Polypharmacy Flashcards Preview

Geriatrics > Polypharmacy > Flashcards

Flashcards in Polypharmacy Deck (31):
1

Define Polypharmacy

4 or more medications

2

What increases the chance of having an adverse drug event?

The more medications the patient takes

3

Adverse Drug Reaction Events

Falls
Orthostatic hypotension
Heart failure
Delirium
GI bleeding
Intracranial bleeding
Renal failure

4

Most Common Causes of Death from Adverse Drug Reactions

GI bleeding
Intracranial bleeding
Renal failure

5

Problem with Polypharmacy

New prescriptions
Failure to discontinue old prescriptions

6

Most Common Drugs Associated with Adverse Events

Antithrombotics
Antidiabetics
Diuretics
NSAIDs

7

Common Symptoms Secondary to an Adverse Drug Reaction

Falls
Orthostatic hypotension
Heart Failure
Delirium

8

Drug Metabolism & Older Adults: Liver

Hepatic blood flow decreases by 40%
Decreased 1st pass metabolism

9

Drug Metabolism & Older Adults: Kidneys

Renal blood flow decreases by about 1/2 at 80 years old

10

Drug Metabolism & Older Adults

Hepatic
Renal
Decreased lean body weight to fat ratio
Decreased serum protein
Substance abuse

11

Decreased Lean Body Weight to Body Fat Ratio & Drug Metabolism

Alters the distribution of drugs in body compartments

12

Decreased Serum Protein & Drug Metabolism

Protein bound drugs are free to roam around

13

Substance Abuse & Drug Metabolism

10% are problem drinkers

14

Prevention of Hospitalization Due to Drug Reactions

Medication review & reconciliation
Be familiar with Beers criteria

15

What does STOPP stand for?

Screening Tool of Older Persons' potentially inappropriate Prescriptions

16

What does START stand for?

Screening Tool to Alert prescribers to Right Treatment

17

Beers Criteria

2 lists of medication to be avoided in older adults
1 list of medications that should be used with caution

18

Examples of Potentially Inappropriate Medication Use

Nitrofurantoin (Macrobind)
Digoxin in doses >0.125 mcg
Sliding scale insulin
Sulfonylureas
Non-Cox-selective NSAIDs

19

Reasons not to Use Nitrofurantoin in the Elderly

Potential for pulmonary toxicity
Lack of efficacy with CrCl less than 30

20

Reasons not to Use Digoxin in the Elderly

Increased risk of toxicity
Decreased renal clearance
Decreased protein binding

21

Reasons not to Use the Insulin Sliding Scale in the Elderly

High risk of hypoglycemia without improvement of hyperglycemia management

22

Reason not to Use Sulfonylureas in the Elderly

Prolonged hypoglycemia

23

Reasons not to Use Non-Cox-Selective NSAIDs

Increased risk of GI bleeding, PUD
Use of PPI or misoprostol decreases risk

24

Drugs That May Worsen Constipation

Antimuscarinics for urinary incontinence
Non-dihydropyridine CCBs
First generation antihistamines

25

Medications to Use Cautiously in Older Adults Because it can cause SIADH or Exacerbate SIADH

SNRIs
SSRIs
Antipsychotics

26

Inappropriate Drugs in the Elderly

Diphenhydramine (Benadryl)
Amitriptyline (Elavil)
Alprazolam (Xanax)
Diazepam (Valium)
Chlorpropamide & Glyburide
Digoxin in doses >0.125
GI antispasmodics
Merperidine (Demerol)
Methyldopa (Aldomet)

27

Reasons Diphenhydramine is Inappropriate in the Elderly

Dry mouth
Confusion
Urinary retention
Constipation
Source of in-hospital mobility/delirium
In many OTC products

28

Reasons Digoxin is Inappropriate in the Elderly

Anorexia
Confusion
Renal excretion changes over time

29

START Most Common Omissions

Statins
Warfarin
Anti-platelet therapy
Calcium/Vit. D

30

"Choose Wisely" Criteria

Don't use antipsychotics as a 1st choice treatment for dementia
Avoid meds to achieve A1C of less than 7.5%
Don't use benzos or other sedative hypnotics as 1st choice for insomnia, agitation, or delirium
Don't use antimicrobials to treat bacteriuria unless symptoms present
Don't prescribe cholinesterase inhibitors for dementia without assessment for cognitive benefits & adverse GI effects
Avoid using appetite stimulants or high-calorie supplements for anorexia or cachexia
Don't prescribe meds without a med review

31

Reduce Adverse Drug Reactions

Look for meds started at young age that may need to be adjusted
Check dose for chronic therapy after a hospitalization
Avoid adding meds to treat AE's of another med
Capture all herbal & OTC meds
Verify compliance prior to increasing dose
Avoid long term treatment for pain, behavior, & cognition
Start low & go slow
Regular follow up
Avoid starting 2 meds at one time
Incorporate a standardized method for medication review