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Polypharmacy problems Cheat Sheet (DRAFT) by [deleted]

Polypharmacy problems

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Introd­uction: Why It Occurs

Polyph­armacy is very common. Often, seniors or people with many health problems need to take several medica­tions to control multiple medical condit­ions. While these medica­tions, indivi­dually, may be warranted, there are times when the number of drugs prescribed for a given issue is more than is necessary. There are a variety of other reasons polyph­armacy can occur as well, including:

Pres­cribing cascad­es: Having several health condit­ions, you may experience what is described as a "­pre­scr­ibing cascad­e," where you are given a prescr­iption to counteract side effects of another medication or to counteract an intera­ction between two or more other prescribed medica­tions.

Disc­onn­ected medical care: This is more likely to occur if you or your loved one is cared for by several doctors, including specia­lists or physicians who may only see you for a short period of time, such as during an urgent hospit­ali­zation. One doctor may give you a prescr­iption that compounds or counte­racts the effect of a medication you already take, partic­ularly if you are getting care at a different healthcare center than usual.

Pharmacy changes: If you fill your prescr­iptions at multiple pharma­cies, none are likely to have a complete list of your medication regimen (unless you have visited multiple locations of a pharmacy chain). Intera­ctions between medica­tions may go unnoticed when the combin­ation would have raised a red flag if you were getting all of your prescr­iptions from the same place.

Challenges

1. Comorb­idi­ties;
2. Use of more than one prescr­ibing physician and pharmacy;
3. Utiliz­ation of OTC medica­tions, such as dietary supple­ments and herbal remedies that are often not reported to a physician;
4. Difficulty reading and unders­tanding medication instru­ctions;
5. Age-re­lated, physio­logical changes;
6. Over- and under prescr­ibing; and
7. Improper dosing.
The latter two are two of the most critical challenges for polyph­armacy. A 2004 study in the Annals of Internal Medicine showed that the prevalence of omissions of approp­riate medicines was 50%, while the prevalence of admini­stering inappr­opriate medication was only 3%.
 

Polyph­armacy

Reference: Preventing Dangerous Effect of Polyph­armacy
https:­//c­euf­ast.co­m/i­mgs­/ce­ufa­st_­pol­yph­arm­acy.pdf

Dosage Problems

Regarding dosage problems, dosing might be approp­riate at the onset of a condition and change as a patient’s status improves or worsens, or it might be based on inaccurate patient weight. Approp­riate doses for warfarin, for example, could change more than once a week based on a patient’s target INR, a standard for evaluating blood coagul­ation.

Effects

While a drug may be recomm­ended to you because of a specific intended purpose, drugs do not act in isolation in your system. As such, everything you are taking must be considered when making treatment choices.

Poly­pha­rmacy poses several concer­ns:
Excessive known side effects, partic­ularly for the elderly, as sensit­ivities to medication increase with age
Additive side effects when several medica­tions induce similar physical responses
Dangerous drug intera­ctions, which may produce new side effects not typically associated with either medication
Diminished effect­iveness of one medication due to the metabolic action another medication
Confusion with regard to medication use, resulting in missed doses, extra doses, or other errors