Polypharmacy Workshop

Question 1

SBAR communication tool used for hx taking and consultations, what does it stand for

Answer 1

situation
background
assessment
recommendation

Question 2

s in sbar involves what

Answer 2

identify urself and location
identify px by name and reason for ur call
explain ur concerns

Question 3

b in sbar involves what

Answer 3

give px reason for admission
explain pastmed hx, emds, allergies
relevant investigations

Question 4

a in sbar involves what

Answer 4

most recent obs (vital signs)
clinical impressions and concerns

Question 5

r in sbar involves explaining what

Answer 5

what u need
recommendations

Question 6

what 3 things to check/ assess as part of med review

Answer 6

any presc errors?
are meds prescribed appropriate in view of hx?
any meds u think should be stopped/ started?

Question 7

nitrofurantoin antibiotic avoid if egfr less than what

Answer 7

45

Question 8

can u use nitrofurantoin in egfr 30-44?

Answer 8

yes w caution as a short course only 3-7 days

Question 9

alternative for presc nitrofurantoin for uti

Answer 9

check microbiology results!
trimethoprim 200mg bd 3/7

avoid cephalosporins: risk of antibiotic assoc colitis

Question 10

what should be assessed w fall risk px

Answer 10

hx of falls
- gait, balance, mobility, muscle weakness
- risk of osteoporosis
- perceived func ability/ falling fear
- vision
- cognitive func/ neurological review
- urinary incontinence?
- home hazards
- do CV exam and med review

Question 11

mechanisms by which meds increase fall risk? what ses may increase risk

Answer 11

postural hypotension
sedation/ drowsiness
dizziness
bradycardia, tachycardia

Question 12

how does codeine phosphate inc risk of falls

Answer 12

causes drowsiness which increases risk
can cause constipation

Question 13

what to do in fall risk px on codeine

Answer 13

stop
start paracetamol 500mg qds prn - do not exceed 2g/ 24hrs in px <50kg

Question 14

avoid nsaids why?

Answer 14

cause kidney injury

Question 15

why are antipsychotics other than risperidone contraindicated in dementia px?

Answer 15

increase risk of stroke

Question 16

how can antipsychotics (prochlorperazine, haloperidol) inc risk of falls

Answer 16

can cause sedation

also postural hypotension

Question 17

typical antipsychotics exacerbate what symptoms

Answer 17

parkinsons

Question 18

temazepan has t1/2 5-12hrs, up to 15 hrs in older adults. what can it cause which inc risk of falls

Answer 18

sedation

Question 19

what to consider when stopping benzos eg temazepam due to stroke risk

Answer 19

withdrawal symptoms

Question 20

bisphosph tx for osteoporosis should be re-evaluated periodically based on risk benefit, particularly after X yrs of use

Answer 20

5 or more

Question 21

amitryptyline
haloperidol
prochlorperazine
temazepam
all cause sedation, which ones also cause postural hypo

Answer 21

haloperidol and prochlorperazine

Question 22

drugs with withdrawal potential 5

Answer 22

benzos
bb
centrally acting antihypertensives
clonidine
barbiturates

Question 23

all prescs that are stopped should be X and Y

Answer 23

dated and signed
likewise changes should not be made after first admin - strike out and reqwrite to avoid confusion

Question 24

what things DECREASE with increasing age

… all of which affect pk and pd of meds eg reduce dose of paracetamol, enoxaparin

Answer 24

lean body mass
body water
bone mass
liver enz activity
hepatic blood flow
gfr

Question 25

what increases with inc age, in relation to total body weight

Answer 25

body fat

Question 26

amlodipine and indapamide are what step in antihypertensive tx for over 55

Answer 26

2

Question 27

temazepam cd drug class

Answer 27

cd3

Question 28

what to do about nitrofurantoin if egfr 44?

Answer 28

<45 so switch to alt: trimethoprim or dec dose

Question 29

why would you dec amitryptyline (TCA)

Answer 29

anticholinergic burden
titrate, does have withdrawal effects

Question 30

t/f haloperidol and prochlorperazine inc stroke risk by 3x

Answer 30

true
both have anticholinergic burden
cause sedation, give for anxiety?

Question 31

2 SE risks w alendronic acid

Answer 31

ONJ
atypical femoral fractures