration of a new drug to a patient because of side effects produced by another prescription. Later prescriptions increase the risk of further side effects, drug interactions, and patient harm.
Describe the clinical presentation and healthcare burden of Clostridium difficile
Clinical Presentation:
-Clostridium difficile are gram-positive, spore-forming anaerobic bacillus. Clostridium difficile infections occur mostly in those who have had recent medical care and antibiotics (within 2-3 months) and can have symptoms ranging from diarrhea to colitis to perforation to death.
The healthcare burden:
-Clostridium difficile infects 250,000 annually, resulting in 14,000 deaths and $1,000,000,000 (1B) in excess medical costs/year
Fast Facts:
Almost ½ of infections in people < 65
>90% of deaths in people ≥ 65
Resistance to antibiotics to treat C. difficile isn’t problem, but bacteria spreads rapidly because it is naturally resistant to many drugs
Explain how a healthcare provider can help prevent both the spread of Clostridium difficile infections and the spread of resistance.
Fighting spread of resistance:
- Prescribe antibiotics carefully; modify or discontinue based on culture results
- Order a C. difficile test if patient has had 3 or more unformed stools within 24 hours
- Follow infection control recommendations – contact precautions, isolation precautions
Prevention of Spread:
-Wash your hands with soap and water, hand sanitizer will not be effective against Clostridium difficile
**Further C. difficile test information (out of scope):
The C. DIFF QUIK CHEK COMPLETE® test is the only rapid cassette assay that simultaneously detects both glutamate dehydrogenase (GDH) antigen and toxins A & B of C. difficile in fecal specimens. The test detects C. difficile antigen, GDH, as a screen for the presence of C. difficile and confirms the presence of toxigenic C. difficile by detecting toxins A and B in fecal specimens from persons suspected of having C. difficile disease. This test is to be used as an aid in the diagnosis of C. difficile disease.
Define Pharmacology
pharmacology (far´´mă-kol´ŏ-jē) [pharmaco-+-logy] The study of drugs and their origin, nature, properties, and effects upon living organisms. pharmacologic (-kŏ-loj´ik) pharmacological(-kŏ-loj´i-kăl),adj.
This term is usually used to describe taking 4 or more regular medications
Define Prescription Drug
prescription drug: A drug available to the public only upon prescription written by a physician, dentist, or other practitioner licensed to do so.
Define Morbidity
morbidity (mor-bid´ĭt-ē) [L.morbidus, sickly]The state of being diseased.
Define Multimorbidities
Multimorbidities (multiple morbidities) = co-occurring diseases
Define Deconditioning
deconditioning (dē´´kŏn-dĭsh´ŭ-nĭng) A loss of physical fitness due to failure to maintain an optimal level of physical activity or training. Inactivity for any reason may lead to deconditioning. For example, individuals placed on prolonged bedrest may experience overalldeconditioningof the skeletal, muscular, circulatory, and respiratory systems.
Define Defervescence
Defervescence = the abatement of a fever
Define iatrogenesis
iatrogenesis (ī´´a-trō-jen´ĕ-sĭs) [iatro-+genesis] Any injury or illness that occurs because of medical care. Some examples: chemotherapy used to treat cancer may cause nausea, vomiting, hair loss, or depressed white blood cell counts. The use of a Foley catheter for incontinence can create a urinary tract infection and urinary sepsis. In the U.S., 0.67% of patients admitted to a hospital die because of health care associated error.iatrogenic(-jen´ĭk)
Side effect vs. Adverse drug event
Sideeffect An action oreffectof a drug other than that desired. It is commonly an undesirable effectsuch as nausea, headache, insomnia, rash, confusion, dizziness, or an unwanted drug-drug interaction.
Adverse drug event (according to World Health Organization) = unintended and undesired effects of a medication at the normal dose
*In her words, the adverse drug event is unexpected, while the side effect is within the realm of expectation.
Which group of the population is most likely to be affected by polypharmacy?
Old peeps…
> 50 % of all prescription (Rx) medications dispensed to people > 60
90% of noninstitutionalized patients on at least 1 Rx med
Patients seen in office take 6-8 medications
1/6 hospital admissions due to adverse drug event
1/3 hospital admissions in persons >75
Possible treatments for C. Difficile?
Antibiotics
Probiotics, yeast
Fecal transplant for recurrent/resistant infections
