In this episode of the Primary Care Knowledge Boost (PCKB) podcast, doctors Lisa and Sara talk to senior pharmacist, Sarah Hafeez, about Polypharmacy. Sarah explains the difference between inappropriate and appropriate polypharmacy, before talking through some typical cases to illustrate common scenarios.
There is further discussion on prioritising concerns, weaning and/or stopping medications, counselling patients on the effects of opioids and gabapentinoids and involving community teams aiming for successful reduction of addiction forming medications.
The discussion also includes information about the potential long-term risks of proton pump inhibitors and advice on weaning and remembering to consider anticholinergic burdens. Lisa, Sara and Sarah also discuss useful resources for tackling polypharmacy, structured medication reviews and medication reduction.
Listen to the podcast episode at https://pckb.org/e/polypharmacy/
Useful resources:
- Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf
- Scotland Polypharmacy Resources for Professionals and Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/
- Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf
- Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/
- Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf
- An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file
- Canadian Resource for Deprescribing, including reducing medications and some patient information leaflets: https://deprescribing.org/
- Resource for help reducing and stopping medications: https://medstopper.com/
- Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/
- Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full
- Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024: https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793
- Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/
- Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf
