Detailed medication history

Question 1

Each medication we prescribe is basically a calculated _____

Answer 1

“poison.”

Question 2

When is it important to obtain a detailed medication history?

Answer 2

At every single visit

Question 3

The 5 Primary Goals of Drug Therapy

Answer 3

○ Alleviate pain, suffering, and disability
○ Improve functional capacity
○ Promote quality of life
○ Prolong life
○ Prevent iatrogenic (caused by medicine) disease

Question 4

Drug ____ should always be on the list of differential diagnoses

Answer 4

adverse effects

Question 5

Things about currently prescribed drugs to ask patients about

Answer 5

■ Formulations (ie. extended-release)
■ Doses
■ Routes of administration (oral, transdermal, PR, etc)
■ Frequencies
■ Duration of treatment

Question 6

When interviewing the patient, be
sure to find out about

Answer 6

○ Currently prescribed drugs
○ Other medications (ie. OTC, herbal)
○ Drugs that have been taken in the recent past.
○ Previous drug hypersensitivity reactions
○ Previous adverse drug reactions
○ Adherence to therapy

Question 7

What do we mean when we say “Polypharmacy”?

Answer 7

The use of 5 or more medications

Question 8

Risk factors for polypharmacy

Answer 8

• Presence of certain disorders (psychiatric, neurologic, medical)

Question 9

Age, race, and gender variables that increase risk of polypharmacy

Answer 9

■ Patients age 65 and older
■ Caucasians
■ African-Americans
■ Females

Question 10

Psychosocial variables that increase risk of polypharmacy

Answer 10

■ Lower socioeconomic class
■ Inner-city residence
■ Lower level of education
■ Unemployment
■ Concealed drug use

Question 11

Risk Factors for Polypharmacy Associated with Aging

Answer 11

○ Multiple medical conditions
○ Multiple medications taken
○ Suboptimal social situation
○ Inability to pay for medication
○ Inability to comply with medication instructions or understand the treatment regimen
○ Cognitive impairment
○ Lack of a primary caregiver
○ Problems with vision or hearing
○ Underrepresentation in studies of new medications
○ Physiologic changes (reduced ability to eliminate medications

Question 12

Causes of polypharmacy

Answer 12

○ Multiple chronic medical problems and vague symptoms.
○ Patient pressure to prescribe (“a pill for every ill”).
○ Susceptibility to product advertisements.
○ Multiple providers of care and lack of coordination.
○ Addition of medications to treat drug related complaints in a “cascading” fashion.
○ Availability of OTC medications and supplements

Question 13

Several factors are associated with increased incident ofMedication-Related Problems

Answer 13

○ Presence of > 6 chronic medical problems
○ > 12 doses of medication/day
○ Use of 9 or more medications
○ Prior adverse reactions
○ Low body weight or body mass index
○ Creatinine clearance < 50 mL/min

Question 14

What is an economic consequence of polypharmacy?

Answer 14

For individuals living on a fixed income or who lack adequate health coverage, the burden of purchasing medications may be significant.

Question 15

Physiologic Consequences of Polypharmacy

Answer 15

○ Loss of functional ability and memory impairment.
○ Drowsiness, loss of coordination, and confusion can lead to falls or automobile accidents.
○ 17% of hospitalizations among seniors are due to adverse medication reactions (a rate that
is 6x that of the general population)

Question 16

What is therapeutic planning?

Answer 16

○ Begins with identification of the actual diagnosis.
○ Consider non-drug treatments instead.
○ Establish a therapeutic goal and a timeline for assessing progress towards that goal.
○ A drug that is not effective should be discontinued promptly

Question 17

Factors to consider when choosing an initial drug

Answer 17

Efficacy, cost, ease of administration, patient’s risk profile, possibility of treating several conditions with one drug

Question 18

Steps to follow once initial drug is chosen

Answer 18

■ “Start low and go slow.”
■ Monitor drug therapy (history, PE, lab tests)
■ Determine if therapeutic goal has been reached.
■ Determine appropriate duration for each medication therapy

Question 19

When prescribing, we should strive for _____

Answer 19

We should strive for “one disease, one drug, once a day.”

Question 20

Importance of OTC medications

Answer 20

OTC supplements are potent drugs that affect prescription therapies and PCP should be consulted before self-prescribing

Question 21

Types of drug non-compliance

Answer 21

○ Omitting doses
○ Adding doses
○ Taking doses at the wrong time
○ Incorrectly administering the medication

Question 22

Ways to maximize comliance

Answer 22

● Simplify the number of medications and doses per day.
● Discuss with the patient whether they can open child-resistant caps.
● Prescribe generics when available. Know the differences in costs between drugs in the same class.
● Provide the patient and family/caregiver with written information/instructions.