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. |