23 hours ago, at 9:17 PM
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Polypharmacy is the usage of at least five medications regularly and the older adults usually above 62 years old and younger children are more susceptible. Polypharmacy is brought about by a wide range of risk factors some of which are patient-related factors and others are system level (Halli-Tierney, Scarbrough, & Carroll, 2019). Aggarwal, Woolford, & Patel (2020) points that multi-morbidity is one of the risk factors that lead to polypharmacy happens where at least two concurrent chronic health conditions are present in an individual. Multimorbidity is characterized by the observation of clinical guidelines that advocate for patients using a variety of medications to contain and manage the diseases and the risk factors associated with the diseases. Therefore, the increase in the frequency of dosages and medications to manage diseases’ risk factors leads to polypharmacy. Halli-Tierney, Scarbrough, & Carroll, (2019) asserts that poor medical record keeping is a system-level risk factor that could lead to polypharmacy. Poorly updated medical records are bound to lack a previous medical history of the medications prescribed. This may lead to the healthcare providers failing to monitor the patients’ history and reviewing medications if they are not clinically beneficial hence the patients are susceptible to more medications.
As a nurse practitioner, to prevent the occurrence of polypharmacy and its complications, a few interventions would be recommended. According to Young et al., (2021), first, an intervention to engage patients in a discussion to emphasize the need for patients to keep a precise outline of all medications prescribed, their dosage frequency, their names, potential side effects, dosages, and the reason why the medications were prescribed. Secondly, as a nurse practitioner teaching patients to the importance of taking medications as prescribed by the physicians, not sharing the medications, and storing the medications in a safe and secure means
References
Aggarwal, P., Woolford, S. J., & Patel, H. P. (2020). Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice. Geriatrics, 5(4), 85.
Halli-Tierney, A. D., Scarbrough, C., & Carroll, D. (2019). Polypharmacy: evaluating risks and deprescribing. American family physician, 100(1), 32-38.
Young, E. H., Pan, S., Yap, A. G., Reveles, K. R., & Bhakta, K. (2021). Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. Plus, one, 16(8), e0255642.
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Amniellys Rodriguez Diaz
1/25/22, 6:46 PM
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Polypharmacy
Week 4 , Discussion Question
Advanced Pharmacology
Two of the common risk factors for polypharmacy include age and obesity. With regards to age, it can be said that when people get older, they are much more likely to be afflicted with various illnesses and diseases. This can include such issues as frailty (which increases risk of falling and getting injured), problems with various organs, loss of vision, loss of hearing, and many other medical and health problems (Ersoy & Engin, 2018). This is why older people tend to be prescribed with various medications for their conditions, which is something that can lead to polypharmacy. Other than that, we find that obesity is also something that is associated with polypharmacy. The reason for that is that when a person is obese, he or she is at a much higher risk of getting various illnesses, such as diabetes, cardiovascular diseases, as well as other ailments. This is why it can be said obesity is also a risk factor for polypharmacy, as the patients would be taking medications for all these illnesses.
Nurse practitioners can take various actions to help prevent polypharmacy and its complications. One of the things that can be done is to ensure that the nurse practitioner is working closely with the patients and the families so that an accurate list of medications can be created. This would allow the nurse practitioner to be aware of all the different medications that the patient is taking so that any interactions and/or contraindications can be studied. Another intervention would be to ensure that there are no inappropriate, incorrect, unnecessary, or duplicate prescriptions. In some cases, patients might be taking two different medications to treat the same symptom, which can result in unnecessary and duplicate medications. This is something that can also help reduce complications from polypharmacy (Pala et al., 2021)
References
Ersoy, S., & Engin, V. S. (2018). Risk factors for polypharmacy in older adults in a
primary care setting: a cross-sectional study. Clinical interventions in aging, 13, 2003.
Pala, E., Ersoy, S., Engin, V. S., & Benli, A. R. (2021). Effectiveness of STOPP/START
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Aymee Morales Aranegui
Polypharmacy, Risk Factors
Excessive polypharmacy, a condition where people take more than five medicines, has many potential risk factors. Individuals above 65 years old report risk factors such as obesity and decreased mental health status after exposure to multiple drugs (Rieckert et al., 2018). Obesity is a significant challenge in America, and many people are struggling to find solutions to this issue that has proven to be challenging to manage. Additionally, many Americans struggle with reduced mental health status, which impacts their everyday operations, especially when there are few prevention measures (Rieckert et al., 2018). Thus, it is appropriate to identify the rationale for obesity and decreased mental health status as important risk factors among older adults exposed to excessive polypharmacy.
Obesity and decreased mental health status lead to polypharmacy because of many factors. For instance, multiple risk factors are associated with obesity, leading to more than five drugs. Some of the consequences of obesity that increase chances for excessive polypharmacy include high blood pressure (HBP), coronary heart disease, osteoarthritis, stroke, and gallbladder disease (CDC, 2021). On the other hand, reduced mental health status in older adults has contributed significantly to excessive polypharmacy. Older adults with lower mental health status have reported the uptake of medicines for chronic pain, reduced mobility, depression, frailty, and dementia, among other health problems (World Health Organization, 2017). These risk factors contribute to polypharmacy.
Interventions to Prevent Polypharmacy and Complications
There are different interventions that I can take as a nurse practitioner to help prevent polypharmacy at my clinical practice. The first intervention is adopting comprehensive medication reviews (CMRs) that will enable the collection of specific patient information and the creation of a plan to solve any medical challenges, alongside limiting the number of medicines given to a patient. Understanding a patient’s medical history is important in terms of preventing polypharmacy and potentially inappropriate medications (PIMs). Another intervention embraces deprescribing algorithms that involve steps to eliminate inappropriate medications that a patient might be using. For example, rational knowledge of each drug, risk/benefit assessment of each active ingredient, patient Assessment, patient, family and/or caregiver education, always consider the possibility of iatrogenesis: both when adding such as stopping a drug, and the indications must be continuously evaluated and adjusted. APNs are clinical leaders and are responsible for assessing their practice for quality and patient safety (Moser & Robinson, 2016).
References
Centers for Disease Control and Prevention (CDC). (2021, March 22). Adult obesity causes & consequences. https://www.cdc.gov/obesity/adult/causes.html
Moser, T., & Robinson, M.V. (2016). Pharmacotherapeutics for Advance Practice Nurse Prescribers. (4th ed.). Philadelphia: F. A. Davis Company.
Rieckert, A., Trampisch, U. S., Klaaßen-Mielke, R., Drewelow, E., Esmail, A., Johansson, T., Keller, S., Kunnamo, I., Löffler, C., Mäkinen, J., Piccoliori, G., Vögele, A., & Sönnichsen, A. (2018). Polypharmacy in older patients with chronic diseases: A cross-sectional analysis of factors associated with excessive polypharmacy. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0795-5
World Health Organization. (2017, December 12). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
Villelixe Soto
Advanced Pharmacology
Medical advancements have greatly contributed to better health globally. Consequently, this has led to an increase in the population of the elderly, who are above the age of 65. Despite this being a remarkable foot, it has come with a compounded problem of polypharmacy. Polypharmacy is defined as the use of multiple medications concurrently that are more than medically necessary (Holmes, 2018). It is estimated that over 50% of the older population takes more than two medications that may not be medically necessary (Holmes, 2018). This puts the gains made in jeopardy due to the risk factors, such as non-adherence and adverse drug effects, posed by polypharmacy.
Adverse drug effects (ADE) can be described as the negative effects one experiences because of prolonged drug use. Most elderly people are at a risk of suffering from ADE due to the use of multiple drugs over a long period to treat certain medical conditions (McCabe & Shaw, 2017). This compounded with the fact that they are on several other medications concurrently may consequently lead to medical non-adherence. This is the unintended state whereby prescribed medication fails to fully meet its intended purpose towards the patient. A study shows that medical non-adherence stands at 35% for patients taking more medication concurrently than required (McCabe & Shaw, 2017). This non-adherence can cause rapid disease progression, treatment failure, and ultimately be life threatening to a patient. Functional failure among the elderly is also associated to polypharmacy. This is a situation whereby the patient is unable to perform instrumental daily activities hence leading to gradual decline physical functioning.
As a healthcare provider, there is a general rule that stands; ‘keep it simple’. This implies that we should reduce the number of medications prescribed to older people and give them simplified doses (Santana & Lane, 2018). As per my observation, this is the simplest yet most effective way to deal with polypharmacy. Technology has been on the forefront to help mitigate the adverse effects of polypharmacy. Integrated prescribing and administration alert systems are the fields being explored to effectively help manage medication, especially among the aging population (Santana & Lane, 2018). Having medical records, lab report records, and prescriptions handled electronically are among the innovations being sought to counter these challenges. These are the measures I would certainly implement in my clinic to Help in reducing chances of polypharmacy.
Polypharmacy is a medical issue that affects the elderly due to the necessity to treat common prevalent diseases associated with old age. This poses great risks such as treatment failure and disease advancement among patients. However, the effects of polypharmacy can be reduced with proper medical care, interventions, and technological advancements.
References
Holmes, H. (2018). Polypharmacy, An Issue of Clinics in Geriatric Medicine-E-Book (Vol. 28, No. 2). Elsevier Health Sciences.
McCabe, P. C., & Shaw, S. R. (Eds.). (2017). Psychiatric disorders: Current topics and interventions for educators. Corwin Press.
Santana, M. S., & Lane, K. (2018). Improving prescription practice to reduce polypharmacy in the elderly.
Ana Barreras Lopez
Florida National University
NGR 6172: Advanced Pharmacology
Dr. Latoya Dotson
January, 2022
Discuss two (2) common risk factors for polypharmacy
Life expectancy is increasing worldwide. This has brought about the awareness that chronic diseases reach a top place. The multimorbidity increases the consumption and the risk of polypharmacy. One of the most common conditions that leads to this phenomenon is chronic pain and is often associated with behavioral and somatic comorbidities. The existence of numerous treatment options, interdisciplinary approach, and combination of medications contributes to polypharmacy. Combined drug therapy may improve symptoms because implies multiple physiological mechanism. But medication-related problems such as: adverse effects, impair safety, drug interactions, toxicity, addiction potential, abuse, insomnia, and tolerance are prone to occur (Ersoy & Engin, 2018).
System related factors are difficult to solve and identify. One patient can be evaluated by multiple specialists and each one prescribes certain number of medications for specific condition. The poorly updated medical records, lack of communication between specialties due logistics and legal factors, automatic refills services, among other issues contributes the expansion of this negative event. Particular vulnerability is seen on those individuum with no primary physician that monitor all subspecialities recommendations. Management of resident in long-term care facilities result a challenger. This particular population are more prone to have a mix of medical and mental issues with cognitive impairment and polypharmacy is common (Payne, 2020).
Discuss two interventions you can take as a Nurse Practitioner (NP) in your clinical practice to prevent polypharmacy and its complications.
Exist several tools that providers can use on the dairy practice to assess, evaluate and take action in this matter. The explicit assessment tools (Beers, STOPP, and START) are based on rigid standards that allows the identification of potential inappropriate medication, duplication, interaction, but the patient complexity is not considered. Implicit tools are more time consuming and based on physician judgment but are more patient-centered. The process of identify and prioritize medications is essential for deprescribe those that cause more harm than benefits. It must be centered on evidence base and judicious use of pharmacology.
