Podcast
Questions and Answers
What is polypharmacy referring to in the context of geriatrics?
What is polypharmacy referring to in the context of geriatrics?
- The use of only generic drug names in prescriptions for older adults
- The inappropriate use of multiple medications in a patient (correct)
- The use of over-the-counter medications by geriatric patients
- The exclusive use of brand name medications in older patients
Which concept applies specifically to the relatively contraindicated drug classes in geriatric patients?
Which concept applies specifically to the relatively contraindicated drug classes in geriatric patients?
- Toxicology
- Pharmacokinetics
- Immunology
- Pharmacodynamics (correct)
What are the Beers’ Criteria used for in the context of geriatrics?
What are the Beers’ Criteria used for in the context of geriatrics?
- Diagnosing skin disorders in older adults
- Identifying classes of drugs relatively contraindicated in geriatric patients (correct)
- Prescribing endocrine medications for elderly patients
- Determining neurological side effects of medications in older adults
What is a key objective of prescribing for older patients?
What is a key objective of prescribing for older patients?
What does the term 'polypharmacy' imply when used negatively?
What does the term 'polypharmacy' imply when used negatively?
Which part of prescribing requires understanding the interaction between drugs and the body?
Which part of prescribing requires understanding the interaction between drugs and the body?
Why is polypharmacy commonly associated with older adults?
Why is polypharmacy commonly associated with older adults?
What are some of the risks associated with polypharmacy in the geriatric population?
What are some of the risks associated with polypharmacy in the geriatric population?
Which classes of drugs are relatively contraindicated in the geriatric population?
Which classes of drugs are relatively contraindicated in the geriatric population?
How does the term 'polypharmacy' typically relate to the concept of 'good' or 'necessary' medication use?
How does the term 'polypharmacy' typically relate to the concept of 'good' or 'necessary' medication use?
What role do the Beers’ Criteria play in geriatrics regarding medication use?
What role do the Beers’ Criteria play in geriatrics regarding medication use?
In pharmacokinetics and pharmacodynamics, which factor is particularly relevant to consider in older patients?
In pharmacokinetics and pharmacodynamics, which factor is particularly relevant to consider in older patients?
What is the term used to describe the use of multiple medications, indicated or not, in a patient with multiple medical problems?
What is the term used to describe the use of multiple medications, indicated or not, in a patient with multiple medical problems?
Which term is used to suggest the overprescribing or overuse of medication in a patient?
Which term is used to suggest the overprescribing or overuse of medication in a patient?
In the context of geriatrics, what does the term 'polymorbidity' refer to?
In the context of geriatrics, what does the term 'polymorbidity' refer to?
Which term is used to describe the situation where medications are prescribed without a clear indication or need in a patient?
Which term is used to describe the situation where medications are prescribed without a clear indication or need in a patient?
What is the concept of 'polytherapy' in medication management?
What is the concept of 'polytherapy' in medication management?
How does 'polyprescribing' differentiate from 'polypharmacy'?
How does 'polyprescribing' differentiate from 'polypharmacy'?
What is a potential consequence of polypharmacy in an older patient?
What is a potential consequence of polypharmacy in an older patient?
In geriatric polypharmacy, what is one of the concerns related to the monetary costs associated with multiple medications?
In geriatric polypharmacy, what is one of the concerns related to the monetary costs associated with multiple medications?
Which factor is important when considering the pharmacokinetics and pharmacodynamics of drugs in older adults?
Which factor is important when considering the pharmacokinetics and pharmacodynamics of drugs in older adults?
What makes some drug classes relatively contraindicated in the geriatric population?
What makes some drug classes relatively contraindicated in the geriatric population?
How does polypharmacy in older patients differ from polypharmacy in younger adults?
How does polypharmacy in older patients differ from polypharmacy in younger adults?
In the context of geriatric polypharmacy, what is a potential impact of overprescribing or overuse of medications?
In the context of geriatric polypharmacy, what is a potential impact of overprescribing or overuse of medications?
What is a key consideration when deprescribing medication in older adults?
What is a key consideration when deprescribing medication in older adults?
In the context of geriatrics, what is one reason for underprescribing certain medications for older patients?
In the context of geriatrics, what is one reason for underprescribing certain medications for older patients?
What is a significant principle to consider when prescribing for older patients?
What is a significant principle to consider when prescribing for older patients?
Why is it crucial to consider individualized treatment plans when prescribing for older adults?
Why is it crucial to consider individualized treatment plans when prescribing for older adults?
What is a common challenge faced when selecting appropriate medications for older patients?
What is a common challenge faced when selecting appropriate medications for older patients?
What was the potential issue with Volker's insulin dose calculation?
What was the potential issue with Volker's insulin dose calculation?
In the context of improving medication adherence, which intervention is highlighted as less effective?
In the context of improving medication adherence, which intervention is highlighted as less effective?
What is a key consideration emphasized in the summary regarding appropriate prescribing for older patients?
What is a key consideration emphasized in the summary regarding appropriate prescribing for older patients?
What is a strategy mentioned to improve adherence by simplifying regimens?
What is a strategy mentioned to improve adherence by simplifying regimens?
What is advised when adding medications to a multimorbid polypharmacy patient?
What is advised when adding medications to a multimorbid polypharmacy patient?
Which factor is essential to consider when choosing the correct drug dosage for an older patient?
Which factor is essential to consider when choosing the correct drug dosage for an older patient?
What is a common reason for underprescribing ACE inhibitors in older patients?
What is a common reason for underprescribing ACE inhibitors in older patients?
What is a key principle of prescribing for older patients?
What is a key principle of prescribing for older patients?
In the context of older patients, why is it recommended to start with a low dose when prescribing medications?
In the context of older patients, why is it recommended to start with a low dose when prescribing medications?
What is the primary concern addressed by the principle 'start low and go slow' when prescribing for older patients?
What is the primary concern addressed by the principle 'start low and go slow' when prescribing for older patients?
Why is it advised to avoid starting two drugs or making two dosage changes at the same time when prescribing for older patients?
Why is it advised to avoid starting two drugs or making two dosage changes at the same time when prescribing for older patients?
What is the significance of 'achieving balance between over- and underprescribing' in older adults as mentioned in the text?
What is the significance of 'achieving balance between over- and underprescribing' in older adults as mentioned in the text?
What concept aims to reduce medication-related harm by identifying and avoiding inappropriate medications in older adults?
What concept aims to reduce medication-related harm by identifying and avoiding inappropriate medications in older adults?
In the context of geriatric pharmacology, what is the primary goal of deprescribing?
In the context of geriatric pharmacology, what is the primary goal of deprescribing?
Which factor is crucial to consider when optimizing prescribing for older patients to account for physiological changes in aging?
Which factor is crucial to consider when optimizing prescribing for older patients to account for physiological changes in aging?
Why is age bias in prescribing a significant concern when managing medications for older adults?
Why is age bias in prescribing a significant concern when managing medications for older adults?
How does polypharmacy negatively impact the quality of care for older patients?
How does polypharmacy negatively impact the quality of care for older patients?
What is a common reason for underprescribing beta-blockers in older patients?
What is a common reason for underprescribing beta-blockers in older patients?
Why is it important to consider individualized treatment plans when prescribing for older adults?
Why is it important to consider individualized treatment plans when prescribing for older adults?
What is a significant challenge associated with deprescribing medications in older adults?
What is a significant challenge associated with deprescribing medications in older adults?
Why are proton-pump inhibitors and misoprostol commonly underprescribed for gastrointestinal protection in older patients?
Why are proton-pump inhibitors and misoprostol commonly underprescribed for gastrointestinal protection in older patients?
What is a common misconception contributing to the underprescribing of bronchodilators in elderly patients with pulmonary conditions?
What is a common misconception contributing to the underprescribing of bronchodilators in elderly patients with pulmonary conditions?
What is a key principle highlighted to avoid over- or underprescribing of medications for older adults?
What is a key principle highlighted to avoid over- or underprescribing of medications for older adults?
What is a key principle to consider when prescribing for multimorbid polypharmacy patients?
What is a key principle to consider when prescribing for multimorbid polypharmacy patients?
Which intervention is NOT recommended to improve medication adherence according to the text?
Which intervention is NOT recommended to improve medication adherence according to the text?
What is emphasized regarding appropriate prescribing for older patients according to the summary?
What is emphasized regarding appropriate prescribing for older patients according to the summary?
Which factor is essential when considering individualized treatment plans for older adults according to the text?
Which factor is essential when considering individualized treatment plans for older adults according to the text?
What role do the Beers Criteria play in geriatrics regarding medication use?
What role do the Beers Criteria play in geriatrics regarding medication use?
Why is it crucial to understand drug interactions and disease interactions in older patients' prescriptions?
Why is it crucial to understand drug interactions and disease interactions in older patients' prescriptions?
Which factor could contribute to a high rate of nonadherence among older patients?
Which factor could contribute to a high rate of nonadherence among older patients?
What is a common challenge when optimizing prescribing for older adults?
What is a common challenge when optimizing prescribing for older adults?
Why is it crucial to screen for drug and disease interactions when prescribing for older adults?
Why is it crucial to screen for drug and disease interactions when prescribing for older adults?
What is a key consideration when eliminating unnecessary medications for older patients?
What is a key consideration when eliminating unnecessary medications for older patients?
Why is understanding compatibility with the 4Ms important in older adult prescribing?
Why is understanding compatibility with the 4Ms important in older adult prescribing?
What is a significant principle when considering if one drug can be used to treat two conditions in older patients?
What is a significant principle when considering if one drug can be used to treat two conditions in older patients?
What is the primary intent of the Beers Criteria as discussed in the text?
What is the primary intent of the Beers Criteria as discussed in the text?
Which category of drugs is highlighted in the Beers Criteria for being associated with an increased risk of falls in older adults?
Which category of drugs is highlighted in the Beers Criteria for being associated with an increased risk of falls in older adults?
What is a common potential adverse effect associated with Insulin and sulfonylureas according to the Beers Criteria?
What is a common potential adverse effect associated with Insulin and sulfonylureas according to the Beers Criteria?
Which class of drugs is relatively contraindicated due to their anticholinergic effects as per the Beers Criteria?
Which class of drugs is relatively contraindicated due to their anticholinergic effects as per the Beers Criteria?
For which category of medications should caution be exercised due to their potential drug-drug interactions in older adults?
For which category of medications should caution be exercised due to their potential drug-drug interactions in older adults?
Which common category of medications included in the Beers Criteria is associated with cognitive effects and increased risks of falls in older adults?
Which common category of medications included in the Beers Criteria is associated with cognitive effects and increased risks of falls in older adults?
What is a potential consequence of not following the principle 'start low and go slow' when prescribing medications for older adults?
What is a potential consequence of not following the principle 'start low and go slow' when prescribing medications for older adults?
Why is it crucial to consider physiological changes in aging when optimizing prescribing for older patients?
Why is it crucial to consider physiological changes in aging when optimizing prescribing for older patients?
Which factor makes the medications listed in the Beers Criteria deemed inappropriate for older adults?
Which factor makes the medications listed in the Beers Criteria deemed inappropriate for older adults?
What is a major concern when underprescribing anticoagulants for preventing strokes in older adults?
What is a major concern when underprescribing anticoagulants for preventing strokes in older adults?
How does the concept of 'start low and go slow' relate to avoiding medication-related harm for older patients?
How does the concept of 'start low and go slow' relate to avoiding medication-related harm for older patients?
What is a key reason for underprescribing bronchodilators in older patients with pulmonary conditions according to the text?
