Polypharmacy and deprescribing — structured viva

Structured oral on polypharmacy and deprescribing: prevalence and dose-response risk, cascades, tools as prompts, Scott's algorithm with Reeve's patient-centred cycle, class-specific tapers (benzodiazepines, PPIs), EMPOWER evidence, and goals-of-care framing.

Prompt

The examiner opens: 'Your 88-year-old patient takes fourteen medicines and saw four specialists last year — walk me through what you actually do.' The viva branches through definitions, cascades, tools, process frameworks, tapers and team models.

Stem

You are the GP. An 88-year-old woman takes fourteen regular medicines prescribed by five clinicians; her daughter wants a "full clean-out". ^[4]

References8Show

[1]Hunfeld NG et al. Systematic review: Rebound acid hypersecretion after therapy with proton pump inhibitors. Alimentary pharmacology & therapeutics, 2007.PMID 17229219
[2]Reeve E et al. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Journal of evaluation in clinical practice, 2014.PMID 24661192
[3]Tannenbaum C et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA internal medicine, 2014.PMID 24733354
[4]Scott IA et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 2015.PMID 25798731
[5]Boghossian TA et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. The Cochrane database of systematic reviews, 2017.PMID 28301676
[6]Targownik LE et al. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology, 2022.PMID 35183361
[7]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 2023.PMID 37139824
[8]O'Mahony D et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. European geriatric medicine, 2023.PMID 37256475

Polypharmacy and deprescribing — structured viva

Stem

You are the GP. An 88-year-old woman takes fourteen regular medicines prescribed by five clinicians; her daughter wants a "full clean-out". ^[4]

References8Show

[1]Hunfeld NG et al. Systematic review: Rebound acid hypersecretion after therapy with proton pump inhibitors. Alimentary pharmacology & therapeutics, 2007.PMID 17229219
[2]Reeve E et al. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Journal of evaluation in clinical practice, 2014.PMID 24661192
[3]Tannenbaum C et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA internal medicine, 2014.PMID 24733354
[4]Scott IA et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 2015.PMID 25798731
[5]Boghossian TA et al. Deprescribing versus continuation of chronic proton pump inhibitor use in adults. The Cochrane database of systematic reviews, 2017.PMID 28301676
[6]Targownik LE et al. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology, 2022.PMID 35183361
[7]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 2023.PMID 37139824
[8]O'Mahony D et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. European geriatric medicine, 2023.PMID 37256475