POLYPHARMACY PITFALLS: AVOIDING THE TRAPS OF MULTIPLE MEDICATIONS

Table of Contents

I. Introduction

Definition of polypharmacy.

Importance of discussing polypharmacy.

Purpose of the blog: to explore the risks and challenges of polypharmacy and provide tips for avoiding its pitfalls.

II. Understanding Polypharmacy

Defining polypharmacy.

Prevalence.

Common reasons for polypharmacy.

Risks and consequences of polypharmacy.

III. Identifying the Risks

Adverse drug reactions (ADRs).

Drug interactions.

Increased risk of falls and fractures.

Cognitive impairment.

Health problems get worse.

Financial burden.

Extra: Real Life Story

IV. Strategies for Avoiding Polypharmacy Pitfalls

Medication review and reconciliation.

Communication with healthcare providers.

Introduction

Polypharmacy is the cause of many people not feeling their best while taking their meds. Out meds are supposed to make us feel better and should be taken for the shortest amount of time, but we are seeing individuals relying on these drugs to live. Polypharmacy is when a person is taking multiple medications whether prescribed or over the counter. For it to be labeled as polypharmacy a person must be taking 5 or more medications.

Polypharmacy is a major issue in the aging community because they don’t have anyone advocating on their behalf. 50% of elderly people take more than 5 medications and this percentage will likely increase as time goes on and with increased age. It is important for conversation to be had with healthcare providers of the elderly when multiple medications are being prescribed.

Discussing polypharmacy ensures the safety of the patients and eliminates the risks involved in taking several medications. Talking about polypharmacy can help the doctor reduce the cost for the patient by eliminating medication that is no longer appropriate for the patient, and it gives the patient more education on their treatment and ways they could become more involved in their health decisions. Polypharmacy makes patients more vulnerable to more health crises soon.

In this blog, we will discuss how polypharmacy affects individuals, some of the health risks, why this happens, and what can be done about it. In conclusion, I will provide some resources if you suspect you or someone you know may be suffering from polypharmacy.

Understanding Polypharmacy

There are many types of polypharmacy that a person can be affected by, but they all run the risk of danger. We are going to look at the different types of polypharmacy and what each one is.

• Too Many Drugs– Although this could vary based on the person’s health and age. Too many drugs are when a person is consuming several different drugs, and it causes concerns with the individual putting the person at risk. Think of trying to put too much food in your mouth at the same time, how that will make you feel, and what the effect of that.
• Inappropriate Drug Prescribing– When a medication should have never been given to a patient because of health reasons or other medication the patient could be on at the time. It is like prescribing an antibiotic for a virus infection when we know a virus infection can’t be treated with an antibiotic. It’s like trying to use a screwdriver to take off a tire. Inappropriate tool for the job.
• Inappropriate Drug Combinations- When the different drugs are mixed with another that doesn’t agree it will cause drug interactions which is not good for the patient. If a person were to consume alcohol with Xanax it could in some cases cause death. If you take a sleep aid and then drink a Red Bull that is like driving with your feet on both the gas and the brakes.
• Inappropriate Dose– This involves giving more or less than the number of meds a person may need. The amount of dosage a person should take depends on factors such as age, weight, and medical history. It’s like pouring too much juice into a cup or not putting enough salt on your food. And 1 in every 5 medications prescribed is done with an error.
• Administration Error– Administration error is when a person is given the wrong medication or at the wrong time. Like giving a child, a cup full of alcohol instead of tea. This can cause someone to be very sick! Over 300,000 people die from medication errors each year and this number is increasing with more people getting sick and taking more medication, and the healthcare industry has a shortage of staff.

Each of these forms of polypharmacy happens every single day, especially to those who don’t understand their medication regimen and those who don’t feel they have other options outside the one the doctors suggest. Polypharmacy is more prevalent in the elderly community than any other group of people, but other age groups are affected as well.

Polypharmacy is prevalent with many different populations in several different regions. However, it is more widespread in elderly people with chronic conditions that require multiple meds to maintain the condition. According to the National Library of Medicine, with over 2 billion patient visits 65.1% (one billion-three-hundred-two billion) were common for polypharmacy, 16.2% (three-hundred-twenty-four million) experienced minor polypharmacy which is taking 3-4 medication, 12.1% (two-hundred-forty-two million) considered moderate, and 36.8% (seven-hundred-thirty-six- million) were major polypharmacy. Major polypharmacy is when a person is taking 5 or more medications at one given time. That’s a major number of people per year dealing with this deathly problem.

