Transcript Factors that contribute to polypharmacy

POLYPHARMACY
Factors that contribute to
polypharmacy
Chronic medical conditions
Female gender
Multiple physicians, especially specialists
Prescribing by brand and generic names
Self medication with OTC medications
Increased elder mobility
Direct-to-the-consumer advertising
Physician on call
More factors that contribute to
polypharmacy
Physicians are reluctant to stop a
medication started by another physician
End points of drug therapy are seldom set
and patients are not reevaluated for the
need to continue medications
"Start slow, Go slow" may yield failure to
raise the dose to a therapeutic level
Multiple pharmacies
Adverse Drug Effects
ADEs and Drug interactions in
the elderly
 25% of the elderly at home.
 2 to 8% of hospital admissions of all patients.
 If 65+, then 5 to 30% of hospital admissions.
 60% of patients admitted due to adverse drug
reactions were taking 11 or more drugs.
 Risk increases with number of drugs.
 Elders in the hospital get more drugs so at even
greater risk of ADE while an inpatient.
Drug interactions
More common in the elderly simply
because they take more drugs
More than 20% of adverse drug
reactions in the elderly are due to
drug interactions
Drug-drug interactions
Drug-nutrient interactions
Patient compliance problems
Patient compliance problems
Morbidity and disabilities from disease
Complex regimens
Drug characteristics
Solutions
Nonadherance and No. of Drugs
100%
80%
60%
40%
20%
0%
1
2
3
4
5
>6
Morbidity and disabilities from
disease
 Movement disorders
 Amputations
 Impaired vision
 Comprehension and memory deficits
 Depression or psychosis
Complex regimens
Multiple medications
Multiple administration times
Complex administration
Devices
Miscellaneous drug
characteristics
 Taste
 Cost
 Side effects
 Capsule or tablet size
Altered physiology in the elderly
affects medications
Multiple organ system changes
Pharmacodynamics
Pharmacokinetics
Pharmacodynamics
Altered drug receptor sensitivity
Fewer receptors
Receptors are less sensitive
Receptors are more sensitive
Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Absorption
Reduced gastric acid and fluid- dissolution
Delayed gastric emptying
Reduced gastric acid - pH dependent
absorption
Reduced GI blood flow - absorption
Distribution
Decreased total body water
Decreased lean body mass
Increased total body fat
CHF and impaired drug delivery
Metabolism
Hepatic blood flow
First pass metabolism
Liver enzyme system activity
Excretion
Reduced renal blood flow
Age related decline in blood flow
CCr declines 1% per year after 40
Solutions to Problem
Once a day medications
Absolutely necessary medications only
Education
Involve family
Review of medications at each visit
Listening to the patient