Polypharmacotherapy, specific of geriatrics and geriatric pharmacotherapy - GDKSF15
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Polypharmacotherapy in the old age and risks of multidrug regimens belong to significant clinical phenomena that require specific postgraduate knowledge and skills in the field of clinical pharmacy in geriatrics. The risks and management of polypharmacy have a high impact on the quality of healthcare and healthcare systems. With the ageing of the world population and raising prevalence of polymorbidity, the importance of knowledge and skills regarding clinical principles of the individualization of combined drug regimens in older patients and management of polypharmacy is increasing.
Management of polypharmacy (which is the most frequent phenomena in geriatric patients and particularly in this cohort it contributes to negative outcomes) includes detail knowledge of clinical pharmacy in geriatrics and geriatrics for diagnostics and resolution of specific problems. And, pharmacoepidemiological knowledge on the prevalence, risk factors and negative outcomes of polypharmacy as well.
Therefore, this postgraduate subject is primarily established as a clinical subject that extend the postgraduate knowledge of students in the evaluation and individualization of combined drug regimens with the aim to reduce the risky polypharmacotherapy in older patients (1). It extends the postgraduate knowledge and skills of students necessary for qualified evaluation of benefit and risks of combined drug regimens in geriatric patients with the effort to reduce negative outcomes of polypharmacotherapy. Polypharmacotherapy is the most frequent phenomenon in geriatric patients and in geriatrics has a lot of specific features. For this reason this subject will also emphasize the importance of specific knowledge of geriatrics (2)- specific features of geriatric pharmacotherapy (selection and individualization of drug regimens older age) and how to respect specific geriatric principles of safe and effective drug use of combined drug regimes in older patients. Among other knowledge, the subject emphasize the importance of evidence from epidemiological studies on positive and negative outcomes of reducing polypharmacotherapy in older adults (3), where positive outputs are documented if clinical specialists skilled in geriatrics interventions are involved in medication reviews and geriatric principles are respected.
This postgraduate subject will help to generate postgraduate absolvents experience in major clinical and epidemiological aspects of polypharmacotherapy in geriatric patients having and gain important expertise for future quality medication reviews. Healthcare systems already face to extensive increase in proportion of geriatric patients and overall increase in the prevalence of polypharmacotherapy that need to be appropriately reduced.
Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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The student is oblidged to self-study for the examination from materials given by the guarantor of the subject. The materials will focus on areas that follow the examination questions 1-10. Oral exam: Part I (examination questions): committee will select 2 of 10 questions that the student will have to answer 1/ Physiological changes accompanied ageing of the human body (gastrointestinal tract, heart, kidneys, liver, brain, hormonal system, muscle tissue, skin) 2/ Pharmakokinetic changes of medications in the aged and their linkage to physiological changes accompanied ageing (changes in drug absorption, distribution, biotransfromation and elimination, examples of frequently prescribed medications significantly affected by age-related changes in pharmacokinetics) 3/ Pharmakodynamic changes of medications in geriatric patients and their linkage to physiological changes accompanied ageing (major changes in sensitivity of target sites for medications- receptors, enzymes, channels etc.….and most common changes in pharmacodynamic effect of medications in frequently used drugs) 4/ Geriatric syndromes (excluding frailty and polypharmacy)- definitions, risk factors and major tools used to assess these syndrome (falls; incontinence; cognitive impairment/dementia/delirium; pressure ulcers; manutrition; sarcopenia; mood disorders/depression; dizziness/confusion/vertigo; sleep disorders) 5/ Drug-related geriatric syndromes (all frequently used drugs/drug classes that can worsen above stated geriatric syndromes) 6/ Frailty- definition, major assessment methods, stages, risk factors, consequences, medications contributing to worsening of frailty 7/ Multimorbidity, polypharmacy/hyperpolypharmacy- definitions, prevalence in geriatric patients in different settings of care, assessment, risk factors, consequences, examples of prescribing cascades 8/ Medications potentially inappropriate in the aged. Beers 2023 criteria, EU-7 criteria and STOPP/START criteria- definition, detail knowledge of items stated in these explicite criteria 9/ Medication reviews in geriatric patients- types of medication reviews, characteristics of a comprehensive medication review, implicite review of drug regimen, steps of MAI index (Medication Appropriateness Index) and ability to apply it on a patient case 10/ Population ageing in developed and developing countries: contrbuting factors, consequences, prevalence of patients in different age cathegories in developed and developing countries, economic and social consequences, aspects of ageism
Part II (Patient case solving): Discussion on a geriatric patient case using polypharmacy that will be given to a student by the guarantor of the subject ahead for the preparation for oral examination Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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Obligatory:
Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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Consultation with the course supervisor regarding the materials obtained for studying for the exam, individual arrangements of dates. Course instructor: Course supervisor_ PharmDr. Fialová Daniela, Ph.D. (member of the Clinical and Social Pharmacy Scientific Board, clinical pharmacist in geriatrics, Head of the University Educational Center for Clinical Pharmacy, Faculty of Medicine, Charles University), fialovad@faf.cuni.cz, phone: 00420 731 029 291 Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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Sylabus of the subject (modules of lectures serves also as questions for postgraduate examination): / Physiological changes accompanied ageing of the human body (gastrointestinal tract, heart, kidneys, liver, brain, hormonal system, muscle tissue, skin) 2/ Pharmakokinetic changes of medications in the aged and their linkage to physiological changes accompanied ageing (changes in drug absorption, distribution, biotransfromation and elimination, examples of frequently prescribed medications significantly affected by age-related changes in pharmacokinetics) 3/ Pharmakodynamic changes of medications in geriatric patients and their linkage to physiological changes accompanied ageing (major changes in sensitivity of target sites for medications- receptors, enzymes, channels etc.….and most common changes in pharmacodynamic effect of medications in frequently used drugs) 4/ Geriatric syndromes (excluding frailty and polypharmacy)- definitions, risk factors and major tools used to assess these syndrome (falls; incontinence; cognitive impairment/dementia/delirium; pressure ulcers; manutrition; sarcopenia; mood disorders/depression; dizziness/confusion/vertigo; sleep disorders) 5/ Drug-related geriatric syndromes (all frequently used drugs/drug classes that can worsen above stated geriatric syndromes) 6/ Frailty- definition, major assessment methods, stages, risk factors, consequences, medications contributing to worsening of frailty 7/ Multimorbidity, polypharmacy/hyperpolypharmacy- definitions, prevalence in geriatric patients in different settings of care, assessment, risk factors, consequences, examples of prescribing cascades 8/ Medications potentially inappropriate in the aged. Beers 2023 criteria, EU-7 criteria and STOPP/START criteria- definition, detail knowledge of items stated in these explicite criteria 9/ Medication reviews in geriatric patients- types of medication reviews, characteristics of a comprehensive medication review, implicite review of drug regimen, steps of MAI index (Medication Appropriateness Index) and ability to apply it on a patient case 10/ Population ageing in developed and developing countries: contrbuting factors, consequences, prevalence of patients in different age cathegories in developed and developing countries, economic and social consequences, aspects of ageism Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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Study literature recommended by the guarant of the subject and actually published scientific papers. Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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The subject is appropriate for subcription to those postgraduate students that absolved the subject Clinical pharmacy during pregraduate studies and would like to extend their knowledge and skills during postgraduate studies in Clinical pharmacy in geriatrics and in management of polypharmacy drug regimens in geritric patients. Last update: Fialová Daniela, doc. PharmDr., Ph.D. (30.09.2025)
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