Polypharmacy Assessment & Reduction Flashcards
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Read the first 7 Polypharmacy Assessment & Reduction flashcards as text
A pharmacy team is designing a polypharmacy reduction program for a long-term care facility. Which metric BEST measures the program's effectiveness over time?
Answer: Mean number of medications per resident and rate of adverse drug events
Tracking both the mean medication count and adverse drug event rates provides outcome data reflecting both process and safety improvements.
A 68-year-old patient with COPD is taking tiotropium, salmeterol/fluticasone, and albuterol PRN. The physician also prescribes ipratropium. Which pharmacist recommendation is MOST appropriate?
Answer: Recommend discontinuing ipratropium since tiotropium provides equivalent long-acting anticholinergic coverage
Tiotropium is a long-acting muscarinic antagonist (LAMA) that duplicates the mechanism of ipratropium (short-acting anticholinergic), making concurrent use therapeutic duplication.
Which scenario BEST represents 'problematic polypharmacy' as distinguished from 'appropriate polypharmacy'?
Answer: A patient taking 3 medications for a single condition with one providing no measurable benefit
Problematic polypharmacy occurs when medications lack evidence of benefit, have no clear indication, or the risk-benefit ratio is unfavorable, regardless of the total number.
A pharmacist is reviewing a patient who takes zolpidem 10 mg nightly for chronic insomnia. Per the Beers Criteria, what is the MOST appropriate recommendation?
Answer: Recommend cognitive behavioral therapy for insomnia (CBT-I) as first-line and begin a gradual taper of zolpidem
Benzodiazepine receptor agonists like zolpidem are listed in the Beers Criteria as potentially inappropriate in older adults due to fall and cognitive risks; CBT-I is the evidence-based first-line treatment.
When prioritizing which medications to deprescribe first, which framework helps pharmacists rank medications by patient-specific risk and benefit?
Answer: The GoodPalliativeCare.org.au deprescribing algorithm considering time-to-benefit and life expectancy
Deprescribing frameworks that consider time-to-benefit relative to patient life expectancy help prioritize which medications to discontinue in patients with limited life expectancy.
A pharmacist identifies that a 70-year-old patient's nausea and confusion began shortly after metoclopramide was added for gastroparesis. This presentation MOST likely represents which adverse effect?
Answer: Extrapyramidal effects including tardive dyskinesia risk with long-term use
Metoclopramide blocks dopamine receptors and can cause extrapyramidal symptoms; the Beers Criteria recommends avoiding it in older adults due to risk of tardive dyskinesia.
In the context of polypharmacy in older adults, what does the term 'drug burden index' (DBI) measure?
Answer: Cumulative exposure to medications with anticholinergic and sedative properties
The Drug Burden Index quantifies a patient's cumulative exposure to drugs with anticholinergic and sedative effects, which correlate with functional impairment in older adults.