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Medications
Published in Henry J. Woodford, Essential Geriatrics, 2022
Rather than defining polypharmacy by pill count alone, it can also be classified as ‘appropriate' or ‘inappropriate'. With appropriate polypharmacy, the potential benefits are greater than harms and it is in alignment with individual needs, goals and preferences. Inappropriate or ‘problematic' polypharmacy is when the desired outcomes are not being achieved.115 For example, hazardous or interacting drug combinations, ineffective drugs, unacceptable therapeutic burden, reduced adherence or prescribing cascades. It is possible to discover the co-prescription of agents that have directly opposing mechanisms of action, for example, pro-cholinergics and anticholinergics; dopamine agonists and antagonists; or furosemide and fludrocortisone.
Medications That May Be Useful in the Management of Patients with Chronic Intractable Pain
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
Poly means many, and pharmacy means a pharmaceutical or drug. Some patients will insist on polypharmacy (many drugs) in an attempt to find the right combination(s) of drugs that will satisfy their faith in medication to “do the trick” in treating their problems. Some patients may be on tranquilizers, sedatives, muscle relaxers, sleeping pills, analgesics, and antidepressants or mood elevators all at the same time or over a period of time. Their history of drugs used for pain relief reads like a physician’s drug reference book. Sometimes as many as 50–60 different prescription medications are tried over a period of 5 years. They do not realize that medications are to be used as a means to an end and never an end in themselves. Problems also arise from some patients’ continued attempt to find the right drug or combination of drugs that helps them the most.
Living and dying in old age
Published in Heather Fillmore Elbourne, Andrée le May, Nursing Older People, 2019
Catherine Evans, Caroline Nicholson
An essential aspect of care towards the end of life is optimal management of medicines (called medicines optimisation). This is particularly important for older people with multimorbidity where polypharmacy (taking at least four or five medicines) is common (NICE 2017). Polypharmacy is typically driven by the introduction of multiple medicines for specific health conditions. Medications are prescribed to prevent complications, such as taking statins to lower cholesterol and prevent heart disease; optimally manage a single disease e.g. use of bronchodilators in COPD; and manage symptoms, such as taking analgesia for chronic pain. In England and Wales, it is estimated that 20% of people aged over 70 years are taking five or more medications, and 16% take ten or more medications (Duerden et al. 2013).
Current evidence for pharmacologic therapy following stage 1 palliation for single ventricle congenital heart disease
Published in Expert Review of Cardiovascular Therapy, 2022
Meredith C. G. Broberg, Ira M Cheifetz, Sarah T Plummer
Due to the heterogeneity of the disease and low volume of cases seen by many centers, it is difficult to reliably study many of the aforementioned medications in large randomized control trials. Considering the increased burden and risk that polypharmacy poses to this vulnerable patient population, eliminating medications that fail to show benefit is important. The risks and benefits of medications used for symptomatic relief, such as diuretics, proton pump inhibitors, H2RAs, should be considered closely. Discontinuation of these medications if they fail to improve patient symptoms should always be considered. Accordingly, the use of ACEI has decreased since studies have failed to show a benefit with no difference in interstage mortality, AV valve regurgitation or ventricular dysfunction. However, ACEI are still prescribed to many patients, especially those with significant AV valve regurgitation [30]. Whether there is a role for their use in certain patient populations has yet to be elucidated.
Cardiac rehabilitation for older adults: current evidence and future potential
Published in Expert Review of Cardiovascular Therapy, 2022
Maha A. Alfaraidhy, Claire Regan, Daniel E Forman
Polypharmacy involves the administration of multiple medications, generally defined as an individual who is taking ≥5 medications [65]. It is particularly common among older patients with CVD and multimorbibity as multiple clinicians tend to address a single disease such that the polypharmacy results [66]. Polypharmacy is associated with an increased risk of orthostatic hypotension, falls, bleeding, confusion, hospitalization, disability, drug interactions (between drugs and or by one drug exacerbating a different disease) and other adverse drug events, as well as mortality [67–70]. Age-related changes in pharmacodynamics and pharmacokinetics further potentiate the risk of adverse drug–drug and drug-disease events [71]. Additionally, polypharmacy in older adults contributes to medication non-adherence. It was noted that medication adherence for chronic cardiac conditions declines up to almost 40% by 2 years [72]. Medication non-adherence has been associated with poor quality of life, and increased risk of hospitalization and mortality [72].
Use of a Short-term Psychiatric Inpatient Model to Address Problem Behavior Exhibited by Youth with Intellectual or Developmental Disabilities
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2021
Patrick W. Romani, Tiffany Banks, Julia C. Barnes, James Murphy, Elise M. Sannar, Tyler Anderson
Concurrent with behavioral assessment and data collection, psychiatrists evaluate for co-occurring psychiatric disorders or medical diagnoses to develop an evidence-informed medication regimen. Psychopharmacologic intervention for the problem behaviors exhibited by youth with IDD often includes a combination of medication types (Sabus et al., 2019). Risperidone and aripiprazole are the only two antipsychotic medications approved by the Food and Drug Administration (FDA) for the treatment of aggression and irritability associated with ASD (LeClerc & Easley, 2015). Other medication choices are informed by evidence of benefit in typically developing populations. While monotherapy is often preferred, many children with IDD are exposed to complex polypharmacy. A common example of polypharmacy is pairing an antipsychotic with an SSRI (e.g., sertraline) or alpha agonist (e.g., clonidine).