Polypharmacy

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Management 5 More General Terms 6 Additional Terms 7 References

Introduction

• The administration of many drugs concurrently, usually meaning that a patient is receiving an excessive number of medications.

• Unnecessary medications are common in the elderly.

Etiology

• reasons

• lack of indication
• lack of efficacy
• therapeutic duplication

• agents inappropriately prescribed

• H2 receptor antagonists
• laxatives
• genitourinary anticholinergic agents
• ferrous sulfate
• tricyclic antidepressants
• potassium chloride
• benzodiazepines
• antibiotics
• antipsychotics
• proton pump inhibitors
• NSAIDs

• predictors

• multiple prescribing physicians
• prescription of 9 or more medications
• multiple specialists consulted with no coordination of care
• multiple pharmacies prescibing medications
• lack of medication reconciliation

Epidemiology

• common with the elderly (44%)
• 18% of elderly receive 2 or more inappropriate prescriptions

Management

• pharmacy intervention through patient education between patient visits can reduce mortality in the elderly [1]
• successful drug discontinuation may lead to improved outcomes [4]

More General Terms

• pharmacy

Additional Terms

• Beers criteria
• prescription

References

1. Wu JY, Leung WY, Chang S, Lee B, Zee B, Tong PC, Chan JC. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ. 2006 Sep 9;333(7567):522. Epub 2006 Aug 17. PMID: [1]
2. Terrell KM et al Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: A randomized, controlled trial. J Am Geriatr Soc 2009 Aug; 57:1388 PMID: [2]
   - Fortuna RJ et al Reducing the prescribing of heavily marketed medications: A randomized controlled trial. J Gen Intern Med 2009 Aug; 24:897. PMID: [3]
3. Steinman MA et al Agreement between drugs-to-avoid criteria and expert assessments of problematic prescribing. Arch Intern Med 2009 Jul 27; 169:1326. PMID: [4]
4. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: Addressing polypharmacy. Arch Intern Med 2010; 170(18):1648-1654 PMID: [5]
5. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010

polypharmacy (unecessary drug prescription)