Medication reconciliation is a continuous process. In each visit is important to review the treatment plan, use of over-the-counter medications, herbs, etc. in order to identify potential problems. It allows a proper and rational management of medical treatment (Ersoy & Engin, 2018). It is a holistic and patient-centered review and implies decision making. Also, allows the addressing of unnecessary prescriptions increasing the effectiveness, safety and reduce cost (Payne, 2020). One of the most difficult barriers to overcome is the cultural believes. Health education plays an important role on the comprehension of facts and agreement to commit with treatment plan. Only with a transparent and real communication between provider and patient, polypharmacy can be eradicated or prevent.
References
Ersoy, S., & Engin, V. S. (2018). Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study. Clinical Interventions in Aging, Volume 13, 2003–2011. https://doi.org/10.2147/cia.s176329
Payne, R. A. (2020). Polypharmacy and deprescribing. Medicine, 48(7), 468–471. https://doi.org/10.1016/j.mpmed.2020.04.003
Luanda Gan Bedoya
Polypharmacy Risk Factors and Prevention
Polypharmacy has been linked to functional deterioration in older patients. When various drugs are used in a mix to treat psychiatric conditions, cognition and living capacities are commonly harmed. Functional decline increases with an increase in polypharmacy. Patients who have been subjected to high levels of polypharmacy experience the decreased ability to perform daily tasks (Hughes, 2021). Secondly, drug interactions are more likely in older people subjected to polypharmacy (Wastesson et al., 2018). Multiple drugs can raise the likelihood of adverse side effects (ADEs) by potentiating them with one or more medications. The chances of a drug-drug interaction grow together with the number of medications. Avoidable ADEs and medication-related admissions are frequently caused by drug-drug interactions (Wastesson et al., 2018). The risk of drug side effects should concern healthcare practitioners as patients with chronic conditions often require extensive drug therapy (Wastesson et al., 2018). In turn, these risks factors affect the quality of life.
Polypharmacy can be managed by elaborating a complete and accurate list of all drugs a patient needs to take. Patients may be prescribed duplicate drugs or medicines that interact with a current regimen if their medication list is inadequate or erroneous when they are hospitalized (Hoel et al., 2021). As a result, they may experience interaction or adverse medication events throughout their stay, with some of these events continuing after they leave. Another way to manage polypharmacy is ensuring that every drug is linked to a condition or another justification. The rationale for taking it must be explicitly conveyed to the patient. If it is not done, doctors should ask why the patient is taking the drug in the first place (Hughes, 2021). If no indication exists, deprescribing may be necessary. The condition for which the medicine is prescribed should be included in all prescriptions (Wastesson et al., 2018). This information must be clearly stated on prescriptions and instructions.
References
Hoel, R. W., Connolly, R. M. G., & Takahashi, P. Y. (2021, January). Polypharmacy management in older patients. Mayo Clinic Proceedings, 96(1), 242-256. https://doi.org/10.1016/j.mayocp.2020.06.012
Hughes, C. (2021). Appropriate and inappropriate polypharmacy — choosing the right strategy. British Journal of Clinical Pharmacology, 87(1), 84-86. https://doi.org/10.1111/bcp.14589
Wastesson, J. W., Morin, L., Tan, E. C., & Johnell, K. (2018). An update on the clinical consequences of polypharmacy in older adults: A narrative review. Expert Opinion on Drug Safety, 17(12), 1185-1196. https://doi.org/10.1080/14740338.2018.1546841
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9:17 p.m., 23 hours ago
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Polypharmacy is the regular use of at least five medications, and older persons (typically over the age of 62) and younger children are more vulnerable. Polypharmacy is caused by a variety of risk factors, some of which are patient-related and others which are system-level (Halli-Tierney, Scarbrough, & Carroll, 2019). Aggarwal, Woolford, & Patel (2020) points that multi-morbidity is one of the risk factors that lead to polypharmacy happens where at least two concurrent chronic health conditions are present in an individual. Multimorbidity is characterized by the observation of clinical guidelines that advocate for patients using a variety of medications to contain and manage the diseases and the risk factors associated with the diseases. Therefore, the
