Polypharmacy can be described as the provision of several drugs to a single patient in order to manage multiple health problems. Polypharmacy mostly occurs in elderly patients that may face several health issues such as cardia diseases, hypertension, diabetes, and arthritis. The provision of multiple drugs can become a problem when the patient has lots of medication from different or the same health care provider. The interaction between drugs in the body can be a major concern for elderly patients whose functioning of body organs could be declining. This case study analyzes a case study on polypharmacy and considers the effects of polypharmacy and how it can be avoided among the elderly population.
Patients that are above the age of 65 and have multiple diseases will have multiple providers manage their medication. For such a scenario, patients will have more than five medications at a time. Ageing patients are thus at a higher risk to experience treatment-related complications (Mortazavi et al., 2016). According to Chau et al. (2016) overtreatment and undertreatment result in 41.4% of all drug-related problems. One of the problematic nature of pharmacological treatment is that the patient may not remember whether they took a specific medication or not. Elderly patients may especially find it difficult to remember whether they took a medication or not. This can result in missing some of the doses and a reduction in the effectiveness of the treatment.
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For the given scenario, Mrs. A has developed a compulsive disorder and confusion and the result is that she can no longer administer drugs by herself. She thus requires supervision to facilitate proper administration of the medication. Additionally, she requires psychiatric evaluation so as to rule out the possibility of mental illness. Additionally, she would require a general assessment of the functioning of her liver and kidney in order to adjust her drug intake and prevent a wrong dosage. Additionally, the problematic nature of her drug intake means that she should opt for home nursing care or her daughter be closely educated on how she can provide close supervision and facilitate her medication. The confusion that Mrs. A experiences can lead to poor adherence of medication and also poor food nutrition. The result could be ineffective treatment, further complications with her health, side effects from non-adherence to medication, and increased health care costs (Bhatty et al., 2017).
Pharmacokinetic Changes That May Affect Drug Disposition in the Geriatric Population
There are several changes in the geriatric population which are usually associated with the aging process. The process of aging first results in a progressive impairment in the functioning of multiple drugs and this can affect pharmacokinetics and drug metabolism. Significant changes that occur in the composition of the body can include the deterioration of the white matter of the brain and the result is significant mental changes. The patient may thus experience symptoms such as memory loss and confusion (Klotz, 2009). For the given patient in the case study, the confusion that she experiencing may be due to mental changes.
The changes in the body can also be caused by the decrease in the body water and muscle mass and an increase in the body’s fat as one ages. The result is that the volume distribution of fat-soluble drugs could increase and thus delay maximal effects and continual accumulation with the frequent usage of drugs (Gujjarlamudi, 2016). The volume distribution of water soluble drugs may decrease and hence the need to decrease loading doses (Gujjarlamudi, 2016). For the given case study, the patient is undertaking water soluble drugs such as dioxin. The changes in her muscle mass and body water would mean that there is a need to change the dosage of dioxin. It is thus important to observe the dosage and monitor its effectiveness.
Renal and Hepatic Functions
The changes in the renal and hepatic functions for the geriatric patient may also result in complications and may affect the treatment strategies. The renal blood flow and tubular secretions start to decrease after age of 55 years and the clearance of many drugs reduces. Toxicity may easily result especially with drugs that are usually eliminated by the kidneys (Raman et al., 2017). When considering the treatment, it is therefore important to calculate the glomerular filtration rate (GFR) for drugs that are eliminated by the renal glands. This should be especially applied in situations where there is an acute deterioration of the renal function (Lavan & Gallagher, 2016). The medication may be adjusted accordingly in order to prevent the occurrence of an adverse drug reaction. One of the drugs that Mrs A. has been taking is dioxin and there is a need to adjust her medication accordingly.
Aging can also result in the damage of the hepatic cells and changes in the normal functioning of the liver with aging. The alteration of the hepatic structure and functioning along with various changes in liver cells like the hepatic cells means that how the body will react to the administration of drugs changes (Kim, Kisseleva, & Brenner, 2015). There can also be a reduction in the hepatic mass and hepatic blood flow can cause changes in the concentration of drugs that are metabolized in the liver (Cantlay, Glyn, & Barton, 2016). These changes mean that there should be a specific caution when prescribing drugs that are to be metabolized by the liver. For the given case study, the medications administered to Mrs. A may be staying within her body for longer due to low metabolism. The result with drugs staying for long in her body is that she could be getting more medication than that which she really needs.
Possible Side Effects
From the analysis of the medication, the interactions of the drugs would be moderate. The first drug furosemide is a diuretic that can decrease the level of potassium. It is thus important to monitor the electrolytes of the patient closely. The decreased potassium and the digoxin medication can place the patient at risk for development arrhythmia. Monitoring the levels of digoxin would be important so that she does not experience digoxin toxicity (Lavan & Gallagher, 2016).
Some of the other drugs that Mrs. A is taking include NSAID such as paracetamol and Piroxicam. The other drugs including Mylanta suspension and Coloxyl are to help with her digestion. However, the interaction of these drugs could potentially decrease the digoxin levels within her blood. Other medications that she is taking that should help her compromised renal function and the medications for heart failure could also interact severely.
Conclusion
The given patient could be experiencing problems with drug interactions and it is important to adjust her dosage. The recommendation would be to first monitor her digoxin and electrolyte levels. Monitoring this way should also be done on a frequent basis and appropriate interventions should be done frequently. The doses of digoxin would also be decreased in case the digoxin levels were rather high and potassium levels low. The patient is on medications for constipation and heart burns and instead of making use of medications the recommendation would be diet changes. Mrs. A should avoid spicy foods, take more water, and take foods rich in fibers. These recommendations may serve to help her with the complications.
References
Bhatty, E. T., Meraj, A., Malik, M., Imtiaz, M., Nasir, A., Saleem, N., ... & Saleem, Z. (2017). Drug Related Problems Associated with Polypharmacy: A. Pak. J. Pharm , 30 (1), 10-16.
Chau, S. H., Jansen, A. P., van de Ven, P. M., Hoogland, P., Elders, P. J., & Hugtenburg, J. G. (2016). Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands. International journal of clinical pharmacy , 38 (1), 46-53.
Cantlay, A., Glyn, T., & Barton, N. (2016). Polypharmacy in the elderly. InnovAiT , 9 (2), 69-77.
Gujjarlamudi, H. B. (2016). Polytherapy and drug interactions in elderly. Journal of mid-life health , 7 (3), 105.
Kim, H., Kisseleva, T., & Brenner, D. A. (2015). Aging and liver disease. Current opinion in gastroenterology , 31 (3), 184.
Klotz, U. (2009). Pharmacokinetics and drug metabolism in the elderly. Drug metabolism reviews , 41 (2), 67-76.
Lavan, A. H., & Gallagher, P. (2016). Predicting risk of adverse drug reactions in older adults. Therapeutic advances in drug safety , 7 (1), 11-22.
Mortazavi, S. S., Shati, M., Keshtkar, A., Malakouti, S. K., Bazargan, M., & Assari, S. (2016). Defining polypharmacy in the elderly: a systematic review protocol. BMJ open , 6 (3), e010989.
Raman, M., Middleton, R. J., Kalra, P. A., & Green, D. (2017). Estimating renal function in old people: an in-depth review. International urology and nephrology , 49 (11), 1979-1988.
