Polypharmacy: The Dangers of Taking Too Many Medications

Polypharmacy  entails the concurrent use of several medications carry out the treatment of a particular illness or disorder. In medicine, the term Polypharmacy has existed for many years with both positive and negative attributes. Polypharmacy can be categorized based on the beneficial aspect. Appropriate polypharmacy entails the prescriptions offer for complex ailments in situation where the medicinal use has been completely optimized and given based on the appropriate evidence. In Problematic polypharmacy, the medication prescribed is inappropriately administered and the benefits are not realized ( Duerden, Avery & Payne, 2013) . 

Although considered something to be avoided in the past, contemporarily, it has been accepted and viewed as a remedy that might be of beneficial therapeutically. It can be both appropriate and problematic. For the elderly, polypharmacy occurs because of, population factors, health related issues and the ability to access to healthcare facilities. (Stuart- Hamilton, 2011). This is a concern for the elderly since accessing health care facilities and maintaining health at this particular age set is paramount because they have low immunity. The chances of polypharmacy are presumably higher for the elderly males and those who live in the urban regions (Slabaugh , Maio, Templin, Megan & Safiya, 2010). 

Polypharmacy can result in incorrect recommendation of drugs that might result in adverse drug events (ADEs).  In older adults, ADEs results in costly provision of health care. When the elderly avoid the intake of wrong and high-risk medication they are able to reduce problems related to the drugs (American Geriatrics Society 2012 Beers Criteria Update Expert Panel, 2012). For the elderly, it can surge the develop of risk and impair the adherence of drugs and patients life. Al Ameri, Makramalla, Albur , Kumar, & Rao (2014), established that drug interaction was increase because of the among of medication take. The drug interaction was highest at the 60-69 age group .Polypharmacy is extensive and ever more common, in homes for the elderly. Administering various appropriate therapies can to some extent, improve the patient outcomes ( Duerden, Avery & Payne, 2013). 

2) Medication Review: 

Sertraline (Zoloft®) 100mg in the morning 

Treats psychological issues 

Metformin (Glucophage®) 500mg three times daily 

Glucophage  ( metformin) is an oral diabetes medicine that helps control blood sugar levels .  

Omeprazole (Prilosec®) 20mg in the morning 

Omeprazole   reduces the acidity level in the stomach. For the elderly, it is associated with increased fractural risks especially for long term use and high doses 

Aspirin 325mg in the morning 

Aspirin  for her case reduces the pain. The dose should be mils to limit brain hemorrhage and gastroenteritis 

Isosorbide mononitrate CR (Imdur®) 60mg daily 

The drug  prevents angina in patients suffering from coronary artery disease. Dosage adjustment is required to regulate the BP levels and heart problem. 

Digoxin 0.25mg daily in the morning 

Digoxin  is a medication that treats heart failure when used in combination with other drugs. 

Furesomide 40mg twice a day 

Furosemide   treats the retention of fluid associated with heart failure, Its action is slow among the elderly. 

Alendronate (Fosamax®) 10mg daily 

Alendronate (Fosamax®) 10mg daily is an appropriate for patients with prior fractures. 

Acetaminophen 1000mg four times a day 

The medication if vital since it eases the pain from frequent urination and the burning sensation because of the UTI 

Naproxen (Naprosyn®) 500mg three times a day 

Naproxen  is a pain reliever that relieves 

Oxybutyn (Ditropan)® 10mg at night 

Ditropan   treat signs of feverish bladder, for example recurrent urination and urine leakage For Older adults, drowsiness and confusion may arise. 

Zolpidem (Ambien®) 10mg at night 

Zolpidem  is a sedative that tackles (insomnia).For the elderly it confusion and dizziness, and contribute a lot to the falling percentage 

Alprazolam 0.5mg three times a day as needed 

Alprazolam, is used for anxiety disorders treatment. For the elderly it may cause confusion and lung problems. 

Senna® two tablets at night 

Senna, is a drug that medic prescribe for the treatment of constipation and empty the large intestine prior to any surgery. It may cause stomach upsets and diarrhea. 

3) Plan of Care: 

She has type 2 diabetes mellitus 

Glucophage  ( metformin) is an oral diabetes drug that helps regulate blood sugar levels . The medication provided to her in this case was appropriate and would influence well with the diabetic conditions. 

Recurrent urinary tract infections 

The medication provided fails to threat this case since there is none that tackles this condition in this case. I would advocate for antibiotic treatment. Amoxicillin preferred. In the case of a recurrent infection that is severe, levaquin, which is a blood-spectrum antibiotics, will serve for the treatment (Duerden, Avery & Payne, 2013). The medication should be administered for the entire period until the dosage is over since any stoppages my result in reoccurrences and the resistance to the medication. Patient is advised to take plenty of fluids 

Osteoporosis 

For this condition, Alendronate (Fosamax®) 10mg daily is an appropriate dose taken orally. With her prior fracture 12 months ago, the medication will reduce the risk of hip fracture. It has also minimal side effects that might increase other health related ailments. 

Osteoarthritis 

The use of aspirin in this case will reduce the joint pain and the swellings being experienced . the dosage should also be controlled to limit the adverse effects such as brain hemorrhage. 

Chronic heart disease. 

Digoxin  is this case will be used to treat and the irregularity of the heartbeat. .To reduce its toxicity in the patients system the low doses will be effective in the treatment of heart failure because of the systoles functionality. It may also contribute in the reduction of digitalis toxicity  . 