Polypharmacy happens for many different reasons, and I see the main reason is a lack of communication amongst doctors and clear communication with the patient. Many older adults with various medical conditions see multiple doctors and get prescribed medication from each doctor for each health problem. None of these doctors speak to each other about the patient unless something serious happens and many of the time this may be too late.

Some of the common reasons for polypharmacy are:

• Prescribing Cascading– So prescribing is when a new medication is prescribed to treat the side effects of another medication. When you think about this, it sounds crazy. What happens when a side effect happens from the new medication, I just received to take off the side effects from the other pill? You guessed it, you get another pill for that new side effect.

Imagine you have a toy that makes a loud noise that bothers your ears, and you are given earplugs to help the noise. But then the earplugs start to make your ear feel clogged up so, you are given a tool to help with that. And then that tool starts to cause another issue and you are given something else to fix that problem. This is how cascading happens. You are given more and more to fix each problem without taking away what you no longer need or just trying to correct the problem altogether.

• Overprescribing- Think of overprescribing as you are a person who collects shoes, and every week gets new shoes even though you already have many and you don’t clear out any shoes from your collection. This is how a person gets overprescribed medication. Patients getting meds they don’t need, getting prescribed multiple drugs for the same conditions, lack of awareness on the person’s part, and giving medication for a condition that will get better on their own are all problems with overprescribing. How would it look for a person to put an adult hair clamp on an infant’s head? Too much right? Same with doctors overprescribing medication.
• Fragmented Care- Fragment care is when a patient goes to more than one doctor and receives care from each of these doctors. None of these doctors have any connection with each other and don’t communicate with each other so, this leaves the unknown when it comes to the patient’s medical history.

So, you have a lot of pieces to build a Lego project but some of the pieces are with different friends, and when it comes time to put the project together without talking with the friends who have the other pieces. How would you know what is missing without talking with your friends?

• Patient Self-Medicating– This is when a person is taking prescribed medication and decides to start taking over-the-counter supplements without communicating this with her doctor. This is when a person takes their health into their own hands without understanding how those OTCs can affect their lives. This is polypharmacy committed by self because now other drugs are added to the med regimen that could cause negative interactions with other drugs, we are consuming.

So many dangerous risks and consequences come with polypharmacy. Patients with wrong polypharmacy will experience some harmful effects that can sometimes be deadly. Increased risk for adverse effects, affects a person’s quality of life, medication error, meds interactions, and cognitive impairment. Polypharmacy is a silent epidemic that affects millions of people each year with no solution. This is a harsh reality for so many uninformed patients.

Identifying the Risks

Knowing what polypharmacy is and the effect of polypharmacy is important for people who are taking multiple medications and are seeing several different doctors. Being able to identify the risks that come with taking several medications is a must for the benefit of the patient’s safety, help the healthcare provider make the treatment best for the patient, improve quality of life by not having to take medication no longer needed, and help cut the cost related to the medication expenses for the individual and the insurance companies.

Let’s explore six of the risks following polypharmacy:

• Adverse Drug Reactions (ADRs)- This is an unexpected and unwanted effect of taking a medication your body doesn’t agree with. ADR is not the same as a side effect. A side effect would be a person’s hair falling out due to chemotherapy. This side effect is expected and doesn’t catch the patient off guard. An ADR would be an example of someone taking medication for pain but started feeling nauseous or dizzy. This is considered an adverse drug reaction because this feeling was not expected.
• Drug Interactions- If you are taking medicine A and medicine B, and they don’t get along in your body, they will cause some unwanted effects. It’s like you have two dogs see each other for the first time and the interaction was good but sometimes they don’t get along and want to fight each other. The interaction can be that one med can make the other med stronger or weaker and there are times they combine and create a whole new problem. And there are different types of interaction outside of drugs on drugs

1. Pharmacokinetic Interactions (when one drug changes how another drug works in the body): absorption– how the body digests the meds, distribution– how the drug is broken down in the bloodstream, metabolism-how the drug strength is altered, and exertion-the rate as which the drugs are eliminated from the system.
2. Pharmacodynamics Interactions (how the body responds to multiple medications when they meet each other) which leads to synergistic – taking two drugs that do the same job and make each other more effective. Example: taking two pain pills, antagonistic– this is when medications tend to work against each other making them less effective. Example: taking medication to prevent blood clotting and taking vitamin K which increases blood clotting, additive– when two drugs work together to give a much greater benefit. Example: if you take Tylenol for a headache and take Excedrin for your back pain the outcome will be the same as if they took them at different times.
3. Food and Drug Interaction (sometimes the food and medication don’t get along which can make the drug ineffective) Example: Orange juice helps vitamin B12 metabolize in the bloodstream faster and grapefruit juice can slow down liver enzymes.
4. Drug and Disease Interactions (the interactions of medication against pre-existing medical condition) Example: antidepressant pills go against people with bipolar due to the trigger of manic episodes.

