Module 5: Polypharmacy & Deprescribing

Question 1

Geriatric Pharmacokinetics

-Clinical considerations

Answer 1

1. Renal Funtion
   - Calculate CrCl — creatinine is produced in skeletal muscle — If patient is frail, creatinine may appear artifically low d/t underproduction
2. Albumin
   - Poor nutrition may result in low albumin — This will impact protein-bound agents

Question 2

ER visits for ADEs

-Most commonly implicated meds in patients 65+

Answer 2

1. Warfarin
2. Insulin
3. Clopidogrel
4. Aspirin
5. Rivaroxaban
6. Lisinopril

Question 3

3 Drug classes implicated in 60% of ED visits for ADEs

Answer 3

1. Anticoagulants
2. Diabetes agents
3. Opiod analgesics

Question 4

Prescribing Cascade

Answer 4

1. Drug 1 — ADE interpreted as new med condition — Drug 2 — ADE interpreted as new med condition — Drug 3

Question 5

Non-Adherence Predictors

Answer 5

1. Asymptomatic disease
2. Inadequate follow-up
3. Patient’s lack of insight of value of treatment
4. Missed appointments/transportation difficulties
5. Poor provider-patient relationship

Question 6

Interventions to improve drug compliance

Answer 6

1. Medication reviews and counseling to identify barriers, simplify regiemns, and provide education is MOST EFFECTIVE
2. Telephone reminders
3. Reminder charts and calandars are LEAST effective
4. Interactive technology to supervise, remind and monitor adherence — Limited analysis
5. Involve a caregiver
6. Utilize a medication tray

Question 7

Deprescribing Definition

Answer 7

1. A Systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits w/in the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences

Question 8

Identifying Medications for Discontinuation

Answer 8

1. Ineffective
2. No current indication
3. Sx’s have resolved
4. Prescribing cascade
5. Unacceptable tx burden and/or risk of harm
6. Unlikely to confer benefit over patient’s lifespan

Question 9

Scott’s Conceptual Framework?

Answer 9

1. Ascertain all drugs the patient is currently taking and reasons for each
2. Consider overall risk of drug-induced harm in indivisdual patients in determining the required intensity of deprescribing intervention
3. Assess each drug for eligibility to be discontinued
4. Prioritize drugs for discontinuation
5. Implement and monitor drug discontinuation regimen