Yelisa Rivero

Florida National University

NGR 6172: Advanced Pharmacology

September 22, 2021

Polypharmacy

                      Polypharmacy is primarily common among older patients due to their susceptibility to diseases and younger at-risk populace. However, some risk factors lead to polypharmacy. A patient with numerous medical conditions resulting in management from different subspecialist medical practitioners is one of the risk factors for polypharmacy. It is rational for medical personnel to administer effective medication to treat a specific sickness; hence each practitioner will prescribe the suitable medicine for the patient having multiple medical conditions, resulting in more than five medications. Additionally, patients living in long-term medical facilities are more vulnerable to polypharmacy. Patients in these facilities are usually more fragile and typically have several sicknesses and cognitive disabilities, which frequently rationalize pharmacologic treatment. According to research, around 91% of patients in these facilities receive a daily dosage of five or more drugs (Carroll, 2019).

                     There are numerous factors and actions that, when addressed, can help prevent polypharmacy. Being sure of a drug’s therapeutic effect concerning age or the disease is one way to avoid polypharmacy. Uncertainty of the benefit of a particular drug causes an unnecessary prescription.  The best way to ensure certainty is to consider the age and the stage of the sickness properly. Additionally, lifestyle changes or the normal aging process are often ignored instead of drug prescription. It is better to prescribe lifestyle changes occasionally than give drugs when appropriate to avoid possible adverse reactions (ADR) from polypharmacy (Woo, 2021).  On the other hand, physicians should differentiate the normal aging process from the disease to prevent prescribing drugs to the natural process other than the disease. The same case goes for drugs that tackle ADR; instead, the original drugs causing the ADR should be removed or changed.

                     Also, avoiding therapeutic duplication (TD) is another way to prevent polypharmacy. TD is prescribing many drugs to tackle different indicators a patient is showing. Normally effects of TD drug combinations are unknown and may result in ADR. However, medical practitioners can reduce polypharmacy by finding a single drug that handles multiple therapeutic effects.

References

Carroll, S. H. A. G. (2019). Polypharmacy: Evaluating Risks and Deprescribing. American Family Physician. https://www.aafp.org/afp/2019/0701/p32.html

Woo, T. M. (2021). Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4e (4th ed.). F.A. Davis Company.

Orestes V. Sacerio Garcia

Polypharmacy (PP) is a very important topic related with older adults with a potential harm in the community. Therefore, assessment of daily drug consumption (DDC) and its relationships is important. Nurse Practitioners have a crucial role in monitoring and preventing PP. Polypharmacy is an area of concern for elderly because of several reasons. Between the main risk factors we can identify older patients with multiple chronic conditions take several different medications with various dosages, prescribed by many separate physicians. Another one is the metabolic changes and reduced drug clearance associated with aging.

The first risk factor identified is the case of elderly with multiple chronic conditions we have a patient with advance Diabetes.The comorbidities of diabetes commonly include hypertension, dyslipidemia, depression, and coagulopathies, each of which may require one or more drugs for adequate control. Add to this other conditions that often accompany diabetes, such as hypothyroidism, heart failure, and osteoporosis, and the total number of possible medications needed become significant.

Second risk factor identified is case of change in the body system related to aging such as metabolic changes and reduced drug clearance. Aging involves progressive impairments in the functional reserve of multiple organs, which might also affect drug metabolism and pharmacokinetics. The hepatic first-pass effect of highly cleared drugs could be reduced (due to decreases in liver mass and perfusion), the bioavailability of some drugs can be increased in the elderly. The hepatic drug clearance of some drugs can be reduced by up to 30% and CYP-mediated phase I reactions are more likely to be impaired than phase II metabolism, which is relatively preserved in the elderly. Finally, renal excretion is decreased (up to 50%) in about two thirds of elderly subjects, but confounding factors such as hypertension and coronary heart disease account also for a decline in kidney function. In conclusion, age-related physiological and pharmacokinetic changes as well as the presence of comorbidity and polypharmacy will complicate drug therapy in the elderly.

One of the interventions to reduce the incidence and adverse effects of polypharmacy medication regimes of elderly patients should be evaluated monthly. A single agent/drug should be prescribed instead of multiple drugs for the treatment of a single condition, if possible. Medications should be started with the lower drug dosage where clinically indicated and if required incremental increase can be done.

Another intervention could be the frequency daily. Drugs that can be given once or twice a day should be preferred over the drugs given three times a day.Drugs that are suspected to cause a problem should be discontinued. If the drug taken has no therapeutic beneficial effect or clinical indication it should be eliminated. Unessential drugs should be identified and eliminated prescribed by different health care providers for the same condition/disease.

References

Rochon PA, Gurwitz JH. (2017). Optimising drug treatment for elderly people: The prescribing cascade. BMJ. Pages 315(7115):1096–9.

Sergi G, De Rui M, Sarti S, Manzato E. (2018) Polypharmacy in the elderly: Can comprehensive geriatric assessment reduce inappropriate medication use? Drugs Aging. Pages 28(7):509–18

Abdulraheem IS. (2016) Polypharmacy: A risk factor for geriatric syndrome, morbidity &mortality. Aging S

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