Geriatric Medicine Book

Approach

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  • Polypharmacy

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Polypharmacy

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  1. Definition: Polypharmacy
    1. Too many medications or use of unnecessary drugs
    2. Five or more medications used empirically
  2. Prevention: Decreasing Polypharmacy
    1. Try to use "one drug per disease once daily"
    2. Stop drugs without proven benefit or indication
    3. Consider withdrawing antihypertensives in elderly
      1. Especially in those with low pressure on therapy
      2. Up to one third of patients remain normotensive
        1. If BP increases, it usually does in first 70 days
      3. References
        1. Nelson (2002) BMJ 325:815
    4. Avoid treating iatrogenic side effect with another drug
    5. Use least toxic medications
    6. Review adverse effects of prescribed medications
    7. List all drugs by generic name and class
    8. Patient should bring all medications to each visit
      1. Accurate record of drug, dosing, and schedule
      2. Includes all prescribed, OTC, herbals and supplements
    9. Every visit is an opportunity to STOP a medication
      1. Trial off one medication at a time
      2. Re-evaluate weeks after stopping a medication
        1. What symptoms were improved, unchanged, worsened?
        2. What clinical markers changed (eg. Blood Pressure)?
        3. Is there a reason to restart or replace this drug?
    10. Practice guidelines and PFP drive polypharmacy
      1. Interpret PFP and guidelines in context of patient
        1. May be inappropriate for extreme elderly
        2. May decrease quality of life in end-stage disease
        3. Drug benefits often delayed beyond life expectancy
      2. Where are they on cure vs Palliative Care spectrum?
        1. Primary prevention is not focus in Palliative Care
        2. Shift end stage care to focus on palliation
          1. Prevent decline by treating acute disease
          2. Focus on symptom management for comfort
    11. References
      1. Carlson (1996) {a 6854} 51:26
  3. Protocol: Evaluate each drug for risk versus benefit
    1. Is the medication indicated with efficacy?
    2. Is dosage and directions appropriate and practical?
    3. Are there significant drug or disease interactions?
    4. Is the duration of therapy appropriate?
    5. Is there unnecessary duplication with other drugs
    6. Is this the most cost-effective drug option?
    7. References
      1. Samea (1994) J Clin Epidemiol 47:891

Polypharmacy (C0184545)

Definition (MSH)The use of multiple drugs administered to the same patient, most commonly seen in elderly patients. It includes also the administration of excessive medication. Since in the United States most drugs are dispensed as single-agent formulations, polypharmacy, though using many drugs administered to the same patient, must be differentiated from DRUG COMBINATIONS, single preparations containing two or more drugs as a fixed dose, and from DRUG THERAPY, COMBINATION, two or more drugs administered separately for a combined effect. (From Segen, Dictionary of Modern Medicine, 1992)
ConceptsTherapeutic or Preventive Procedure (T061)
MSHD019338
EnglishPOLYPHARM, Polypharmacy
Spanishpolifarmacia
Parent ConceptsPharmacotherapy (C0013216), Drug therapy finding (C0586814)
SourcesLNC, MSH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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