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Medication Appropriateness Index Cheat Sheet by

How to Review Medication Profile
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Drug Regiment Review Checklist

Drug Indica­tions
Does each prescribed medication have a current and valid indica­tion?
Does the resident have conditions or indica­tions for which medica­tions would be approp­riate but are not being used?
Medi­cation Effect­ive­ness
Is the medication approp­riate for the indication being treated?
Is the dose of medication adequate?
Medi­cation Safety
Is the dose of medication excessive?
Is the resident experi­encing signs or symptoms of adverse medication effects?
Is the resident experi­encing a problem resulting from a drug-drug, drug-food, or drug-l­abo­ratory test intera­ction?
Medi­cation Monito­ring
Are monitoring parameters in place to evaluate medication effect­iveness and safety?
Do results of medication monitoring indicate a need for interv­ention?
Medi­cation Errors
Is there evidence of a medication error?
Medi­cation Cost
Do any issues related to medication cost need to be addressed?

Medication Approp­ria­teness Index

1. Is there an indication for the drug?
2. Is the medication effective for the condition?
3. Is the dosage correct?
4. Are the directions correct?
5. Are the directions practical?
6. Are there clinically signif­icant drug-drug intera­ctions?
7. Are there clinically signif­icant drug-d­ise­ase­/co­ndition intera­ctions?
8. Is there unnece­ssary duplic­ation with other drug(s)?
9. Is the duration of therapy accept­able?
10. Is this drug the least expensive altern­ative compared to others of equal utility?
Max Inappr­opr­iat­eness Score

Antich­oli­nergic Burden Scale

Credit: Today's Geriatric Medicine July/A­ugust

Antich­oli­nergic Medica­tions

Antich­oli­nergic drugs block the action of the neurot­ran­smitter acetyl­cho­line. A neurot­ran­smitter is a chemical released by nerve cells to send signals to other cells. Acetyl­choline is used in transm­itting messages that affect muscle contra­ctions in the body, and learning and memory in the brain.

Older people are more sensitive to the antich­oli­nergic effects. Antich­oli­nergic medica­tions are used for a wide range of chronic conditions including urinary incont­inence, hay fever, depres­sion, psychosis, chronic obstru­ctive pulmonary disease (COPD) and Parkin­son’s disease.
Where possible, antich­oli­nergic medicines should be avoided in older people.

Antich­oli­nergic Drugs Typical Use

Drugs with antich­oli­nergic properties have been used for many decades to treat such diverse conditions as:
Overactive bladder and urinary incont­inence
Chronic obstru­ctive pulmonary disease (COPD)
Surgery and anesthesia for muscle relaxation
Motion sickness
Toxicity of certain poisonings
Parkinson’s disease symptoms
Psychiatric disorders

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