Polypharmacy in Geriatrics Quiz

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Questions and Answers

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?

Toxicology

Pharmacokinetics

Immunology

Pharmacodynamics (correct)

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?

Minimizing the risks associated with polypharmacy Signup and view all the answers

What does the term 'polypharmacy' imply when used negatively?

Overprescribing or overuse of medication in a patient Signup and view all the answers

Which part of prescribing requires understanding the interaction between drugs and the body?

Pharmacodynamics Signup and view all the answers

Why is polypharmacy commonly associated with older adults?

Decreased physiological reserves and altered pharmacokinetics Signup and view all the answers

What are some of the risks associated with polypharmacy in the geriatric population?

Increased falls and cognitive impairment Signup and view all the answers

Which classes of drugs are relatively contraindicated in the geriatric population?

Antidepressants and antipsychotics Signup and view all the answers

How does the term 'polypharmacy' typically relate to the concept of 'good' or 'necessary' medication use?

'Good' or 'necessary' polypharmacy implies judicious medication use Signup and view all the answers

What role do the Beers’ Criteria play in geriatrics regarding medication use?

They outline potentially inappropriate medications for older adults Signup and view all the answers

In pharmacokinetics and pharmacodynamics, which factor is particularly relevant to consider in older patients?

Altered drug absorption and distribution due to aging processes Signup and view all the answers

What is the term used to describe the use of multiple medications, indicated or not, in a patient with multiple medical problems?

Polypharmacy Signup and view all the answers

Which term is used to suggest the overprescribing or overuse of medication in a patient?

Polypharmacy Signup and view all the answers

In the context of geriatrics, what does the term 'polymorbidity' refer to?

The presence of multiple medical problems in a patient Signup and view all the answers

Which term is used to describe the situation where medications are prescribed without a clear indication or need in a patient?

Polyindication Signup and view all the answers

What is the concept of 'polytherapy' in medication management?

The practice of using multiple drugs for a single medical condition Signup and view all the answers

How does 'polyprescribing' differentiate from 'polypharmacy'?

'Polyprescribing' means using multiple medications without clear need, while 'polypharmacy' refers to using several medications for several conditions. Signup and view all the answers

What is a potential consequence of polypharmacy in an older patient?

Increased risk of falls and fractures Signup and view all the answers

In geriatric polypharmacy, what is one of the concerns related to the monetary costs associated with multiple medications?

Potential financial strain on patients Signup and view all the answers

Which factor is important when considering the pharmacokinetics and pharmacodynamics of drugs in older adults?

Delayed elimination of drugs Signup and view all the answers

What makes some drug classes relatively contraindicated in the geriatric population?

Increased risk of adverse events Signup and view all the answers

How does polypharmacy in older patients differ from polypharmacy in younger adults?

Different physiological responses to medications Signup and view all the answers

In the context of geriatric polypharmacy, what is a potential impact of overprescribing or overuse of medications?

Compromised patient safety Signup and view all the answers

What is a key consideration when deprescribing medication in older adults?

Considering potential drug-drug interactions Signup and view all the answers

In the context of geriatrics, what is one reason for underprescribing certain medications for older patients?

Concerns about polypharmacy Signup and view all the answers

What is a significant principle to consider when prescribing for older patients?

Considering the efficacy of the drug in the individual patient Signup and view all the answers

Why is it crucial to consider individualized treatment plans when prescribing for older adults?

To account for variations in drug metabolism and response Signup and view all the answers

What is a common challenge faced when selecting appropriate medications for older patients?

Balancing the risks and benefits of treatment options Signup and view all the answers

What was the potential issue with Volker's insulin dose calculation?

He misinterpreted the sliding scale for glargine insulin Signup and view all the answers

In the context of improving medication adherence, which intervention is highlighted as less effective?

Reminder charts and calendars Signup and view all the answers

What is a key consideration emphasized in the summary regarding appropriate prescribing for older patients?

Preserving function and patient well-being Signup and view all the answers

What is a strategy mentioned to improve adherence by simplifying regimens?

Using medication reviews and counseling Signup and view all the answers

What is advised when adding medications to a multimorbid polypharmacy patient?

Periodically review and reduce medications Signup and view all the answers

Which factor is essential to consider when choosing the correct drug dosage for an older patient?

Age-related pharmacokinetic changes Signup and view all the answers

What is a common reason for underprescribing ACE inhibitors in older patients?

Lack of knowledge about their potential benefits Signup and view all the answers

What is a key principle of prescribing for older patients?

Avoiding sudden changes in the number of medications prescribed Signup and view all the answers

In the context of older patients, why is it recommended to start with a low dose when prescribing medications?

To avoid side effects that may be more pronounced in this population Signup and view all the answers

What is the primary concern addressed by the principle 'start low and go slow' when prescribing for older patients?

Mitigating the risk of adverse effects or reactions Signup and view all the answers

Why is it advised to avoid starting two drugs or making two dosage changes at the same time when prescribing for older patients?

To minimize potential drug interactions Signup and view all the answers

What is the significance of 'achieving balance between over- and underprescribing' in older adults as mentioned in the text?

Balancing potential benefits and risks of therapies Signup and view all the answers

What concept aims to reduce medication-related harm by identifying and avoiding inappropriate medications in older adults?

Beers Criteria Signup and view all the answers

In the context of geriatric pharmacology, what is the primary goal of deprescribing?

Reducing inappropriate medications Signup and view all the answers

Which factor is crucial to consider when optimizing prescribing for older patients to account for physiological changes in aging?

Renal function Signup and view all the answers

Why is age bias in prescribing a significant concern when managing medications for older adults?

It leads to underprescribing essential medications Signup and view all the answers

How does polypharmacy negatively impact the quality of care for older patients?

Increases the risk of adverse drug events Signup and view all the answers

What is a common reason for underprescribing beta-blockers in older patients?

Fear of potential side effects Signup and view all the answers

Why is it important to consider individualized treatment plans when prescribing for older adults?

To account for variations in physiology and comorbidities Signup and view all the answers

What is a significant challenge associated with deprescribing medications in older adults?

Resistance from patients to change their medication regimen Signup and view all the answers

Why are proton-pump inhibitors and misoprostol commonly underprescribed for gastrointestinal protection in older patients?

Concerns about adverse effects such as GI bleeding Signup and view all the answers

What is a common misconception contributing to the underprescribing of bronchodilators in elderly patients with pulmonary conditions?

Assumption that bronchodilators are ineffective in older adults Signup and view all the answers

What is a key principle highlighted to avoid over- or underprescribing of medications for older adults?

Starting with a low dose and titrating up slowly Signup and view all the answers

What is a key principle to consider when prescribing for multimorbid polypharmacy patients?

Starting low and going slow Signup and view all the answers

Which intervention is NOT recommended to improve medication adherence according to the text?

Keeping the pharmacist out of the team Signup and view all the answers

What is emphasized regarding appropriate prescribing for older patients according to the summary?

Choosing the correct dosage of the correct drug Signup and view all the answers

Which factor is essential when considering individualized treatment plans for older adults according to the text?

Preserving function Signup and view all the answers

What role do the Beers Criteria play in geriatrics regarding medication use?

Provide guidance on unnecessary medications for older adults Signup and view all the answers

Why is it crucial to understand drug interactions and disease interactions in older patients' prescriptions?

To reduce ADEs and risks associated with multiple medications Signup and view all the answers

Which factor could contribute to a high rate of nonadherence among older patients?

Asymptomatic disease Signup and view all the answers

What is a common challenge when optimizing prescribing for older adults?

Polypharmacy Signup and view all the answers

Why is it crucial to screen for drug and disease interactions when prescribing for older adults?

To avoid potential adverse effects Signup and view all the answers

What is a key consideration when eliminating unnecessary medications for older patients?

Simplifying dosing regimens Signup and view all the answers

Why is understanding compatibility with the 4Ms important in older adult prescribing?

To enhance therapeutic end points Signup and view all the answers

What is a significant principle when considering if one drug can be used to treat two conditions in older patients?

Balancing benefits and risks Signup and view all the answers

What is the primary intent of the Beers Criteria as discussed in the text?

Improve care by decreasing exposure to PIMs Signup and view all the answers

Which category of drugs is highlighted in the Beers Criteria for being associated with an increased risk of falls in older adults?

Muscle relaxants Signup and view all the answers

What is a common potential adverse effect associated with Insulin and sulfonylureas according to the Beers Criteria?

Hypoglycemia Signup and view all the answers

Which class of drugs is relatively contraindicated due to their anticholinergic effects as per the Beers Criteria?

Non-benzo hypnotics ('z' drugs) Signup and view all the answers

For which category of medications should caution be exercised due to their potential drug-drug interactions in older adults?

Proton pump inhibitors (acid blockers) Signup and view all the answers

Which common category of medications included in the Beers Criteria is associated with cognitive effects and increased risks of falls in older adults?

Antipsychotics Signup and view all the answers

What is a potential consequence of not following the principle 'start low and go slow' when prescribing medications for older adults?

Increased risk of medication-related harm Signup and view all the answers

Why is it crucial to consider physiological changes in aging when optimizing prescribing for older patients?

To adjust drug doses based on renal function changes Signup and view all the answers

Which factor makes the medications listed in the Beers Criteria deemed inappropriate for older adults?

Increased risk of falls Signup and view all the answers

What is a major concern when underprescribing anticoagulants for preventing strokes in older adults?

Elevated risk of blood clots Signup and view all the answers

How does the concept of 'start low and go slow' relate to avoiding medication-related harm for older patients?

It decreases the risk of adverse drug reactions Signup and view all the answers

What is a key reason for underprescribing bronchodilators in older patients with pulmonary conditions according to the text?

Perceived lack of benefit in older adults Signup and view all the answers

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:
1. Drugs to avoid (except if…)
2. Drugs to avoid in specific diseases
3. Drugs to use with caution
4. Drug-drug interactions
5. 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

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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.