Deprescribing Flashcards
(27 cards)
What must the medicines optimisation process include?
The notion of stopping medication.
What does the BEST scenario of stopping medication involve?
Identifying the point at which drugs are no longer providing a worthwhile benefit.
What does the WORST scenario of stopping medication involve?
Thoughtless termination of drugs based on arbitrary thresholds such as age.
What is de-prescribing?
A prescribing decision.
What are some barriers to de-prescribing?
Clinical anxieties, easier to leave status quo, drugs started by specialists, patient anxieties, trust in the prescriber, and incentives to prescribe.
What are clinical anxieties regarding de-prescribing?
Concerns about how the patient or family will perceive the decision.
Why might it be easier to leave the status quo?
It can be complex and time-consuming.
What patient anxieties may affect de-prescribing?
Faith in their medications, over-estimating benefits, under-estimating risks, and fear of stopping medications.
What is a common belief patients have regarding prescriptions?
‘Take for the rest of your life.’
What is a challenge regarding guidance on de-prescribing?
There is little guidance available.
In which patients are HARMS more common?
In frail and elderly patients.
What is a common issue with over-rating benefits?
Preventative drugs may no longer be appropriate, and symptomatic drugs may not address current symptoms.
What is a common issue with under-estimating burdens?
Cumulative side effects are more common in old age, worsened by frailty.
What risks are associated with polypharmacy?
Risk of errors and drug interactions.
How can acute illnesses affect medication management?
They alter drug handling and increase risks.
What are sick-day rules?
Medications stopped while patients are unwell.
What acronym can help in medication reviews?
SWAN.
What does the ‘S’ in SWAN stand for?
Safety (renal/falls risk/electrolyte/bleed/C/I?).
What does the ‘W’ in SWAN stand for?
Working well (what is the therapeutic aim?).
What does the ‘A’ in SWAN stand for?
Appropriate (valid and current indication?).
What does the ‘N’ in SWAN stand for?
National guidance (or local guidance).
What should be considered when undertaking medication reviews?
Drugs to be particularly aware of when considering deprescribing.
What is the first stage of the patient centred de-prescribing process?
Complete a comprehensive review of the patient’s medicines—encourage patients to identify medicines that they value and those that they feel may no longer be needed.
What is the second stage of the patient centred de-prescribing process?
Identify potentially inappropriate medicines—consider adherence, outcomes of treatment, pharmacological benefit, risk of adverse drug reactions, risk of drug-drug and drug-disease interactions, and presence of high-risk medicines.