She has urinary incontinence and the use of Ditropan  as an anticholinergic treats symptoms such as overactive bladder, urine leakage. Drowsiness and confusion are the main side effects among the elderly. 

Medication to be done away with 

Some of the prescribed drugs perform the same functions. The drugs have not been appropriately used for the treatment of the patient’s conditions.. With such, adverse drug effects might arise because of various side effects. 

Sertraline (Zoloft®) 100mg in the morning 

In this case, there is no indication the patient suffer from psychological issue like depression or any form of panic attack and hence the usage of the medication should be stopped. Since the drug has side effects of ingestion and drowsiness, for our elderly 83 year old female, it would have an adverse effect on her health. 

Omeprazole (Prilosec®) 20mg in the morning 

Omeprazole   reduces the acidity level in the stomach. For the elderly, it is associated with increased fractural risks especially for long term use and high doses. The patient has osteoporosis and osteoarthritis and the drug may enhance the incidence. The intake of this medication thrice daily has no impact on the patient’s condition. From the history, it is evident that the patient has no gastrointestinal issues. 

Furesomide 40mg twice a day . Furosemide  treats the retention of fluid associated with heart failure, Its action is slow among the elderly. The functionality of this medication has been absorbed by Digoxin . It’s twice intake daily should be stopped. 

Naproxen (Naprosyn®) 500mg three times a day 

Naproxen  is a pain reliever that relieves headache, muscle aches and menstrual cramps. It also reduces pain,  Naproxen  may cause gastrointestinal (GI) tract hemorrhage and ulcers . With no indication that the patient has pain, the medication should be stopped. In worst cases, the side effects may result in gastrointestinal bleeding and ulcers in her case ( Patterson, Hughes, Kerse, Cardwell & Bradley, 2012 . 

Alprazolam 0.5mg three times a day as needed 

Alprazolam, is used for anxiety disorders treatment. For the elderly it may cause confusion and lung problems. For this case, there is no indication that the patient suffer from anxiety issues. Stopping its usage will be the right action. 

Senna® two tablets at night 

Senna, is a drug that medic prescribe for the treatment of constipation and empty the large intestine prior to any surgery. It may cause stomach upsets and diarrhea. This is an inappropriate drug to be used based on the client’s condition and should be stopped . 

Laboratory test 

Blood test 

In order to ascertain the condition of the chronic heart disease , a blood test should be done to check for anemia and cholesterol levels. A (BNP)should also be carried out. 

Chest X-ray   

Chest X-ray  in this situation will determine whether the patient’s heart has an enlargement and whether there is retention of fluids in the lungs 

Urinalysis 

Because of the deficiency in estrogen, most elderly females usually develop risk complications from UTIs. Low levels of estrogen may trigger infections from E.coli. 

4) Improving the System: 

Recommendation 1 

The first recommendation will be effective communication about medication. To reduce the incidences of polpharmacy, patients in this situation and with supplementary risk issues for drug problems are entitled to a structured medication counseling. The counseling should be carried out at least twice yearly. The information provided by the SMC will have a complete list of the medication being taken by the patient and consequently limiting the risk that might be associated with polpharmacy (Patterson, Hughes, Kerse, Cardwell & Bradley, 2012). 

Recommendation 2 

When patient with polypharmacy are given a comprehensible list of the medication required, they will be able to only follow what has been prescribed for the condition that is being treated. 

Recommendation 3 

On the part of physicians, they should be able to carry out a s structured medication review with the assistance of the Medication appropriateness index. When this is used, it will limit untimely drug regimes. Tools like PRISCUS are appropriate since they provide a list of 83 elements that the elderly patients should not use for treatment ( Butool, Nazir, Afridi & Shah, 2018). Following all these three aspects will result in an improved health outcome. 

References 

Al Ameri MN, Makramalla E, Albur U, Kumar A, Rao P (2014) Prevalence of Poly-pharmacy in the Elderly: Implications of Age, Gender, Co-morbidities and Drug Interactions. SOJ Pharm Pharm Sci, 1 (3), 1-7. DOI: http://dx.doi.org/10.15226/2374-6866/1/3/00115 

American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults.  Journal of the American Geriatrics Society ,  60 (4), 616–631. https://doi.org/10.1111/j.1532-5415.2012.03923.x 

Butool, I., Nazir, S., Afridi, M., & Shah, S. M. (2018). Evaluation and assessment of prescribing patterns in elderly patients using two explicit criteria based screening tools: (The PRISCUS list and STOPP/START criteria).  Pakistan journal of medical sciences ,  34 (6), 1357–1362. https://doi.org/10.12669/pjms.346.14928 

Duerden, M., Avery, T., &Payne, R. (2013). Polypharmacy and medicines optimisation: Making it safe and sound . London : The King's Fund. 

Jäger, C., Steinhäuser, J., Freund, T., Kuse, S., Szecsenyi, J., & Wensing, M. (2017). A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices-process evaluation of a cluster randomized trial.  Implementation science : IS ,  12 (1), 31. https://doi.org/10.1186/s13012-017-0559-y 

Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC.(2012). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews 2012, Issue 5 . Art. No.: CD008165. DOI: 10.1002/14651858.CD008165.pub2 

Slabaugh, Lane & Maio, Vittorio & Templin, Megan & Abouzaid, Safiya. (2010). Prevalence and Risk of Polypharmacy among the Elderly in an Outpatient Setting. Drugs & aging , 27 (12):1019-28 

Stuart- Hamilton, I.(2011). An introduction to gerontology . Cambridge: Cambridge University Press.