Mechanism of action postulates the process through which a drug ingested in the human body produces its effects, both desired and undesired. In order for a given drug to achieve this, it has to bind to its specific receptors, which are located on the surface of the cells or within the cytoplasm inside the cell. This process is primarily dependent on the drug's unique chemical structure (Schmidt et al., 2015). When bound by its receptor, the drug can either act as an antagonist or agonist. The agonist promotes the activation of receptors, while the antagonist deactivates the receptors within the cell (Bast et al., 2017).
Polypharmacy describes a situation where medication is optimized based on a patient's clinical needs (Jungo et al., 2019). To achieve appropriate polypharmacy, (Cadogan, Ryan, and Hughes, 2016) note that prescribing should be evidence-based. However, in the senior population, this is a crucial challenge since they are often underrepresented in clinical trials (Broekhuizen et al., 2015). In mitigating this problem, the American Geriatrics Society has developed a set of principles that guide the management of older patients with multimorbidity (AGS, 2012). It will, however, take some time before the impacts of this are understood.
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When prescribing drugs to a patient, it is essential to pay close attention to the patient's needs. As Jungo et al. (2019) describe it, the medication should be optimized to a patient's clinical needs. While the use of several various drugs concurrently was initially assumed to be hazardous, current studies indicate the beneficial effects this can have on multimorbidity patients (Nightingale, Skonecki and Boparai, 2017).
When prescribing drugs to a patient, the AGS (2012) notes the framework to promote appropriate prescriptions. It begins with identifying the patient's primary concern, reviewing the patient's care plan, identifying the current medical conditions and treatments, assessing the patient's adherence to drugs, considering the patient's preferences, considering the prognosis, considering the potential drug interactions, assessing the benefits and harms in the care plan, communicating with patient to make decisions on initiation of treatment and finally reviewing the patient periodically.
Materials learned in this course are essential since having a good background knowledge in pharmacology will promote valid prescriptions and overall improve a patient's quality of life. Furthermore, understanding the mechanisms of action of the different classes of drugs will be critical in prescribing drugs for chronically ill patients to alleviate the chances of interactions, which can lead to drug inefficacy or certain nutrient deficiencies. Understanding the process of prescribing therapies will also help in preventing the chances of under or over-prescription, which are adversities associated with polypharmacy.
References
American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. (2012). Patient‐centered care for older adults with multiple chronic conditions: A stepwise approach from the American Geriatrics Society. Journal of the American Geriatrics Society , 60 (10), 1957-1968.
Bast Jr, R. C., Croce, C. M., Hait, W. N., Hong, W. K., Kufe, D. W., Piccart-Gebart, M., ... & Holland, J. F. (Eds.). (2017). Holland-Frei Cancer Medicine Cloth . John Wiley & Sons.
Broekhuizen, K., Pothof, A., de Craen, A. J., & Mooijaart, S. P. (2015). Characteristics of randomized controlled trials designed for elderly: a systematic review. PloS One , 10 (5), e0126709.
Cadogan, C. A., Ryan, C., & Hughes, C. M. (2016). Appropriate polypharmacy and medicine safety: when many is not too many. Drug Safety , 39 (2), 109-116.
Jungo, K. T., Rozsnyai, Z., Mantelli, S., Floriani, C., Löwe, A. L., Lindemann, F., ... & Sallevelt, B. T. G. M. (2019). ‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’(OPTICA) to improve medication appropriateness: study protocol of a cluster randomised controlled trial. BMJ Open , 9 (9), e031080.
Nightingale, G., Skonecki, E., & Boparai, M. K. (2017). The impact of polypharmacy on patient outcomes in older adults with cancer. The Cancer Journal , 23 (4), 211-218.
Schmidt, S., Wang, H., Pussak, D., Mosca, S., & Hartmann, L. (2015). Probing multivalency in ligand–receptor-mediated adhesion of soft, biomimetic interfaces. Beilstein Journal of Organic Chemistry , 11 (1), 720-729.
