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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

Ques­tion
Score
1. Is there an indication for the drug?
3
2. Is the medication effective for the condition?
3
3. Is the dosage correct?
2
4. Are the directions correct?
2
5. Are the directions practical?
2
6. Are there clinically signif­icant drug-drug intera­ctions?
2
7. Are there clinically signif­icant drug-d­ise­ase­/co­ndition intera­ctions?
1
8. Is there unnece­ssary duplic­ation with other drug(s)?
1
9. Is the duration of therapy accept­able?
1
10. Is this drug the least expensive altern­ative compared to others of equal utility?
1
Max Inappr­opr­iat­eness Score
18
 

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:
Diarrhea
Asthma
Overactive bladder and urinary incont­inence
Chronic obstru­ctive pulmonary disease (COPD)
Surgery and anesthesia for muscle relaxation
Insomnia
Motion sickness
Toxicity of certain poisonings
Parkinson’s disease symptoms
Psychiatric disorders

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