Polypharmacy In Modern Medicine Awareness Required

By Lorena Popp, MD

Astoria Laser Clinic & Med Spa

. http://www.astorialaserclinic.com/

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Polypharmacy In Modern Medicine Awareness Required

Polypharmacy is not a medical diagnosis but rather a risk factor for mortality and morbidity in any patient who takes more than five medications simultaneously, especially medications that are not clinically warranted.

These patients are often 65 years of age or older and can often develop a broad spectrum of symptoms, ranging from general discomfort and malaise to severe cognitive deficits, internal bleeding, respiratory distress, or death.

Adverse polypharmacy outcomes are a major leading cause of mortality in hospitals, not to mention their astronomical health care costs and economical burden to the patients' families.

Is this an epidemic? In the era of multi-specialists, where patients frequently consult one doctor for one specific problem, the medication list grows quite fast.

They could be prescription drugs, over the counter drugs or herbal supplements / vitamins. The general population often tends to underestimate the potential serious side effects of some dietary supplements when mixed with prescription drugs, but their combination can be dangerous.

Patients and families caring for them should always know the purpose of a specific drug, including their side effects and potential interactions with the rest of the medications.

In the geriatric population drugs are to be used much more carefully, simply because of their changed pharmacokinetics and pharmacodynamics. In other words, the absorption, distribution, metabolism and excretion of a drug, along with its physiological effects change significantly based on the person's age, body mass, liver and kidney function, just to mention few parameters.

Polypharmacy often can trigger the feared “prescribing cascade”, a term which refers to the condition when an adverse drug event is not correctly recognized but falsely interpreted as a new condition, for which additional drug therapy will be subscribed to treat this medical condition.

From a primary care doctor's perspective, caring for the elderly patient can be challenging and that's why it is crucial to have one main doctor orchestrating this complex interdisciplinary care, making sure subspecialists send periodic reports and the chain of communication is open.

It is also important to document the response to therapy, as well as a periodical review of the ongoing need for a specific drug therapy, whether scheduled or on a “as needed base”. The patients should get in the habit to ask their providers to assist them with an updated medication list when it seems confusing.

And for the providers caring for nursing home residents, each visit should address the question of how does the patient benefit from this particular drug and which drug could be discontinued.

Polypharmacy awareness will improve patient outcomes and reduce mortality and unnecessary health

care costs.