Explore answers to commonly asked questions, and build upon other best practices.
Q: Are there pre-populated recommendations within MedWise™ (MW)?
A: Yes. The five MW pre-populated recommendations are anticholinergic cognitive burden, sedative burden, NSAID, PPI, and CYP2D6 opioid. The only pre-populated recommendation that relates to competitive inhibition is for CYP2D6 opioid. The NSAID and PPI recommendations relate to risks associated with prolonged use.
Q: How will the pre-populated recommendations in MW help me?
A: The pre-populated recommendations are a great guide to help focus on major risk factor points. Always make sure it is appropriate for your patient. For example, MW does not discern oral from topical formulations so the NSAID pre-populated recommendation for NSAIDs is not appropriate for a patient on diclofenac gel. If addressing a CYP2D6 opiate interaction, does this recommendation mitigate the CYP2D6 interaction? What is the PPI treating?
Q: How does MW identify competitive inhibition?
A: The Matrix within MW identifies anything that may be clinically significant. To help you organize within the Matrix, click the enzyme (i.e. 3A4) to group all of the medications with affinity for this enzyme in the column.
Q: Are there descriptions available to explain the competitive inhibition rationale?
A: Yes, click on the medication/substrate in the column for a description of the interaction. You can use the analysis as a guide for your rationale or copy and paste this information to save time.
Q: How does the Matrix inform ways to mitigate competitive inhibition?
A: The Matrix displays the percentage of affinity to each metabolic pathway. Therefore, adjusting the time of a day a patient takes his or her medication to avoid competitive inhibition helps cut back on side effects. Small changes can have big impacts.
Q: Can I use multiple SNOMED codes?
A: There are situations when you can use multiple SNOMED codes. Select the best options that help to tell the story for someone who will only see the SNOMED codes you select and the drugs you tag.
Q: How can I use multiple SNOMED codes?
A: As an example, a patient is taking paroxetine, an inhibitor of CYP2D6, and he or she has a prescription for hydrocodone PRN. The patient reports not having pain relief. However, the patient experiences some drying side effects while taking the paroxetine but the patient’s main concern is to avoid the drug interaction.
In this scenario, the most appropriate option would be to select the MRP category: Adverse Medication Event -> MRP: Adverse drug interaction with drug -> Medication Recommendation Category: Change Medication -> Medication Recommendation: Recommend to change medication.
For medications in question, we would tag paroxetine and hydrocodone/apap.
For recommended medications we would tag hydrocodone/apap along with the alternative antidepressant recommended, for this case we’ll say sertaline. We would tag hydrocodone/apap because on the back end the reader would see that there was a drug interaction between paroxetine and hydrocodone.
To avoid this interaction, we would change the paroxetine to sertraline and the patient could able to continue hydrocodone.
Q: How do I document action steps for the patient in the Medication Action Plan?
A: It is best to keep instructions simple and easy to read. This pattern helps ease documentation:
- Start with what the patient will do (i.e., I will ask my doctor about the risks of taking omeprazole.)
- State why the patient is doing this (i.e., Long-term omeprazole use can increase my risk of bone loss or having a bone break.)
- List the patient’s next steps with doctor (i.e., I will ask my doctor about a plan to stop taking omeprazole.)
- Add additional details/notes if important
Q: What is the most effective way to communicate recommendations to a patient’s prescriber in the Prescriber Action Plan?
A: Since you have been working closely with your prescribers, have fostered relationships with them, and may already have template that you follow, please feel free to use it. If you come across a new situation or find you need support developing this section, you can use these statements:
- Describe the interaction/problem
- Include your recommendation to mitigate
- Relate the situation to information the patient provided during the encounter