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Table 1 Definition per category of drug related problems

From: The effect of emergency department pharmacists on drug overuse and drug underuse in patients with an ADE-related hospitalisation: a controlled intervention study

Definition

Example

Drug overuse

 Drug without indication

Using a protonpumpinhibitor with no indication

 Drug dose too high

RAAS-inhibitor dose too high for hypertension in older patient with low blood pressure

 Inappropriate duplication of therapeutic group or active ingredient

Double platelet aggregration inhibitors without indication for double treatment

 Too many drugs prescribed for indication

Four antihypertensive agents while blood pressure is low

Drug underuse

 No drug treatment in spite of existing indication

No laxative agent in combination with chronic opioid treatment

 Drug dose too low

Simvastatin dose is 10 mg once daily while patient has no indication for a low (insufficient) dose

 Duration of treatment too short

Antibiotic prophylaxis treatment is stopped while patient still has high risk of infections

Contraindicated

 Inappropriate drug according to guidelines/formulary

Glimepiride for diabetes mellitus type 2 instead of gliclazide (first choice of sulphonylureaderivative according to national guideline)

 Inappropriate drug (within guidelines but otherwise contra-indicated)

Simvastatin instead of rosuvastatin for patient with non-adherence with evening dose

 Inappropriate combination of drugs

Tramadol in combination with fluoxetine

Other

 Adverse drug reaction

Pulmonary embolism because of olanzapine

 Inappropriate drug form (for this patient)

Tablet too big for patient with swallowing problems

 No or inappropriate outcome monitoring (including therapeutic drug monitoring)

Potassium level too low in patient using high dose of thiazide and no monitoring on electrolytes in the past year.