• Increased Risk of Falls and Fractions- Medications can cause dizziness or drowsiness that prevent a person from being able to balance which causes falls. Drug interaction can intensify side effects and mixing may cause the blood pressure to drop and cause dizziness or fainting. Older people have weak bones already and a fall can cause them to break, and that healing process can take long. Taking a certain mixture of medication can cause muscle weakness and without strong muscles, the body is not able to support itself which causes falls.
• Cognitive Impairment- Cognitive impairment has an impact on thinking and recalling information. It’s like trying to solve a problem without all the details needed to figure out the problem. Sedatives prescribed for anxiety cause a decrease in alertness, medication containing anticholinergic causes memory problems and confusion, and antidepressant medication causes confusion and delusions. When these medications are mixed with other medications, this can increase the problem with a person’s cognitive impairment. A medication mixture confuses the brain. You will have trouble with how the brain operates.
• Health Problems Get Worse- Polypharmacy causes medication to be ineffective when taken with other medication or certain medications. When a medication is not working as intended it leaves the health condition untreated. Overmedication many times puts a strain on the body’s major organs which causes those organs to overwork and eventually break down. It’s like when your car starts running hot and you keep putting fluids in it to cool it down and never address the real problem, it causes your engine to work harder to cool the engine but over time the car gets tired and just blows a gasket. Your only issue was your coolant system now, you have an engine problem now. You see how one problem caused another problem because it was not treated properly. Like how health problems get worse when they are not treated correctly.
• Financial Burden- Polypharmacy can have a huge impact on a person’s finances. There is a price tag with each medication, and many are not covered by insurance or don’t have a generic brand which puts the total cost on the patients and these drugs can cost 100s of dollars for one medication. Taking multiple medications will lead you to take more medication, which leads to more doctor visits which will cost more money out of the pocket of the patient and now this becomes a financial burden for the person.

So, as we see, polypharmacy comes with many different risks, but many can be reduced by having a clear understanding of the patient’s medical history, communication between each doctor, and educating the patients themselves. Polypharmacy can have an impact on a person’s health, livelihood, finances, and quality of life. However, I believe the number one key to getting this contained is communication between everyone involved in the care of the patients.

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Real Life Story:

Title: Pressure Point

My neighbor Mary was a very nice lady who worked as a schoolteacher at the local elementary school. Mary enjoyed life and stayed active daily. Everyone in the neighborhood loved and respected Mary. Mary was sure to do two things every day and that was walk her dog and work in her garden. Little did we know she was suffering from some health issues, and she was taking so many medications that she lost track of which each one was for.

Mary first started taking medication called Terazosin to control her high blood pressure. She had taken this medication for a short while, but the medication would cause her blood pressure to drop and cause dizziness. When she reported these side effects to her doctor his solution was to prescribe her a drug to help keep her blood pressure stabilized which was Midodrine, but this medication caused Mary to have headaches and there you know it she got another prescription to treat the headache. The headache medication caused her insomnia now she has a medication for the insomnia. Then antidepressants for mood swings, and a muscle relaxer for her back pain. At one point Mary was taking 8 medications.

Each medication prescribed to Mary came a new problem and then came more medication until she found herself taking more and more medication each year without question. I remember seeing Mary and she was not moving like herself and that is when she explained to me what was happening to her. She said, “She didn’t feel like herself and her day has come with taking medications she has no clue what they were for anymore and if they were helping her or harming her.”

She had no one else to turn to, she didn’t know how to communicate with her doctor and didn’t recognize polypharmacy was even a thing until I informed her about it. I explained to her everything about polypharmacy and told her I would review her meds. After completing her review, I found that she was taking two medications for the same problem, she was taking a medication for a problem that did not exact, and two of her medications should have not been prescribed together because they did not work well together. I continued to do my research on her health and the medication she was taking and visited her doctor with her.

At the appointment I was able to ask the doctor about some of the meds she was taking why she had been prescribed two drugs for the same issue and why she was taking a medication she had no illness for and his response was “For the two medication for the same issue, she started on one of the medications and when her condition progressed she was given another medication, and as for the medication she was taking that she had no illness associated with, we prescribe that medication just in case she where to develop the illness due to one of the medication she was taking.” You are giving a person medication for a condition she may or may not develop and you never removed the old medication when you gave her a new one for the issue.

