EM · Geriatric and medication-safety emergencies

Polypharmacy and adverse drug events

Also known as Polypharmacy in the elderly · Adverse drug event · Adverse drug reaction · Potentially inappropriate medication · Deprescribing · Medication reconciliation · Beers criteria · STOPP and START criteria

Polypharmacy and adverse drug events — the emergency presentation of medication harm in the older patient on five or more regular medicines, driven by the high-risk drug classes (anticoagulants, antiplatelets, insulin, sulfonylureas, opioids, benzodiazepines, antipsychotics, anticholinergics, NSAIDs), the pharmacology of ageing that amplifies each drug's effect, the ADE syndromes (falls, bleeding, hypoglycaemia, delirium, acute kidney injury) mapped to the culprit class, the screening tools (STOPP/START v2 and the 2023 AGS Beers criteria), the best possible medication history and seven-step reconciliation, and the deprescribing ladder (Scott — ascertain indications, weigh harm against benefit, rank, taper and cease with monitoring, document and…