Polypharmacy and Medicine Management

Question 1

how does increase in body fat mass significant for drug use

Answer 1

increase time to onset of action
prolonged t 1/2 for fat soluble drugs

Question 2

give examples of drugs that are influenced by increased body fat mass

Answer 2

diazepam
verapmil

Question 3

how does decrease in lean body mass and decrease total body water significant for drug use

Answer 3

higher than expected plasma levels of water soluble drugs

Question 4

list drugs affected by decreased in lean body mass and decrease total body water

Answer 4

aspirin
lithium
alcohol

Question 5

how does decrease in renal function water significant for drug use

Answer 5

reduce creatinine clearance and potential accumulation of renally excreted drugs

Question 6

list drugs affected by decrease in renal function

Answer 6

lithium
digoxin

Question 7

how does decrease in liver blood flow and decrease liver function significance for drug use

Answer 7

may lead to decrease metabolism of drugs via Phase I and II metabolic systems
increase bioavailability of first pass effect drugs

Question 8

list drugs affected by decrease in liver blood flow and decrease liver function

Answer 8

warfarin
amiodarone
fentanyl
nitrates
nifedipine
tricyclic antidepressants

Question 9

list the 3 domains potentially inappropriate prescribing

Answer 9

overprescribing
misprescribing
underprescribing

Question 10

age related issued with prescribing in elderly

Answer 10

increased susceptibility to adverse dug effects
cognitive state, nutritional state
number of additional prescribing physicians
unrecorder concomitant use of over the counter medicines

Question 11

what is overprescribing

Answer 11

: the use of drugs where no
clinical indication exists

Question 12

give examples of overprescription

Answer 12

Aspirin with no history of coronary, cerebral or peripheral arterial symptoms or occlusive arterial event
* Loop diuretic as first line for ankle oedema only

Question 13

what is misprescribing

Answer 13

the use of an indicated drug where the risks outweigh the benefits

Question 14

what is underprescribing

Answer 14

the omission of clinically
indicated medicines

Question 15

examples of underprescribing

Answer 15

Omission of:
* Primary treatment e.g. Metformin in diabetes
* Preventative treatment e.g. Bisphosphonate
in chronic steroid use
* Symptomatic treatment e.g. Laxative for
patients taking opioids

Question 16

what is polypharmacy

Answer 16

Polypharmacy usually defined as taking 5 or
more regular medicines

Question 17

how is potentially inappropriate prescribing determined

Answer 17

Explicitly: criteria/indicator-based
* Beers’ criteria
* Screening Tool for Older Persons’
Prescriptions (STOPP)
* Screening Tool to Alert doctors to Right
Treatment (START)

Question 18

what FACTORS must be considered to appropriately prescribe

Answer 18

Medicine factors - adverse effects, dosage, frequency, duration, alternative, dosage form
Patient factors - age, conditions, other medicines, smoker, diet, dysphagia, mobility
Environment factors - setting, medication monitoring, administration

Question 19

what is the definition of medicine management

Answer 19

“The clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimising potential harm”
MUST BE
* Safe, (cost-)effective, clinically indicated,
evidence-based medicines use

Question 20

Components of medicines management

Answer 20

• Effective communication, transcription,
  medicines reconciliation
• Prescribing (+ deprescribing)
• Dispensing
• Medicines storage
• Administration
• Monitoring
• Review
• Medicines disposal

Question 21

checklist for appropriately prescribing an elderly patient

Answer 21

is there a need for pharmacotherapy
is this optimal medicine for the specific clinical diagnosis
will the medicine introduce unnecessary duplication with existing medicines
correct dosage
suitable formulation
acceptable duration of therapy
new medication likely to interact with existing medication
will medicine likely affect concurrent disease
are directions for use correct and feasible

Question 22

what is deprescribing

Answer 22

The planned and supervised process of dose reduction or stopping of medications that may cause harm or are no longer providing benefit

Question 23

when a medical practitioner reviews the medication list every 3 months what medications are especially considered

Answer 23

antipsychotic medication
sleeping tablets and other sedating medication
antiplatelet and anticoagulant medication
non-steroidal anti-inflammatory drugs

Question 24

what are the risks associated with anti psychotic medication

Answer 24

Provide limited benefit to such symptoms,
high potential for harm (stroke, death

Question 25

what are the risks associated with sleeping tablets

Answer 25

Risks of prolonged sedation, confusion,
impaired balance and falls

Question 26

what are the risks associated with antiplatelet/anti-coagulant

Answer 26

Main risk is bleeding/bruising – dose too high?

Question 27

when are NSAIDS contraindicated

Answer 27

Peptic ulcer disease
* Hypertension
* Heart failure
* Renal failure