polypharmacy.pptx by dr. saurabh maurya

polypharmacy

1. “One of the first duties of the physician is to educate the masses not to take (inappropriate) medicines”.

2. Content : Definition Epidemiology Reasons of polypharmacy Types Controlling Measures Strategies and roles Conclusion

3. Definition : According to WHO “ Polypharmacy is defined as the administration of many drugs at the same time or the administration of an excessive number of drugs.” In terms of the number of medications, polypharmacy is the use of five or more medications daily (this includes OTC drugs, prescription, traditional, and complementary medicines used by patients).

4. Epidemiology : Most common in geriatric patients ( because often they suffer from chronic diseases with concomitant pathologies). Prevalence in India: 33% Uttarakhand and Karnataka have the highest prevalence among states.

5. Synonyms: Polymedication Poly-prescription Multi prescription Multimedication .

6. Classification : Same-class polypharmacy – Use of more than one medication from the same class. eg . - Two SSRIs such as Fluoxetine and Paroxetine Multi-class polypharmacy – Use of more than one medication from different classes. eg . – Lithium with an atypical antipsychotic (olanzapine) ACEI with CCBs

7. Adjunctive polypharmacy – use of one medication to treat side effect of another medication from different class. eg . – Antibiotics with Probiotics Bupropion with Trazadone Augmentation polypharmacy – use of medication at lower dose with other medication from different class at full therapeutic dose for same symptom. eg . – addition of low dose haloperidol in a pt responding partially to risperidone.

8. Total polypharmacy – - It is total count of medications used in a patient or total drug load. - It includes prescription medication , OTC drugs, alternative medical therapies.

9. Reasons for polypharmacy – Elderly patients Patients with multiple comorbidities Self-medication with OTC drugs Multiple doctors Prescribing cascade Patient’s non-adherence Lack of patient education In-effective communication

10. Outcomes of polypharmacy – Negative outcomes – 1) Interactions – Drug- Drug interaction , Drug – food interaction Drug – alcohol interaction Adverse effects Inappropriate treatment Non-adherence Increase treatment expenditure

11. Positive outcomes : Synergistic combination – - allows lower doses so less adverse effects. - eg . – Treatment of hypertension Supplemental drug may decrease adverse effect - eg . – anticholinergics added for drug induced extrapyramidal symptoms.

12. Additional drug may approve outcome. eg . – spironolactone added with ACEI for heart failure. Multiple drugs may be needed for multiple conditions. eg . – DM with HTN Economic impact of polypharmacy : Increase in medicine expenditure. Chances of hospitalization and exposure to multiple doctors increase which leads to high economic burden.

13. Controlling Measures : Maintain an accurate medication and medical history - having a complete list of medications can deter a doctor from adding a new drug. Link each prescribed medication to a disease state - any medication that does not match a diagnosis should be discontinued. 3) Identify medications that are treating side effect

14. Use of multiple medication leads to a higher risk of side effects. When side effects occur, addition medicine can be initiated. Eg . – 1- use of laxative to treat medication side effect of constipation. 2 – use of sleeping medication to treat insomnia caused by theophylline and prednisone. 4) Initiate interventions to ensure adherence using combination drug will reduce pill number. Use generic drug to reduce cost.

15. Preventions : Use of appropriate medications Drug which is unnecessary, inappropriate should be avoided. Drugs having high likelihood for causing side effects should be avoided.

16. Role of Physician to reduce polypharmacy : Determine all medications being taken. Indentify indication for all medications. Identify any potential for adverse effect for each medication. Recommend eliminating medication with no benefit, goal. Recommend substituting medication with lesser side effect. Use medications with less frequent dosing schedule. Avoid utilizing another medication to treat side effect of another agent.

17. 8. Keep drug regimens as simple as possible. 9. Review all medication profiles regularly. 10. Encourage the patient to follow up regularly. 11. Encourage patient to carry the list of their medication to every physician.

18. Role of Consumer: Get involved in his own health. Should not be afraid to ask questions. Patients should know the name and indication of each drug. Ensure dietary/herbal supplements are safe before taking. Proper storage of medication.

19. Roles of pharmacists: Hospital pharmacist – Review the complete and accurate list of patients medications. Long-term care pharmacist – to evaluate drug therapy regimen in predominantly elder patients. Community pharmacist – preventing the dispensing of unnecessary, inappropriate and side effect prone medications.

20. Strategies to avoid polypharmacy: ARMOR – A ssess medication - R eview for possible interaction - M inimize nonessential medications - O ptimize dosing - R eassess patient for clinical status and adherence. Tool to evaluate polypharmacy in older adults. A systematic and organized step wise approach.

21. Conclusion: Polypharmacy is a problem of substantial importance. It is a preventable problem mostly. Interventions like reducing the number of medications, increase patient adherence, preventing ADRs are the main tool to combat polypharmacy.

22. References: Priya S, Gupta NL, Chauhan HS.  Polypharmacy – Prevalence and risk factors among elderly patients in government medical college, Tanda , Distt Kangra (HP)  [[Last accessed on 2019 Jun 13]]. Available from:  https://gmch.gov.in/community%20medicine/IPHA_Vol%203_No9.pdf   Rituparna Maiti , Post-graduate Topics in Pharmacology, 3 rd edition, Paras Medical Books 2020 Sarkar S, Srivastava V, Mohanti M. Postgraduate pharmacology, 1st edition Paras Medical Books 2020

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