Polypharmacy Management Skill
Manage polypharmacy in elderly patients, including medication list management, Beers criteria screening, drug interaction checking, and deprescribing planning.
Core Process
用户输入 -> 识别操作类型 -> 提取参数信息 -> 检查完整性 -> [需补充] 询问用户
|
[信息完整]
|
生成JSON -> 保存数据 -> 输出确认
Step 1: Parse User Input
Operation Type Recognition
| Input Keywords |
Operation Type |
Description |
| add |
add_medication |
Add medication |
| list |
medication_list |
View medication list |
| beers |
beers_screening |
Beers criteria screening |
| inappropriate |
inappropriate_meds |
View inappropriate medications |
| interaction |
drug_interaction |
Drug interaction check |
| anticholinergic |
anticholinergic_burden |
Anticholinergic burden assessment |
| acb-score |
acb_score |
ACB score |
| deprescribe |
deprescribing_plan |
Deprescribing plan |
| status |
polypharmacy_status |
View polypharmacy status |
| recommendations |
management_recommendations |
View management recommendations |
Medication Frequency Keywords
| Input Keywords |
Frequency Value |
| qd |
qd |
| bid |
bid |
| tid |
tid |
| qid |
qid |
| qn |
qn |
| prn |
prn |
Interaction Severity
| Input Keywords |
Severity |
| major |
major |
| moderate |
moderate |
| minor |
minor |
Deprescribing Action Types
| Input Keywords |
Action |
| taper |
taper |
| switch |
switch |
| discontinue |
discontinue |
Step 2: Check Information Completeness
Add Medication Required:
- Medication name
- Dose
- Frequency
Interaction Check Required:
- Two medication names
- Severity
Deprescribe Plan Recommended:
- Medication name (optional)
- Action type (optional)
Step 3: Interactive Inquiry (if needed)
Scenario A: Adding Medication Incomplete Information
Please provide complete medication information:
- Medication name
- Dose (e.g.: 100mg)
- Frequency (qd/bid/tid/qid/qn/prn)
- Indication (optional)
Scenario B: Interaction Information Missing
Please provide the following information:
- Medication 1 name
- Medication 2 name
- Severity (major/moderate/minor)
- Interaction description (optional)
Scenario C: Deprescribing Medication Inquiry
The following medications may need deprescribing:
1. Diazepam - Beers criteria potentially inappropriate medication
2. Chlorpheniramine - High anticholinergic burden
Which medication would you like to create a deprescribing plan for?
Action options:
- taper (gradual dose reduction)
- switch (switch medication)
- discontinue (stop directly)
## 步骤 4: 生成 JSON
### 用药记录
```json
{
"medication_id": "med_001",
"name": "阿司匹林",
"dosage": "100mg",
"frequency": "qd",
"indication": "心血管保护",
"start_date": "2025-01-01",
"is_appropriate": true,
"beers_criteria": false
}
Beers Criteria Violation Records
{
"medication_id": "med_002",
"medication_name": "地西泮",
"violation_type": "potential_inappropriate",
"severity": "moderate",
"reason": "老年人使用苯二氮卓类增加跌倒和过度镇静风险",
"recommendation": "考虑使用非苯二氮卓类替代",
"alternative": "佐匹克隆、褪黑素"
}
Drug Interaction Records
{
"drug_1": "华法林",
"drug_2": "阿司匹林",
"severity": "moderate",
"interaction_type": "drug_drug",
"description": "增加出血风险",
