Polypharmacy Polypharmacy management - medication list, Beers criteria screening, drug interaction checking, anticholinergic burden assessment, and deprescribing planning
分类 金融与投资 Polypharmacy Management Skill
Manage polypharmacy in elderly patients, including medication list management, Beers criteria screening, drug interaction checking, and deprescribing planning.
核心流程
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
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[信息完整]
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生成JSON -> 保存数据 -> 输出确认
步骤 1: 解析用户输入
Operation Type Recognition
Input Keywords Operation Type Description add add_medication Add medication list medication_list
npx skillvault add huifer/huifer-wellally-health-skills-skills-polypharmacy-skill-md
星标 3
更新时间 2026年2月17日
职业 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
用药频次关键词 Input Keywords Frequency Value qd qd bid bid tid tid qid qid qn qn prn prn
相互作用严重程度 Input Keywords Severity major major moderate moderate minor minor
精简行动类型 Input Keywords Action taper taper switch switch discontinue discontinue
步骤 2: 检查信息完整性
Add Medication Required:
Medication name
Dose
Frequency
Interaction Check Required:
Two medication names
Severity
Deprescribe Plan Recommended:
Medication name (optional)
Action type (optional)
步骤 3: 交互式询问（如需要）
Please provide complete medication information:
- Medication name
- Dose (e.g.: 100mg)
- Frequency (qd/bid/tid/qid/qn/prn)
- Indication (optional)
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标准违规记录 {
"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"
}
药物相互作用记录 {
"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"
}
抗胆碱能负荷记录 {
"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"
]
}
精简计划记录 {
"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"
}
步骤 5: 保存数据
读取 data/polypharmacy-management.json
根据操作类型更新相应段
更新统计数据
写回文件
执行指令 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
示例交互
示例 1: 添加用药 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
示例 2: Beers标准筛查 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
示例 3: 药物相互作用检查 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
示例 4: 抗胆碱能负荷评估 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
示例 5: 精简计划 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
医学安全边界
不能做的事:
调整药物剂量或停药
建议具体药物剂量调整
建议自行停药
推荐具体药物品牌
开处方药
能做的事:
用药清单管理
不适当用药筛查（Beers标准）
药物-药物相互作用检查
药物-疾病相互作用检查
抗胆碱能药物负荷评估
用药精简计划建议
用药依从性评估
重要提示:
调整用药需医生评估
系统仅提供筛查和建议
用药调整需医疗专业人员
定期用药审查（每6个月）
02
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Polypharmacy | Skills Pool