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Flashcards in polypharmacy Deck (36):
1

The use of multiple medications which increase the likelihood of being administered an adverse drug which results in unwanted side effects that may include headaches, depression, memory impairment, cognitive decline, and/or death

Polypharmacy

2

The use of multiple medications which increase the likelihood of being administered an adverse drug which results in unwanted side effects that may include

headaches, depression, memory impairment, cognitive decline, and/or death

3

Nearly ___in every ___ older adults receive a medication that they should not have been prescribed

1 in 4

4

Adverse drugs account for up to ___of _______ ______and contribute to

25% of hospital admissions and contribute to prolonged hospital stays

5

1 in ___ older adults die from adverse drugs

14

6

Medication Management Challenges:
• Increased ...
• Lack of ...
• Change in ...
• Increased ...
• The incidence...

Medication Management Challenges
• Increased pace of new drug development
• Lack of physician knowledge regarding polypharmacy5
• Change in drug metabolism with aging
• Increased longevity and likelihood of chronic conditions requiring medication
• The incidence of dementia,

7

incidence of dementia in continuing care facilities

50% in continuing care facilities

8

Commonly used to survey clinical medication use, and evaluate intervention studies to decrease medication problems in older adults

Beers Criteria

9

Beers Criteria
Commonly used to...,
and...to decrease medication problems in older adults

Commonly used to survey clinical medication use,
and evaluate intervention studies to decrease medication problems in older adults

10

Beers Criteria lists...

-medications not to be administered to older adults (e.g. lorazepam)
-inappropriate meds for particular conditions (e.g. cognitive impairment and anticholinergics)

11

Beers Criteria does not assess...

inappropriate dosages,
duration of administration or
adverse interactions of medications

12

Oddie's study examined the relationships among adverse drugs prescribed to community-dwelling older adults...

their health status,
need for assistance with activities of daily living,
and cognitive status

13

Oldies participants were..

n=68, 69% women age 71+/- 9 years, 14 years of ed +/- 3years ed

14

Community procedure included...

Structured interviews, a brief ...survey and cognitive assessments, conducted at participants’ residence or research office

15

The interview and survey examined ...

...demographics, health status, need for assistance with daily living, and a medication inventory

16

cognitive assessments included

-Geriatric Depression Scale,
-RBANS,
-Backward Digit Span,
-Trails A and B,
-NAART,
-Verbal Fluency, and the
-MMSE.

17

RBANS stands for...

repeatable battery for the assessment of neuropsychological Status

18

Collectively, these assessments measured:

Collectively, these assessments
1. visuoconstruction,
2. attention,
3. language, and
4. immediate memory,
5. delayed memory,
6. executive functioning
7. depression

19

Adverse Drug Inclusion Criteria included:
Inappropriate adverse meds prescribed...

1. independent of condition
2.due to condition
3.dosage for older adults
4.duration
5.interactions

20

55% had interactions between drugs-the most prevalent potential adverse effect would be ____________( %) associated with the concomitant use of ______________ drugs or with _______ inhibitors

hyperkalaemia (38%) associated with the concomitant use of potassium-sparing drugs or with ACE inhibitors

21

RESULTS:
Inappropriate Duration ___
Inappropriate Dosage ___
ADI by Condition __
ADI by medication___

Inappropriate Duration 21%
ADI by medication 13%
Inappropriate Dosage 9%
ADI by Condition 2%

22

What percentage was not identified by the Beers list

85%

23

Medication and Likelihood of ADE:
1-5 meds___
6-10 ___
11-13 ___
14-20 ___

1-5 meds +20%
6-10-60%
11-13 - 78%
14-20 - 80%

24

___ of participants were prescribed medication that met criteria, with an average of ___medications taken

54% of participants were prescribed medication that met criteria, with an average of 7.6 medications taken

25

__________ (GABA agonists) were most common adverse
drug identified

Benzodiazepines (GABA agonists) were most common adverse
drug identified

26

Benzodiazepines are _____ _______

GABA AGONISTS

27

Most polypharmacy effects your...

cognitive abilities & motor function

28

Alberta is ____ in quality of health care despite being one of the ...

We are second last in quality of health care offered in Canada despite being one of the biggest spenders

29

When GABA inhibition is lost it contributes to ...

a lot of motor issues.

30

Top 3 adverse drugs were:
33%
18%
14%

33% Benzodiazepines
18% NSAIDS
14%Diuretics, SSRI's

31

Cognitive Decline is likely mediated by... of many adverse drugs primarily in ...

GABA agonist effects of many adverse drugs primarily in cortex and hippocampus

32

____ of community-dwelling older adults were prescribed potentially adverse drugs

1/2

33

Beer’s Criteria identified only ____of adverse drug effects

15%

34

Declining scores on cognitive measures were associated with _______ _______ _________ and not health status of participants

adverse drug identification

35

Estimated that___ experienced ___________ cognitive decline likely preventable with ...

25%, significant decline, likely preventable with intervention strategies

36

Scores on MMSE

did not correlate with adverse drugs suggesting it is not sensitive enough to measure cognitive decline