Description

A prescribing cascade may be simple and predictable or complex and unrecognized. The latter can be hazardous to the patient.


A prescribing cascade refers to adverse effects from one drug prompting the prescription of a second drug.

 

This is relatively common and straightforward.

 

Baseline Drug and Effect

Downstream drug

diuretic and hypokalemia

potassium replacement

constipation and opioids

laxative

steroids and immuno-suppression

antibiotics

 

This can become a cascade when the second drug creates another adverse effects prompting a third drug, which has adverse effects that prompts and fourth, and so on.

 

Risk factors:

(1) polypharmacy

(2) polyprovider

(3) higher comorbidity

(4) poor clinical documentation of therapeutic indications

 

Hazards:

(1) continued administration of a downstream drug after triggering drug discontinued

(2) acceleration of clinical decline

(3) failure to recognize that abnormal findings are an adverse effect of a drug that is continued rather than adjusted or changed


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