This is a graded discussion: 50 points possible
Week 2: Polypharmacy Discussion
Polypharmacy is a common concern, especially in the elderly.
Discussion Guiding Principles
The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of discussions provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the discussion generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. Discussions foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.
Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.
As patients age and develop more chronic conditions, the number of medications tend to increase, making our geriatric clients at high risk for polypharmacy. Polypharmacy, the use of multiple pharmacies (in this case providers and self-prescribers) is a public health concern. Multiple prescribers, use of over-the-counter medications, and readily available supplements are all challenges of prescribing for older adults.
We know that adverse outcomes are increased when patients are taking more medications. Over 2 million adverse drug reactions (ADRs) are estimated yearly at a cost of $136 billion with 350,000 of these occurring in nursing home patients. We also know that ADRs can be reduced by 35% with even the smallest reduction in medications (Sengstock & Zimmerman, 2014).
As our population continue to age, providers need to adopt a process to routinely evaluate medication appropriateness and avoid the risk of polypharmacy.
Ways to prevent polypharmacy: a step wise approach
This medication review has multiple purposes. The interviewer can assess
Ongoing polypharmacy surveillance: Medication Reconciliation
Three available polypharmacy tools you can use to evaluate your patients prescriptions:
STOPP (Payne, 2017) (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions)
MAI (Medication Appropriateness Index)
ARMOR (Assess, Review, Minimize, Optimize, Reassess)
The American Geriatrics Society has developed the Beers Criteria (BC) for healthcare providers to use as a guide for medical management of geriatric patients. The goal of the Beers criteria is to improve quality and safety. The BC is not a substitute for individualized care but should be incorporated into your prescribing practices for elderly patients. Nurse practitioners should become familiar with the lists to avoid prescribing potentially inappropriate medications (PIM).
Why do the elderly need a special criteria?
The changes that occur with aging change the body’s metabolism. This was discussed in last week’s readings. Also think back to your pharmacology class and if needed review pharmacodynamics, especially any changes noted in the elderly. Pharmacokinetics changes too with aging, these include changes in absorption, distribution, metabolism and elimination. Medication half-lives can also be altered, which has an effect on steady state and dosing intervals.
What is the risk for the elderly?
Adverse drug reactions (ADR) are a very real risk for elderly patients.
Potential risk factors for ADRs are:
The medications used most often in the elderly account for 60% of ADRs, often requiring hospital admission. The medication list includes common medications such as antibiotics and antihistamines and well as anticonvulsants, antipsychotics, diuretics, digoxin, hypoglycemic agents, antineoplastic medications, and NSAIDS.
Some 2015 noteworthy changes (Terrery & Nicoteri, 2016) include:
These are some examples of applicable recommendations that you may see in clinical and in future work here in our course. The BC is updated regularly and I recommend that you check for changes yearly to assure your reference is up to date.
Important provider facts:
Responsible prescribing is an important part of the NP role. The Beers Criteria can assist you in determining the safest medications for your geriatric patients.
The iGeriatrics app contains the 2015 Beers Criteria. It is available for purchase from the GeriatricsCareOnline.org Web site (Links to an external site.)
Peripheral vascular disease is an occlusive atherosclerotic process that generally develops in the legs and less commonly in the arms. The pathological process can be diffuse, but the flow limiting stenosis develops segmentally usually in the aortoiliac, femoral popliteal or tibial segment of the aortic system.
The femoral artery is the most commonly occluded artery in peripheral arterial disease (PAD). Pain and circulation in the extremity often often occurs during exercise due to restrictive blood flow and the inability to keep up with the increased oxygen demand. The pathologic process of (PAD) increases with the age of the patient. There are several modifiable risk factors for PAD that may help your patients reduce their risk:
Peripheral Artery Disease (PAD) includes a group of diseases, with atherosclerosis being the most common type (White & Truax, 2007). Based on the pathologic process of PAD, it’s easy to understand the clinical presentation:
Physical exam findings of the patient with PAD may include: