This activity is part of the Frankly Speaking with Dr. Frank Domino podcast series.

Podcast

0.25 CME Credit

New Complaint? Wait! Could It Be a Medication Side Effect? - Frankly Speaking Ep 475Guest: Susan Feeney, DNP, FNP-BC, NP-C
Music Credit: Matthew Bugos

A prescribing cascade occurs when adverse effects of a medication are mistaken for a new condition and treated with additional drugs. Older adults experiencing polypharmacy are most at risk. The impact of prescribing cascades can be substantial, leading to falls, organ injury, unnecessary imaging and tests, and more. Join us as we explore how to recognize and prevent these harmful cascades in your patients.

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CME/CE Information

0.25 AMA PRA Category 1 Credits™

Release Date: 3/9/2026

Expiration Date: 3/9/2028

Topics

Learning Objectives

Define prescribing cascade and polypharmacy
Discuss the relationship between polypharmacy and prescribing cascade
Identify potential prescribing cascades and strategies to avoid creating them

The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Episode references and resource links:

Adrien O, Mohammad AK, Hugtenburg JG, et al. Prescribing cascades with recommendations to prevent or reverse them: a systematic review. Drugs Aging. 2023;40(12):1085-1100. doi:10.1007/s40266-023-01072-yPubMedGoogle ScholarCrossref
Brath H, Mehta N, Savage RD, et al. What is known about preventing, detecting, and reversing prescribing cascades: a scoping review. J Am Geriatr Soc. 2018;66(11):2079-2085. doi:10.1111/jgs.15543PubMedGoogle ScholarCrossref
Daunt R, McGettigan S, Kelly L, Curtin D, O'Mahony D. Detection of Potential Prescribing Cascades in Multimorbid Older Patients Hospitalised with Acute Illness-An Observational Prospective Prevalence Study. Drugs Aging. 2025;42(6):535-546. doi:10.1007/s40266-025-01201-9
Growdon ME, Tjota N, Campbell R, et al. Decision-Making and Downstream Outcomes of the Gabapentinoid-Diuretic Prescribing Cascade. JAMA Netw Open. 2025;8(12):e2545274. doi:10.1001/jamanetworkopen.2025.45274
McCarthy LM, Savage R, Dalton K, et al. ThinkCascades: a tool for identifying clinically important prescribing cascades affecting older people. Drugs Aging. 2022;39(10):829-840. doi:10.1007/s40266-022-00964-9PubMedGoogle ScholarCrossref
O’Mahony, D., Cherubini, A., Guiteras, A.R. et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 14, 625–632 (2023). https://doi.org/10.1007/s41999-023-00777-y
Rochon, P.A., O’Mahony, D., Cherubini, A. et al. International expert panel’s potentially inappropriate prescribing cascades (PIPC) list. Eur Geriatr Med 16, 1573–1584 (2025). https://doi.org/10.1007/s41999-025-01215-x
Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One. 2021;16(8):e0255642. Published 2021 Aug 3. doi:10.1371/journal.pone.0255642

Faculty

Frank J. Domino, MD

Professor, Family Medicine and Community Health,
University of Massachusetts Medical School, Worcester, MA

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Susan Feeney, DNP, FNP, FAANP

Assistant Professor, Family Nurse Practitioner Program Coordinator, Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA

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Disclosures

Frank J. Domino, MD: Has disclosed no relevant financial relationships.

Susan Feeney, DNP, FNP-BC, NP-C: Has disclosed no relevant financial relationships.

Non-faculty contributors involved in the planning, development, editing, and review of the content have disclosed no relevant financial relationships.

CME/CE Information

AMA PRA Category 1 Credits™

Accreditation Statement

Pri-Med Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement

Pri-Med Institute designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Obtaining Credit

For APRNs and PAs, AANPCB and NCCPA accept AMA PRA Category 1 Credit™ as the number of hours of participation (AANPCB) or as Category 1 CME credits (NCCPA).

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