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Summary Question bank of deprescribing

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Deprescribing summary of the lecture

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  • May 13, 2024
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  • 2023/2024
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Deprescribing
What is deprescribing?
- Process of stopping or reducing medicines
- with the aim of eliminating problematic (inappropriate) medicines
- then monitoring the individual for unintended adverse effects
What is problematic polypharmacy?
When multiple medications are prescribed inappropriately, or where the intended benefit of
the medication is not realised
Scenarios where we worry about polypharmacy?

 Prescribing of medicines that are no longer clinically indicated or appropriate or
optimised for that person
 benefit does not outweigh harm
 Where the combination of multiple medicines has the potential to, or is causing
harm to the person
Why does polypharmacy exist? causes?

 Multiple long-term conditions
 Increasing age
 new drugs
 NHS guidance and targets (QOF, NICE quality standards)
 Multiple prescribers
 A “pill for every ill” and psychosocial issues
o e.g., diarrhoea as a side effect of a drug, so add a senna tablet to treat that
etc
o rather than determining the cause of the side effect and finding something
more suitable
 Poor therapeutic goal setting
 Patient or carer demand
Challenges to deprescribing

 Fear of litigation
 Poor evidence for stopping therapy
 Non-adherence – “therapeutic failures”
o keep taking tablets after they are said to deprescribe
 Poor communication and transfer of information
o e.g., between dentist, gynaecologist etc and GP
o takes time to send information
 Poor medication review
 Treating condition vs. person
 Non-pharmacological options not readily available or accessed
o waiting for therapy appointments so tablets restarted
How do we calculate anticholinergic burden?
calculator
possible anticholinergic score 1

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