Podcast
Questions and Answers
What is the primary goal of medication review in the context of older persons?
What is the primary goal of medication review in the context of older persons?
What is the main benefit of using the number-needed-to-treat (NNT) measure in medication review?
What is the main benefit of using the number-needed-to-treat (NNT) measure in medication review?
What is a key consideration when deprescribing medications in patients with multi-morbidity?
What is a key consideration when deprescribing medications in patients with multi-morbidity?
What is the primary purpose of medication reconciliation in the context of medication review?
What is the primary purpose of medication reconciliation in the context of medication review?
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What is a key benefit of using prioritization toolkits in medication review?
What is a key benefit of using prioritization toolkits in medication review?
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What is the main difference between medication optimization and deprescribing?
What is the main difference between medication optimization and deprescribing?
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What is the primary focus of medication optimization, according to the NICE guidelines?
What is the primary focus of medication optimization, according to the NICE guidelines?
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What is the main difference between medication reconciliation and medication review, according to ISMP Canada?
What is the main difference between medication reconciliation and medication review, according to ISMP Canada?
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What is the primary goal of the WHO's Global Patient Safety Challenge: Medication Without Harm?
What is the primary goal of the WHO's Global Patient Safety Challenge: Medication Without Harm?
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What is a key factor contributing to high-risk situations, according to the report?
What is a key factor contributing to high-risk situations, according to the report?
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What is the primary purpose of prioritization toolkits in medication review?
What is the primary purpose of prioritization toolkits in medication review?
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What is a core element of prioritizing patients for medication review?
What is a core element of prioritizing patients for medication review?
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What is the main benefit of using pharmacy prioritization tools in medication review?
What is the main benefit of using pharmacy prioritization tools in medication review?
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What is the acronym used by the Australian Clinical Excellence Commission (CEC) to specify high-risk medications?
What is the acronym used by the Australian Clinical Excellence Commission (CEC) to specify high-risk medications?
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What is the primary focus of medication safety in high-risk situations?
What is the primary focus of medication safety in high-risk situations?
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What is the primary goal of shared decision making in evidence-based medicine?
What is the primary goal of shared decision making in evidence-based medicine?
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What is the primary focus of medication optimization in older persons?
What is the primary focus of medication optimization in older persons?
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Which of the following is a key consideration in the medication review process?
Which of the following is a key consideration in the medication review process?
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What is the primary goal of shared decision-making in medication optimization?
What is the primary goal of shared decision-making in medication optimization?
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Which of the following is a key principle of medication optimization?
Which of the following is a key principle of medication optimization?
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What type of medication is vincristine?
What type of medication is vincristine?
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What is the primary purpose of identifying high-risk medications in medication review?
What is the primary purpose of identifying high-risk medications in medication review?
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Which of the following tools is commonly used in medication review to aid decision-making?
Which of the following tools is commonly used in medication review to aid decision-making?
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Which of the following medications is NOT considered high-risk according to the South Tipperary Enablement Program for Older Persons?
Which of the following medications is NOT considered high-risk according to the South Tipperary Enablement Program for Older Persons?
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What is the primary benefit of using the number-needed-to-harm (NNH) measure in medication review?
What is the primary benefit of using the number-needed-to-harm (NNH) measure in medication review?
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What is the primary purpose of a pharmacy prioritization toolkit?
What is the primary purpose of a pharmacy prioritization toolkit?
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What is the goal of medication optimization?
What is the goal of medication optimization?
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Which of the following is a key consideration when optimizing medications for patients with multi-morbidity?
Which of the following is a key consideration when optimizing medications for patients with multi-morbidity?
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Which of the following is NOT a guiding principle for optimizing medicines suggested by the Royal Pharmaceutical Society?
Which of the following is NOT a guiding principle for optimizing medicines suggested by the Royal Pharmaceutical Society?
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What is the process of accurately listing a person's medications?
What is the process of accurately listing a person's medications?
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What type of medication is hydromorphone?
What type of medication is hydromorphone?
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What is the purpose of using tools like STOPP/START and Beers Criteria?
What is the purpose of using tools like STOPP/START and Beers Criteria?
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Which of the following is a type of anti-infective?
Which of the following is a type of anti-infective?
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What is the purpose of medication review?
What is the purpose of medication review?
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What is the reason for tapering off Duloxetine 60 mg daily?
What is the reason for tapering off Duloxetine 60 mg daily?
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What is the basis for Tanya's new prescription of calcichew?
What is the basis for Tanya's new prescription of calcichew?
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What is the primary indication for Tanya's prescription of denosumab?
What is the primary indication for Tanya's prescription of denosumab?
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What is the reason for stopping Sertraline (Lustral) 100 mg daily?
What is the reason for stopping Sertraline (Lustral) 100 mg daily?
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What is the purpose of the FRAX (Fracture risk assessment) tool?
What is the purpose of the FRAX (Fracture risk assessment) tool?
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Why was the dose of Bumetanide reduced from 2 mg to 1 mg?
Why was the dose of Bumetanide reduced from 2 mg to 1 mg?
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What is the term for the process of tapering, stopping, discontinuing, or withdrawing drugs?
What is the term for the process of tapering, stopping, discontinuing, or withdrawing drugs?
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What is the purpose of the DXA scan?
What is the purpose of the DXA scan?
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What is the reason for stopping Ibuprofen?
