🧵 Reducing #PrescribingCascades ⬇️
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
4/ Anticholinergics ➡️ dyspepsia/reflux (“GERD”) ➡️ #PPIs
#Dyspepsia or heartburn due to delayed gastric emptying can be mistaken for spontaneous #GERD
This association was suggested as possible cascade in a study evaluating longterm Rx of #PPIs
ti.ubc.ca/letter138 #MedEd
5/ Anticholinergics ➡️ constipation ➡️ laxatives
Drug-induced constipation is well recognized, an association confirmed by a 2021 systematic review
👉🏽Full Letter: ti.ubc.ca/letter138
#MedEd #prescribing #medsafety #ptsafety
6/ Calcium channel blockers (CCB) gabapentin/pregabalin ➡️ edema ➡️ diuretics
✅CCB cause dose-dependent edema in up to 30% of older pts
✅Reducing or 🛑 CCB can be preferable to adding furosemide, given multiple #AdverseEffects of loop diuretic
ti.ubc.ca/letter138 #MedEd
7/ Drug-induced movement disorders ➡️ Parkinson's meds 💊
Most #antipsychotics & some #antidepressants block dopamine receptors or cause movement disorders by other means
Such #AdverseEvents can be mistaken for Parkinson's
ti.ubc.ca/letter138 #PrescribingCascades
8/ Drug-induced #HTN ➡️ antihypertensive 💊
About 15% of US adults (19% of ppl w/ HTN) take a drug that can ↗️ blood pressure
#Antidepressants (8.7% of adults) & Rx #NSAIDs (6.5%) were most frequent candidates for under-recognized #prescribing cascades
ti.ubc.ca/letter138
9/ Conclusions
✅Prescribing cascades cause avoidable #polypharmacy & harms
✅Prevent by careful indication-based prescribing & screening for cascades during #MedicationReviews
✅Utilize expert #pharmacist or medical consultation when available
ti.ubc.ca/letter138 #MedEd
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