Polypharmacy is recognized as the multiple uses of medications by a patient more time than it is necessary. Minimum variable number of allowed medications is 5 where taking more than the limit could be dangerous to the consumer. Polypharmacy not only increases the cost of healthcare to patients and institutions but also predisposes individuals to adverse drug events that may lead to unplanned hospitalizations. At the same time, the possibility of drug interactions that likely caused a potential hepatic cytochrome was 80% among the elderly taking 5-9 medications ( Lipska, Krumholz, Soones & Lee, 2016). Polypharmacy also increases non-adherence to medications that would lead to treatment failure which could be life-threatening. Additionally, there is the risk of having decreased physical functioning, cognitive impairments such as deliriums, falls, urinary incontinence, and nutritional problems such as malnutrition.
Medication Review
Digoxin is an anticholinergic as should be avoided for first-line therapy of chronic heart disease. If it is to be used, it should not be prescribed as a daily dose if its greater than 0.125 mg for an indication. This is because it increases the risk of toxicity due to decreased renal clearance, hospitalization, or even mortality. Aspirin >325 mg increases the risk of peptic ulcers in patients above 75 years ( American Geriatrics Society 2015 Beers Criteria Update Expert Panel et al., 2015). As a pain therapy for osteoporosis, femur fracture, and arthritis, acetaminophen 1000 mg four times daily should preferably be used in order to eliminate the use of omeprazole which a proton-pump inhibitor that reduces but does not eliminate the risk of ulcers ( American Geriatrics Society 2015 Beers Criteria Update Expert Panel et al., 2015) . Omeprazole has severe effects when interacted with digoxin. Naproxen should also be preferably removed as a pain reliever due to the existence of acetaminophen 1000mg. Taking a lot of pain killers may increase toxicity.
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Zolpidem which is a non-benzodiazepine, benzodiazepine receptor agonist hypnotics, should be avoided due to its low efficacy in treating insomnia. Its recommended dose is 5mg once daily before bedtime since it is associated with falls and may have contributed to the fractured right femur ( American Geriatrics Society 2015 Beers Criteria Update Expert Panel et al., 2015) . Similarly, alprazolam 10 mg at night is a lot in geriatric care and should be avoided due to its increased sensitivity and risk of cognitive impairments, falls, and fractures in older adults. If it is to be given, its recommended dose is 0.25 2-3 times a day based on the Beers criteria ( American Geriatrics Society 2015 Beers Criteria Update Expert Panel et al., 2015) . From the case study, the patient also shows no indication of having anxiety, panic, or depression that warrants its use.
Oxybutynin should be initiated at 2.5 mg PO q8-12hr to treat urinary incontinence. It is safer since it has minor drug interactions with acetaminophen and digoxin. Senna’s use should be monitored to its increased risk of increasing the side effects of digoxin. No more than 17 mg a day should be used in the patient ( American Geriatrics Society 2015 Beers Criteria Update Expert Panel et al., 2015) . The rest of the medications are safe for use at the given prescribed dose.
Plan of Care
Current medications should be reduced and the patient put on other non-pharmacokinetic pain therapy such as yoga and physical therapy to reduce the needs of overdosing on painkillers. Constant monitoring should be done for the minimal drug interactions and to ensure that the patient’s well-being is maintained ( Maher, Hanlon & Hajjar, 2014). Continuous lab tests should be done to ensure that chronic heart diseases and type 2 diabetes mellitus are controlled.
Improving the System
Necessary polypharmacy among elderly patients should be closely monitored within a clinical setting. This is to control the possible distal health outcomes that may occur ( Maher, Hanlon & Hajjar, 2014) . However, clinicians should prescribe medications based on a thorough review of the current prescription and a patient’s medical history. Strictness should be observed at all cost.
References
American Geriatrics Society 2015 Beers Criteria Update Expert Panel, Fick, D. M., Semla, T. P., Beizer, J., Brandt, N., Dombrowski, R., ... & Giovannetti, E. (2015). American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society , 63 (11), 2227-2246.
Lipska, K. J., Krumholz, H., Soones, T., & Lee, S. J. (2016). Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes. Jama , 315 (10), 1034-1045.
Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in the elderly . Expert opinion on drug safety , 13 (1), 57-65.