What is a key reason for underprescribing bronchodilators in older patients with pulmonary conditions according to the text?
Study Notes
Polypharmacy and Geriatrics
- Polypharmacy is the use of multiple medications, indicated or not, in a patient with multiple medical problems (the multimorbid patient).
- It can also imply the overprescribing or overuse of medication in a patient.
Principles of Prescribing for Older Patients
- Start low and go slow: Start with a low dose and titrate upward slowly as tolerated by the patient.
- Avoid starting two drugs, or making two dosage changes, at the same time.
- Consider whether the medication is necessary and whether the benefits outweigh the risks.
Commonly Overprescribed and Underprescribed Drugs
- Overprescribed: Androgens/testosterone, Anti-infective agents, Anticholinergic agents, Aspirin, etc.
- Underprescribed: ACE inhibitors for patients with diabetes and proteinuria, Anticoagulants, Antihypertensives and diuretics for uncontrolled hypertension, etc.
Beers Criteria
- Intended to improve drug selection and reduce exposure to potentially inappropriate medications in older adults.
- Recommendations are evidence-based and categorized into five categories:
- Drugs to avoid (except if…)
- Drugs to avoid in specific diseases
- Drugs to use with caution
- Drug-drug interactions
- Drugs to avoid in renal failure
Improving Adherence
- Involve a caregiver
- Utilize a medication tray
- Keep the pharmacist in the team
- Medication reviews and counseling to identify barriers, simplify regimens, and provide education
- Telephone call reminders
- Interactive technology to supervise, remind, and monitor drug adherence
Take Home
- Add medications with care
- Start low and go slow
- Periodically review and reduce
- Think globally, use your art and your heart
- Preserve function, use the 4Ms
Importance of Deprescribing
- At least annually, ask the patient to bring in all medications for review (the “brown bag review”).
- Ask about side effects and screen for drug and disease interactions.
- Look for duplicate therapies or pharmacologic effect.
- Eliminate unnecessary medications and simplify dosing regimens.### Beers Criteria Summary
- 10 medications that older adults should avoid due to potential harm
- Overmedication and harmful drug reactions can be avoided by identifying inappropriate medications
Prescribing and Deprescribing
- Nearly 4% of office visits and 10% of hospital admissions result in prescription of potentially inappropriate medications
- Underprescribing can occur due to age bias, resulting in older adults not receiving beneficial therapies
- Importance of preserving function and quality of life by considering what matters to the patient
Commonly Overprescribed Drugs
- Androgens/testosterone
- Anti-infective agents
- Anticholinergic agents
- Aspirin
- Urinary & GI antispasmodics
- Antipsychotics
- Benzodiazepines
- Nonbenzodiazepine hypnotics
- Tricyclic antidepressants
- Digoxin as first-line for AFib or heart failure
- H2 receptor antagonists
- Proton-pump inhibitors
- Insulin, basal/bolus
- NSAIDs
- Sedating antihistamines
- Skeletal muscle relaxants
- Vitamins
Commonly Underprescribed Drugs
- ACE inhibitors for patients with diabetes and proteinuria
- Angiotensin-receptor blockers
- Anticoagulants
- Antihypertensives and diuretics for uncontrolled hypertension
- β-blockers for patients after MI or with heart failure
- Bronchodilators for pulmonary patients
- Proton-pump inhibitors or misoprostol for GI protection from NSAIDs
- Statins
- Vitamin D and calcium for patients with or at risk of osteoporosis
Principles of Prescribing for Older Patients
- Start with a low dose
- Titrate upward slowly as tolerated by the patient
- Avoid starting two drugs, or making two dosage changes, at the same time
- Consider whether the medication is necessary
Studying That Suits You
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Description
Test your knowledge on polypharmacy in geriatrics with this quiz prepared by Dr. Paul B. Volker. The quiz covers important aspects of polypharmacy, generic drug names, and guidelines for prescribing medications in older adults.
