Polypharmacy in Older Adults at Home: What It Is and What To Do About It— Implications for Home Healthcare and Hospice, Part 2
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- Registration deadline is February 28, 2015.
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CE TEST QUESTIONS
GENERAL PURPOSE: To help clinicians identify and reduce the problem of polypharmacy in home healthcare and hospice care.
LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:
- Summarize the relevant information and recommended strategies for identifying polypharmacy, particularly for older adult patients.
- Plan the appropriate strategies for reducing polypharmacy, particularly for older adult patients.
- Polypharmacy is defined as
- filling prescriptions at more than one pharmacy.
- taking over-the-counter medications without consulting a clinician.
- using or prescribing more medications than are clinically indicated.
- taking two medications that are in the same drug classification.
- When using prudent prescribing for a patient who reports a new symptom, the clinician should first ask if
- the medications the patient takes are working well.
- increasing the dosage of current medication might help.
- the patient feels that the symptom warrants a new medication.
- the new symptom could be an adverse effect of the patient's medication.
- The best way to identify all unnecessary medications a patient is taking is to
- perform a thorough medication review and reconciliation.
- use the Beers Criteria to assist with the identification process.
- ask a family member to make a list of the patient's medications.
- use the Screening Tool of Older Persons' Potentially Inappropriate Perscriptions and the Screening Tool to Alert Doctors to Right Treatment criteria to assess the situation.
- According to Yang and colleagues, which is the most effective way to obtain a complete medication list for a patient?
- Asking the patient's primary care provider
- Requesting a report from the patient's pharmacy
- Obtaining medical records from the client's last visit
- Conducting an in-home interview and investigation
- Both Avorn and Sloane emphasized that clinicians should first view symptoms older patients report as
- potential medication side effects.
- new pathophysiological problems.
- a worsening of current symptoms.
- an interaction between two medications.
- Once the problem of polypharmacy is identified, the next step is to
- talk with the patient's family.
- work to remedy the problem.
- suggest replacement medications.
- conduct an assessment of the patient.
- When working with the prescriber on a multiple medication discontinuation plan, the clinician should recommend
- immediately discontinuing all medications the client might not need.
- first eliminating medications unrelated to the symptom.
- using an appropriate sequence for discontinuing medications.
- immediately discarding medications whose risks might outweigh their benefits.
- The last step in the four-step process to discontinuing medications proposed by Bain and colleagues is
- When discontinuing a medication that might possibly cause a return of the symptoms for which it was prescribed, the best approach for the clinician is to
- suggest that the provider prescribe a similar but less potent medication.
- take no specific action and wait to see what the patient reports.
- explain that the patient can try an over-the-counter remedy.
- tell the patient there may be a return of initial symptoms.
- According to the article, which of the following plays an especially important role in the decisions made about discontinuing medications?
- The goals of therapy
- Adherence to the regimen
- The costs of the medications
- Access to a pharmacist
- When a patient is admitted to hospice or consents to a palliative care approach, medications that are used for which of the following purposes are likely to be discontinued?
- Pain management
- Cholesterol control
- Relief from constipation
- Emesis control
- The authors suggest that a good way to partner with a prescriber initially is to identify that you are only one of the many clinicians this patient interacts with and therefore
- might not be speaking with the right person.
- need guidance in working with the patient.
- may not have all the information you need.
- do not understand the patient's drug regimen.
- Discontinuing which type of medication can cause withdrawal symptoms of both anxiety and depression?
- Beta blocker
- Discontinuing which type of medication can cause physiologic withdrawal, exacerbation of the underlying condition, and a new set of symptoms?
- Antiparkinson agent
- Histamine-2 blocker
- Nonsteroidal antiinflammatory drug
- Angiotensin-converting enzyme inhibitor
- Discontinuing which type of medication can cause withdrawal symptoms of abdominal cramping and diarrhea?
- Antiangina agents
- Narcotic analgesics
- Beta blockers
- Alpha-antagonist antihypertensives