Thread by @Drug_Evidence

🧵 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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