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Table. 6.

Table. 6.

Summary of potential prescribing omissions suggested in medication review tools (N=9)

Rationale N
General
Vitamin D supplement in housebound elderly or vitamin D intake <800-1000 IU/day or calcium intake <1000-1200 mg/day. 3
Vaccination: seasonal influenza vaccine, especially for those with respiratory or circulatory disorders. 4
Vaccination: meningococcal vaccine, herpes zoster, tetanus-diphtheria toxoid 1
Vaccination: pneumococcal vaccine 3
Medications or medication category Medications or medication category
Methotrexate Folic acid supplement 3
Opioids Laxatives 2
Aspirin and warfarin H2 receptor antagonist, PPI, gastric acid protection 2
Long-acting opioids Short-acting opioids for breakthrough pain 1
Systemic corticosteroid therapy Bisphosphonates (3), Calcium (1) 3
Long-term NSAIDs PPI 1
Disease or syndrome Medications or medication category
Cardiovascular System
Heart Failure RAS inhibitors (5, ACEI (4), ARB (1)), Beta-blocker (3), Diuretics (2), Spironolactone (1), Sacubitril (1) 5
Atrial fibrillation Frequency-lowering Beta-blocker (1), OACs (1), Coumarin derivatives (1) 3
High blood pressure, Hypertension Antihypertensive therapy (3, ACEI (2)) 3
Coronary artery disease ACEI (1), Statin (2), Antiplatelet (2) 4
Acute coronary syndrome (including post-MI) ACEI 1
Peripheral arterial disease Statin, Antiplatelet therapy (aspirin or clopidogrel or prasugrel or ticagrelor)(2) 2
Atherosclerotic cerebrovascular disease, Stroke Aspirin (100mg/day), Clopidogrel (in case of aspirin intolerance), Statins, rt-PA, Anticoagulants including new oral anticoagulants, Dipyridamole+acetylsalicylic acid 2
Central nervous system
Parkinson's disease/Parkinsonism Dopaminergic agents (2), L-dopa (3), Clozapine (1), Quetiapine (1), MAO-B inhibitor (1), COMT inhibitor (1) 4
Dementia AchE inhibitors for mild or moderate stage of Alzheimer disease (1), Memantine for moderate or advanced stage of Alzheimer disease (1) 3
Anxiety SSRI, SNRI for persistent severe anxiety If SSRI contraindicated: Pregabalin (2) 2
Restless Legs Syndrome Dopamine agonist (1), alpha-2-delta calcium channel blockers (pregabalin, gabapentin) (1) 1
Bipolar disorder Lithium 1
Epilepsy Levetiracetam, Lamotrigine, Gabapentin, Topiramate, Lacosamide, Lorazepam 1
Insomnia / sleep disorders Melatonin (slow release) 1
Major depressive symptoms Antidepressant treatment (3, Non-TCA antidepressants (2, SSRI (1))) 3
Ophthalmic System
Open-angle glaucoma Topical prostaglandin, Topical beta-blockers 1
Respiratory System
COPD Regular β2 agonist Inhaler (2), Long-term administration of oxygen (1), Annual influenza immunizations (1),
Pneumococcal immunizations (1), Antimuscarinic bronchodilator (2),
- Acute exacerbation: Systemic glucocorticoid (1), Antibiotics (acute) (1),
- moderate-severe COPD, where FEV1<50% or repeated exacerbations: inhaled corticosteroid (3)
3
Chronic hypoxemia Home continuous oxygen (2) 2
Endocrine System
Proteinuria, microalbuminuria in diabetes ACEI, ARB (if intolerant of ACEI) 2
Type 2 Diabetes mellitus DPP4 inhibitors (2), Insulin and insulin analogs (if absolutely necessary) (1), Metformin (2), Glucagon-Like Peptide-1 analogs (1), ACEI and if intolerant ARB (1) 2
Hypothyroidism If TSH range remain between 4-8 mU/L: Levothyroxine 1
Gastrointestinal System
Constipation Constipation Fiber supplement, polyethylene glycol 1
Gastro-esophageal reflux disease or Peptic stricture requiring dilatation PPI 1
Nausea and vomiting Metoclopramide (short term use) 1
Urogenital System
Benign prostate hypertrophy, Prostatism Alpha-1 receptor blocker (Silodosin, Tamsulosin, Naftopidil), 5-alpha reductase inhibitor 1
Lower urinary tract symptoms Alpha-1 receptor blocker 1
Symptomatic atrophic vaginitis Topical vaginal estrogen, Vaginal estrogen pessary 1
Incontinence Fesoterodine, Solifenacin 1
Musculoskeletal system
Osteoporosis Vitamin D (4), Calcium+vitamin D (1), Raloxifene (1), Denosumab (3), Bisphosphonates (4) 4
Osteopenia Vitamin D 1
Gout Xanthine-oxidase inhibitors 2
Rheumatoid disease DMARD (2), Methotrexate (1) 2
Falls Vitamin D 1
Fracture Vitamin D (2), Bone anti-resorptive or anabolic therapy (e.g. bisphosphonate, strontium ranelate, teriparatide, denosumab)(1) 2
Various
Anemia Iron, vitamin B12, folic acid (in cases of deficiency), Erythropoietin-stimulating agents 1
Malnutrition Oral nutritional supplements 1
Pressure ulcer Oral nutritional supplements 1
Chronic pain Paracetamol, Opioids (if not controlled) 1

ACEI, Angiotensin Converting Enzyme Inhibitor; AChE, Acetylcholine Esterase; ARB, Angiotensin Receptor Blocker; COMT, Catechol-O-Methyltransferase; COPD, Chronic Obstructive Pulmonary Disease; DPP4, Dipeptidyl Peptidase-4; FEV, Forced Expiratory Volume; MAO, Monoamine Oxidase; MI, Myocardial Infarction; NSAIDs, Non-Steroidal Anti-Inflammatory Drugs; OACs, Oral Anticoagulants; PPI, Proton Pump Inhibitor; RAAS, Renin-Angiotensin Aldosterone System; rt-PA, recombinant tissue Plasminogen Activator; SNRI, Serotonin and Norepinephrine Reuptake Inhibitors; SSRI, Selective Serotonin Receptor Inhibitor; TCA, Tricyclic Antidepressant; TSH, Thyroid Stimulating Hormone

Korean J Clin Pharm 2021;31:61-78 https://doi.org/10.24304/kjcp.2021.31.1.61
© 2021 Korean J Clin Pharm