When I left that office with Mary, I was in complete shock to see just how disconnected the doctor was from his patient’s treatment. At that point, I made it possible to get Mary off many of her medications and only take what she needed. The good thing was Mary was ready to feel healthier and was willing to do what needed to be done to reduce her medication and not be bound by all those meds. It was not an easy road but, in the end, I was able to get Mary off the 6 of the 10 medications she was taking at that time and her quality of life went tremendously.

If you are someone you know suffering in silence with polypharmacy, please seek help and you can start with your local pharmacy or ask your doctor for a comb-through review of your meds and the reason for each. But most importantly. Be sure to do your homework about your meds and other alternatives because your opinion is mostly important.

Strategies for Avoiding Polypharmacy Pitfalls

There are a few things that can be done to prevent polypharmacy or help someone who is dealing with this now and wants to reverse polypharmacy. One of the things I will talk about first and is the number one way to combat and spot polypharmacy is a medication check.

A medication check is known as a medication review, medication evaluation, or medication reconciliation. This is a deep dive into a patient’s medication regimen completed by a healthcare professional. What happens in the process of medication reconciliation is:

• All medication is reviewed (prescribed, over the counter, and herbs),
• Review of medication history (meds that have been discontinued, dosage change, or complete medication change)
• Identification of duplicate meds (when similar medication is prescribed for the same thing)
• Identify drug Interactions (when two or more medications interact and cause an adverse outcome)
• Indication evaluation (determines reasons for prescription and is the medication still relevant for the condition and checks for an alternate medication that may be better suited for the patient)
• Check for adverse effects (side effects you may be experiencing due to the medications)
• Improvement of medication therapy (adjusting dosages, stopping the use of medication no longer needed, adding new effective medications, or changing treatments)
• Educate patients (educate the patient on their medications on proper usage, possible side effects, and the importance of adherence.
• Communication method (guidance on how to communicate with their doctor on what questions to ask and how to ask them)

I’m sure you can get the picture of how important a medication can be for any person taking medication and who has been taking it for some time now. The medication check is a detailed review of all the medications you are taking or have taken in the past and their effect on you. The medication reconciliation job is to ensure the safety of the patients and to make sure the patient’s health is the top priority and not just continue to write a prescription.

Communicating with your doctor about your treatment should always take place but you as the patient need to be educated about your health and your treatment. Before you can have a clear conversation with your doctor you must be informed yourself and don’t expect the doctor to do it for you because what educate us on is always the bare minimum and it’s never enough.

When having the conversation with your doctor about polypharmacy you need to be clear about what you are speaking about and how to effectively communicate that.

Here’s an approach you can take when having that chat with your doctor:

1. Get Prepared: Gather all your information such as your medical background, current meds taking, and medication taken in the past. Include herbal supplements and over-the-counter medications. Write down any issue you may be having with the medication. Write down everything you can think of because you never know what will be relevant.
2. Talks with your doctor: Schedule an appointment to see your doctors or doctors. When you call explain to them your reason for the appointment so they can schedule a time that will allow you enough time to get what you need from your doctor.
3. Express your concerns: For you to be able to express your concerns you have to be educated about your concerns. So, please do your research before you visit your doctor otherwise you will not know how to start the conversation. Share your concerns about the medication you are on and how they have impacted your health.
4. Ask, ask, ask, questions: Ask anything you don’t feel sure about, and don’t let the doctor give you random answers to get you out the door. If you don’t understand something, say to the doctor “Explain to me like I’m a 6-year-old”. If you want to explore other treatments, that would be the time to discuss it with your doctor.
5. Make a plan: Work with your healthcare provider to simply adjust meds if needed. That plan should be put in place and enforced so you can feel better and more confident about the meds you take.
6. Stay in touch: Make a follow-up appointment within 60 days to discuss progress with your doctor on how things are going, and you may find another adjustment may be needed.
7. Write it down: Keep a record of what you discussed and what was decided. Most importantly keep track of your health as far as if things getting better or worse. If you not feeling good on Monday after taking your medication, write it down and be mindful of that feeling and what happened to trigger those feelings. Record keeping is highly important because we can sometimes forget about things, we are experiencing how we are experiencing it and what causing that experience. Again, take notes, take notes, take notes!!

Make sure you weigh out all your options when it comes to taking any medication. You can never assume the doctor knows your body better than you. It is up to you to take control of your health and not 100% put all your trust in your doctor. This is your life, your health and it’s your responsibility to see that you are getting the best care possible. Don’t let your health be a mystery start your journey of awareness today!