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Polypharmacy Quiz
Polypharmacy quiz - Hodges
| Question | Answer |
|---|---|
| Elderly patients (EP) are particularly susceptible to polypharmacy issues for 2 reasons: | 1.How aging affects how their body handles meds 2.EPs take more meds |
| In the US, people over 65 make up this % of the population | 13% |
| In the US, EP (Elderly Person/ People) take this % of all RXs written | 30% (and they represent only 13% of the population) |
| At any given time, an EP (is taking how many drugs on average? | 4-5 RXs and 2 OTCs. |
| Medication that is prescribed inappropriately -- | Meds that are unnecessary, ineffective or potentially dangerous. |
| EPs are more likely to be taking a med that is prescribed inappropriately and _____ | suffer an ADE |
| ADE stands for ______ | adverse drug event (ADE) |
| In a study of more than 150K EPs, what % had received an inappropriate drug? | 29 % had gotten prescribed at least 1 of a list of 33 drugs that are not advantageous for EPs. |
| A study of 27,600 Medicare patients found how many ADEs in a year? | More than 1500 ADEs in a single year. |
| Most ADEs are the result of _____ | drug interactions. The more drugs a patient takes, the greater the risk of interactions. |
| Incidence of drug interactions in a patient taking 2 meds/ day | 6% |
| Incidence of drug interactions in a patient taking 5 meds/ day | 50% |
| 3 ways to help EP avoid negative consequences of polypharmacy | 1. Understand how aging affects reactions to drugs 2. Which drugs are the most problematic for EPs 3. How to spot a drug-related problem and intervene |
| Why do EPs take so many meds? | 1.More RXs available to prescribe 2.Once RX, now available OTC 3.Herbal remedies are becoming more popular with EPs. |
| Patients over 65 are more likely to have several chronic disorders. This tends to make them have ______ | several clinicians or health care providers. |
| Having several health care providers causes a problem in that.... | they may prescribe different meds to treat the same problem. |
| Using multiple pharmacies increases or decreases the chance of an ADE? | increases. They can only cross check against the drugs they know about. |
| Prescribing cascade | An EP develops side effects from a med he is taking. The SE is seen as another disease and another RX is prescribed. |
| Pharmocokinetics | What the body does to the drug |
| Pharacodynamics | what the drug does to the body |
| 3 components of pharmacokinetics | Absorption/distribution/clearance |
| Which of the 3 components are affected by aging? | All 3 |
| Which of the 3 components is least affected? | Absorption ~ in particular, oral absorption. It is generally slower but complete. May increase topically. Polypharmacy may impact absorption. |
| What happens to lipid-soluble drugs in the aged? | May stay in body longer as there is more adipose tissue in which it can be distributed. |
| What happens to water-soluble drugs in the aged? | As there is proportionally less water in the body of the aged, blood levels may be higher than expected. |
| How is clearance affected by aging? | There are changes in the liver where drugs are metabolized and in the kidneys where drugs are excreted. |
| As the body ages, blood flow through the liver decreases which can reduce clearance of certain drugs by ___ | 30-40%. Because of this, be careful to closely monitor the patient's labs, particularly liver function tests and creatinine tests(kidney indicator). |
| What is the major enzyme system by which the liver metabolizes drugs? | P450 enzyme system.. This system can be easily overwhelmed in older patients so certain meds are metabolized more slowly or not at all. |
| As a patient reaches age 75, renal clearance of meds can be reduced by___ | up to 50%. |
| Drugs that act on the CNS impact the elderly more or less? Why? | More. Due to changes in the blood brain barrier. |
| What are drug-drug interactions? | Typically occur when a patient takes 2 meds that have different indications but additive pharmacologic effects. Ex: narcotic and anti-diarrheal agent. Both cause constipation. |
| What is drug-disease interaction? | Where a medication exacerbates a disease process. Anticholinergic drugs exacerbate glaucoma, Alzheimers, and BPH. |
| Beers Criteria Syndrome | Developed in 1991, it identified those drugs that are potentially harmful to seniors. |
| Does Beers ban use of drugs? | No, it warns against them. |
| Why does Beers warn against use of certain drugs? | Because they pose a high risk and a safer alternative is available. |
| When taking a drug history, what should you remember to ask? | Include OTC and herbal products as well as drugs. Find out all healthcare providers. Confirm all drugs correct for patient as ordered. |
| What is the brown bag method? Is it effective? | Have all meds brought in to a hospital visit. Yes, it is very effective. Include all products (herbal, meds, vitamins, etc) |
| What % of elderly patients fail to take drugs as instructed? | About 40% |
| If a patient is taking any form of nitrate for heart disease and takes Viagra, what could happen? Besides the erection, that is... | a precipitous drop in blood pressure levels. It is contraindicated. |
| One lab value that indicates how well the kidneys are functioning is the ______ | Creatinine level. Remember thought that creatinine is a byproduct of muscle and, due to loss of lean muscle in aged, use formula to calculate (Cockcroft-Gault)appropriate amount for age, sex, weight. |
| How should you evaluate a new sign or symptom in the elderly? Or change in mental status? | First see if it is an ADE. |
| New or sudden GI distress is often what? | Caused by medication. Most common ADEs are nausea, vomiting, diarrhea, constipation and abdominal pain. |
| Some side effects that elderly are particularly susceptible to... | confusion, blurred vision, dry mouth, lightheadedness, constipation, difficulty with urination or bladder control. |
| Why should you advise your patient only to use 1 pharmacy? | So as to be able to check for drug interactions across all meds. Teach patient about potential side effects. |
| What is the adage about prescribing for the elderly? | Start low and go slow. Doses often must be reduced by 1/3 to 1/2 the recommended adult dose. |
| How should you choose drugs for the elderly? | Drugs that have to be taken 1 or 2 xs a day vs. 3. The fewer drugs, the fewer times, the better. |
| Why should you review the patient's medical record? | To eliminate duplicate or unnecessary drugs. Substitute safer drugs whenever possible. |
| Because aging affects how drugs are cleared by the body, what 2 labs should you monitor closely? | Liver function and kidney function (as reflected in Cockcroft-Gault adjusted creatinine levels). |
Created by:
Marshall3
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