Medical Reconciliation Lecture

Interview Questions

-What meds is the patient taking?

-What is the purpose for the medication?

-What is the dosa + how often do you take it?

-What are the side effects? does the patient have any?

-Is the medication effective for it’s purpose?

Common Medication Abbreviations

BID (twice a day) , QID (four times a day), IM (intramuscular), TID (three times a day), IV (intravenous), PRN (As needed)

Medical Reconciliation

formal process of obtaining a complete + accurate list of each patient’s current medications

Toxicity

adverse drug event @ high dose

Teratogenicity

causes fetal damage

Carcinogenicity

causes cancer

Benefit of medications

-resolves issue

-stabilizes disease

-predents disease

risk of medications

-adverse drug reaction

-drug drug interactions

-food drug interactions

-allergic reactions

Side Effects

unintended minor drug effects that are most common

Adverse Drug Reaction

unintended major drug events

Adverse Drug event

negative outcome

Causes of drug reactions

-narrow therapeutic index

-polypharmacy

-noncompliance

-errors in transcribing

-dose emission

Narrow Therapeutic Index

range where issues/toxicity may occur is very small for some drugs

Type A Adverse Drug event

Augmented

dose related

Ex: bleeding w/ anticoagulants

Type B Adverse Drug event

Bizzare

unpredictable, uncommon

Ex: tendon ruptire with cipro

Type C Adverse drug event

Chronic

only occur w/ prolonged period of drug use

Ex: colon issues caused by a laxative

Type D Adverse drug event

Delayed

remote from treatment (years later)

Ex: secondary cancers

Type E Adverse Drug event

End of treatment

when stopped, especially suddenly

Ex: unstable angina w/ abrupt stopping of prednisone (beta blocker)

Type 1 Allergies

Anaphylactic (most severe)

Type 2 Allergies

antigen adheres to target cell

Type 3 Allergies

autoimmune reactions

Type 4 Allergies

cell-mediated hypersensitivity

Drug-Drug interaction

add another drug, causing decreased response/enhanced response

Drug-Food interaction

-change in absorption rate (acidic food/food in stomach)

-Bioavailability changes (grapefruit juice, cabbage, broccoli, vitamin K)

Contraindications of medication use

-kidney disease: do not take meds that affect the kidneys

-aspirin: children d/t Reye’s disease

Beer’s Criteria

criteria intended to be applied to adults 65y/o + older in all ambulatory, acute, and institutionalized settings of care, except hospice + end of life care settings

Dispensing of medications

-medication bottles

-medication/pill box

-bubble packs

Polypharmacy

simultaneous use of multiple drugs for more than one condition

-people 65 years and older > 1/3 presctriptions

-independent risk factor for hip fractures in older adults

Issues with polypharmacy

-multi-morbidity

-adverse drug effects

-drug interactions

-medication non-adherence

-prescribing cascades

-risk of hip fracture

-use of OTC and complementary meds

Polypharmacy: multi-morbidity

leads to an increase in chances of being prescribed multiple medications

Polypharmacy: adverse drug effects

higher in older adults due to metabolic changes + decreased drug clearance w/ age

(increases with increasing # of drugs used)

Polypharmacy: drug interactions

multiple medications increase potential for drug-drug interactions and Rx of potentially inappropriate medications

-CV drugs are most commonly involved

-Neuropsychological, acute renal failure, hypotension are most common

Polypharmacy: medication non-adherence

can lead to problems w/ med adherence, especially w/ visual or cognitive decline

Polypharmacy: prescribing cascades

adding drugs to treat ADE of other drugs by misinterpreting ADE as a new medical conditon

-confusing side effects w/ symptoms of normal aging

Ex: tiredness, decreased alertness, constipation, diarrhea/incontinence, loss of appetite, confusion, falls, etc.

Polypharmacy: risk of hip fracture

independent risk factor for hip fractures in older adults

-# of drugs may be dt higher likelihood of exposure to specific drugs line CNS-active srug associated w/ falls

Polypharmacy: Use of OTC and Complementary Meds

highly prevalent in elderly populations

-<1/2 of patients discuss herbal supplement use w/ providers

-analgestics, laxatives, vitamins, minerals are among the most commonly used OTC med