What is the reason for stopping Ibuprofen?
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What is the purpose of the number-needed-to-harm (NNH) measure?
What is the purpose of the number-needed-to-harm (NNH) measure?
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What is the primary reason why clinicians often have limited evidence to support the use of preventative medicines in the frail, multi-morbid, and cognitively impaired?
What is the primary reason why clinicians often have limited evidence to support the use of preventative medicines in the frail, multi-morbid, and cognitively impaired?
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What is the primary goal of deprescribing in patients with multi-morbidity?
What is the primary goal of deprescribing in patients with multi-morbidity?
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When is the ideal time to deprescribe in patients with multi-morbidity?
When is the ideal time to deprescribe in patients with multi-morbidity?
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What is the primary benefit of using the NICE Multimorbidity guideline in patients with multi-morbidity?
What is the primary benefit of using the NICE Multimorbidity guideline in patients with multi-morbidity?
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What is the primary consideration when adopting a patient-centered and shared decision-making approach to deprescribing?
What is the primary consideration when adopting a patient-centered and shared decision-making approach to deprescribing?
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What is the primary purpose of using a prioritization toolkit in medication review?
What is the primary purpose of using a prioritization toolkit in medication review?
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What is the primary benefit of reducing the number of medications prescribed in patients with multi-morbidity?
What is the primary benefit of reducing the number of medications prescribed in patients with multi-morbidity?
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What is the primary consideration when considering preventative medicines in patients with multi-morbidity?
What is the primary consideration when considering preventative medicines in patients with multi-morbidity?
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What is the primary purpose of the number-needed-to-harm (NNH) measure?
What is the primary purpose of the number-needed-to-harm (NNH) measure?
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What is the primary challenge in deprescribing in patients with multi-morbidity?
What is the primary challenge in deprescribing in patients with multi-morbidity?
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Study Notes
Medication Review and Optimization
- Medication review is crucial to ensure patients take their medicines as intended, supporting the management of long-term conditions, multimorbidity, and polypharmacy.
- The review process can incorporate medication optimization and deprescribing, with varying levels depending on factors like professional knowledge, time constraints, and objectives.
Principles of Medication Review
- The goal of medication review is to optimize the patient's medication using a patient-centered approach, aiming to achieve the best possible outcomes from their medicines.
Learning Outcomes
- Outline the principles of medication reconciliation and optimization.
- Identify high-risk medication, including those with a high anticholinergic burden.
- Leverage appropriate tools to aid decision-making in the medication review process.
- Explain the value of the number-needed-to-treat (NNT) measure and the number-needed-to-harm (NNH) measure.
- Explain the role of prioritization toolkits in practice.
- Identify deprescribing opportunities in patient care.
- Consider the role of multi-morbidity in the deprescribing process.
Medication Optimization and Review
- Medication review is a structured evaluation of a patient's medicines, which can incorporate medication reconciliation, medication optimization, and/or deprescribing.
- The goal of medication optimization is to achieve the best possible outcomes from the individual patient's medicines.
- The Royal Pharmaceutical Society suggests four guiding principles for optimizing medicines:
- Aim to understand the patient's experience
- Make choices based on evidence
- Make optimization routine in practice
- Ensure medicines are as safe as possible
Medication Reconciliation and Review
- Medication reconciliation is the process of accurately listing a person's medications.
- Medication review is a person-centered approach to safe and effective use of medicines.
- The World Health Organization (WHO) has identified three areas for strong commitment to protect patients from harm while maximizing the benefit from medication:
- Medication safety in transitions of care
- Medication safety in polypharmacy
- Medication safety in high-risk situations
Pharmacy Prioritization Tools
- Pharmacy prioritization tools are used to identify patients who are at a higher risk of adverse drug events or increased risk of medication-related safety issues.
- These tools can help predict clinical risk and target patients who would benefit most from a medication review.
- Examples of high-risk medications include:
- Anti-infectives
- Potassium and other electrolytes
- Insulin
- Narcotics (opioids) and other sedatives
- Chemotherapeutic agents
- Heparin and anticoagulants
Deprescribing
- Deprescribing is the process of tapering, stopping, discontinuing, or withdrawing drugs, with the goal of managing polypharmacy and improving outcomes.
- The ideal time to deprescribe is during a medication review, before a prescribing cascade or ADR occurs.
- Challenges in deprescribing include:
- Fear of adverse withdrawals
- Lack of knowledge around identification of opportunities to deprescribe
- Lack of available resources
- Time constraints
Statistical Measures
- The number-needed-to-treat (NNT) is a measure that indicates how many people need to be treated to result in a beneficial outcome in one person.
- The number-needed-to-harm (NNH) is a measure that indicates how many people need to be exposed to a risk factor over a specific period to cause harm to an average of one person.
Polypharmacy and Multimorbidity
- The NICE Multimorbidity guideline (2016) enables clinicians to stop stringently adhering to all the single disease guidelines that preceded its issuance.
- The guideline aims to help identify when a patient needs management specifically for their multi-morbidity, where broad functional outcomes are usually the major therapeutic goal.
- Single disease guidelines may not apply to the complex needs of an individual patient, especially those who are frail, multi-morbid, and cognitively impaired.
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Description
Medication review is crucial to ensure patients take their medicines as intended, supporting the management of long-term conditions. This quiz covers the principles and processes of medication review and optimization.