"management": "密切监测出血迹象，考虑调整剂量",
"clinical_significance": "需要监测"
}
Anticholinergic Burden Records
{
"total_score": 4,
"risk_level": "显著风险",
"contributing_medications": [
{"name": "氯苯那敏", "score": 2},
{"name": "阿米替林", "score": 2}
],
"associated_risks": [
"认知障碍",
"便秘",
"口干",
"尿潴留",
"跌倒风险增加"
]
}
Deprescribing Plan Records
{
"medication_name": "地西泮",
"action": "taper",
"timeline": "4周逐渐减量",
"schedule": [
{"week": 1, "dosage": "5mg qn"},
{"week": 2, "dosage": "2.5mg qn"},
{"week": 3, "dosage": "2.5mg qod"},
{"week": 4, "dosage": "停用"}
],
"monitoring": ["睡眠质量", "焦虑症状", "撤药症状"],
"alternative": "认知行为治疗"
}
For the complete Schema definition, see schema.json。
Step 5: Save Data
- Read
data/polypharmacy-management.json
- Update the corresponding section based on the operation type
- Update statistics
- Write back to file
Execute Instructions
1. 识别操作类型 (add/list/beers/inappropriate/interaction/anticholinergic/deprescribe/status/recommendations)
2. 提取参数信息
3. 检查必填字段完整性
4. 如有缺失，询问用户补充
5. 生成符合 schema.json 的 JSON
6. 保存到 data/polypharmacy-management.json
7. 输出确认信息和医学建议
Example Interactions
Example 1: Add Medication
用户: add 阿司匹林 100mg qd 心血管保护
AI: 已添加用药记录
药物: 阿司匹林
剂量: 100mg
用法: 每天1次
适应症: 心血管保护
Beers标准筛查: 适当
抗胆碱能负荷: 0
当前用药总数: 5种
Example 2: Beers Criteria Screening
用户: beers
AI: Beers标准筛查结果
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
发现2种潜在不适当用药：
1. 地西泮 5mg qn
问题: 苯二氮卓类增加跌倒和过度镇静风险
严重程度: 中度
建议: 考虑使用非苯二氮卓类替代
2. 氯苯那敏 4mg prn
问题: 第一代抗组胺药有抗胆碱能作用
严重程度: 中度
建议: 考虑使用第二代抗组胺药（氯雷他定）
建议与医生讨论用药调整
Example 3: Drug Interaction Check
用户: interaction check
AI: 药物相互作用检查结果
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
发现1个中等严重程度相互作用：
华法林 + 阿司匹林
- 严重程度: 中度
- 影响: 增加出血风险
- 管理: 密切监测出血迹象，定期检查INR
- 临床意义: 需要监测
建议: 告知医生正在同时使用这两种药物
Example 4: Anticholinergic Burden Assessment
用户: anticholinergic
AI: 抗胆碱能负荷评估
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
ACB总分: 4分
风险等级: 显著风险
贡献药物:
- 氯苯那敏 (2分)
- 阿米替林 (2分)
相关风险:
- 认知障碍
- 便秘
- 口干
- 尿潴留
- 跌倒风险增加
建议: 与医生讨论精简高抗胆碱能负荷药物
Example 5: Deprescribing Plan
用户: deprescribe
AI: 用药精简建议
━━━━━━━━━━━━━━━━━━━━━━━━━━━━
候选药物:
1. 地西泮 5mg qn
原因: Beers标准不适当用药
建议: 逐渐减量（4周）
替代: 认知行为治疗、褪黑素
2. 氯苯那敏 4mg prn
原因: 高抗胆碱能负荷
建议: 替换为氯雷他定
替代: 氯雷他定 10mg prn
精简原则:
- 逐步减量避免停药反应
- 监测减药反应
- 定期复查
重要: 任何用药调整前请咨询医生
For more examples, see examples.md。
Medical Safety Boundaries
What cannot be done:
- Adjust medication dosage or discontinue medication
- Recommend specific medication dosage adjustments
- Advise discontinuing medication on one's own
- Recommend specific medication brands
- Prescribe prescription drugs
What can be done:
- Medication list management
- Inappropriate medication screening (Beers Criteria)
- Drug-drug interaction check
- Drug-disease interaction check
- Anticholinergic drug burden assessment
- Deprescribing plan recommendations
- Medication adherence assessment
Important notes:
- Medication adjustments require physician evaluation
- The system only provides screening and recommendations
- Medication adjustments require a medical professional
- Regular medication review (every 6 months)
