polypharmacy

Saturday, June 10, 2017

The problem with fame is that privacy is hard to come by. The problem with social media is the willingness of people to give up any privacy that they might have. Michael Oher, a lineman for the Carolina Panthers, posted an Instagram picture of the 10 prescription medications that he takes for concussion symptoms, and then quickly deleted the post. Nothing is ever truly deleted on the internet and the photo made its rounds. The need for ten prescriptions is a private matter between Mr. Oher and his physician, but that numbers of medications is not a rare occurrence but it is a big problem, especially in the elderly.

Many people suffer from multiple chronic conditions that can be interlinked and each might need specific treatment. Polypharmacy describes a patient taking more than four medications at a time and it especially affects the older population. Up to 40% of people older than 65 take that many pills and more than 10% take ten or more. Those aren’t just prescriptions, but also include over-the-counter medicines, herbal medications, and dietary and vitamin supplements. While each pill may have a benefit, interactions and complications increase with each added drug.

Ideally, chronic illnesses would not need any medication treatment. Some patients with high blood pressure and diabetes might be able to be treated with diet, exercise and weight loss, but may need medications to maintain lifelong control of their disease to prevent complications like heart attack and stroke. Some patients with high blood pressure (hypertension) may need two or three medications to keep their blood pressure controlled. In addition to insulin, some diabetics may need oral medications to lower blood sugar. Add high cholesterol and then the need for aspirin to help prevent heart disease and the number of pills needed on a daily basis grows quickly.

With each medication added, the risk of a significant complication or interaction increases. Drug interactions can happen inadvertently, even with over the counter pills.

  • patients with kidney disease or ulcers shouldn’t take ibuprofen or naproxen. NSAIDs can worsen kidney function and can cause bleeding in the esophagus, stomach or intestine
  • patients with liver issues should avoid acetaminophen (Tylenol), since it can be toxic to the liver. If there is major liver disease like cirrhosis, the NSAIDs might not be a good idea either because of the potential risk of bleeding. Patients with cirrhosis cannot make enough blood clotting factors and can have varices (swollen veins that can bleed)
  • those with high blood pressure should avoid cold medications containing phenylephrine, because it looks like adrenaline to the body increasing blood pressure readings
  • people on antidepressants that can cause drowsiness should not take Benadryl (diphenhydramine) which is used for allergies but is also the active ingredient in over the counter sleeping medications

There are plenty of drug interaction between prescription drugs. So many exist that electronic medical records and computer programs continually remind and warn doctors and pharmacists about what is safe to prescribe and what might cause problems. There are so many warning that error fatigue can occur…there are so many warning that they get ignored.

All may be well and good if there is just one provider coordinating medical care, but too often, there are lots of specialists trying to look after their one part of the body and nobody is charged with looking after the whole person. Adding to the confusion and potential for error is the mail-order pharmacy and lack of face time with the patient. But most importantly, it’s the patient who may not keep track of their pills and thinks nothing of walking into a convenience store to pick up a cold or pain medication without appreciating the potential harm that might occur.

And then there is Michael Oher. 10 prescription medications for a concussion is a whole bunch. He signed off his Instagram post with “SMH”, shaking my head…well, we are too.

 

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