Special patient groups + poly pharmacy and medicine optimisation

What are the four main Special Patient Groups identified as requiring additional prescribing considerations?

1. Paediatric patients, 2. Pregnant people, 3. Older people, 4. Patients with renal or hepatic impairment.

Why are Special Patient Groups often excluded from clinical trials?

Due to higher risk, the presence of polypharmacy, and multimorbidity.

What are the two key physiological differences in children that affect drug ABSORPTION?

Altered gastric pH (neutral at birth), 2. Reduced intestinal transit time

How does a higher proportion of total body water in infants affect drug dosing?

It increases the Volume of Distribution (Vd) for water-soluble drugs, often requiring a higher mg/kg dose.

When do kidneys typically become functionally mature in a child?

Around 8 years of age.

In pregnancy, what pharmacokinetic changes can lead to LOWER plasma concentrations of a drug?

Increased renal filtration (increasing excretion) and increased blood volume (increasing Vd).

What are three key age-related physiological changes that affect drug metabolism and elimination in older people?

Reduced liver mass/blood flow & CYP450 metabolism, 2. Reduced renal mass/blood flow & eGFR, 3. Reduced albumin production.

Why can delirium and dementia in older people be particularly challenging in medication management?

They can mask or mimic the symptoms of other conditions or adverse drug reactions (ADRs).

Why is predicting drug metabolism specifically challenging in patients with hepatic impairment?

Because there is no simple, reliable equivalent test to eGFR for liver function; its capacity is difficult to quantify.

What is the definition of Multimorbidity?

The presence of two or more long-term health conditions in an individual.

Name three problems associated with multimorbidity for a patient.

Reduced quality of life

high treatment burden

difficulty managing treatments

increased frailty/falls

need for emergency care.

What is the broad definition of Polypharmacy?

The prescribing or taking of multiple medicines.

What is the key difference between Appropriate and Problematic Polypharmacy?

Appropriate is optimised and evidence-based for complex conditions.

Problematic is inappropriate, or the benefits are not realised.

Even in Appropriate Polypharmacy, what risks persist that require monitoring?

Risks of Drug-Drug Interactions (DDIs) and Adverse Drug Reactions (ADRs).

What is the core definition of Medicines Optimisation?

A person-centred approach to safe and effective medicines use, to enable the best possible outcomes.

What are the four core aims of Medicines Optimisation?

1. Understand patient experience, 2. Evidence-based medicine choice, 3. Ensure safe use, 4. Make it routine practice.