Polypharmacy

in the Elderly:

mmLearn.org is a program of Morningside Ministries

Are you taking too many medications?

Carrie Allen

PharmD, CGP, BCPS

Example Case Study, 65 year old male - Common

1. Tylenol PM 2 tablets by mouth at bedtime

for insomnia (person chose this)

2. Amitriptyline 50 mg by mouth at bedtime

for depression, pain and insomnia (Nurse

practitioner)

3. Celexa 40 mg by mouth daily for

depression (psychiatrist)

4. Abilify 5 mg by mouth daily for depression

(psychiatrist)

5. Multivitamin 1 tablet by mouth daily for

anemia (?)

6. Tamsulosin 0.4 mg PO every other day at

bedtime for benign prostatic hypertrophy

(urologist)

7. Cosopt (dorzolamide/timolol) 1 drop in

each eye BID for glaucoma (eye doctor)

8. Acetaminophen 325 mg, take 2 tablets by

mouth every 4 to 6 hours as needed for

pain or fever (person chose)

9. Ibuprofen 200mg tablet, take 2 tablet by

mouth every 4 to 6 hours as need for joint

pain (PCP)

11. Hydrochlorothiazide 25 mg by mouth every

morning for high blood pressure

(cardiologist)

12. Coreg 6.25 mg by mouth twice a day with

breakfast and dinner for high blood pressure

(cardiologist)

13. Lisinopril 20 mg by mouth for high blood

pressure (cardiologist)

14. Clonidine patch 0.3 mg/24 h, apply 1 patch

every 7 days for high blood pressure

(average daily blood pressure = 105/70; last

doctor’s office blood pressure 115/78) (?)

15. Simvastatin 80 mg by mouth nightly for high

cholesterol (last lipid panel indicates: total

cholesterol = 170, LDL = 70, HDL = 31,

Triglycerides= 89) (cardiologist)

16. Red yeast rice 2 capsules by mouth nightly

for cholesterol (person chose)

17. Sleepy Tea – herbal tea for relaxation and

sleep as needed

14-16 Doses a day NOT including the weekly patch and as

needed use of acetaminophen or ibuprofen or the tea

4 different prescribers plus what person chooses to take

Polypharmacy Taking too many medications!

• Usually defined as taking 5

or more medications OR

taking more medications

than are medically required.

• With each addition of a

medication the risk for a

drug-drug or drug-disease

interaction increases.

Polypharmacy Taking too many medications!

•Increase in adverse drug

interactions (e.g., falls)

•Increase in side effects,

maybe even decrease in

physical function or mobility.

•Increase in likelihood that

someone will prescribe another

medication to treat what may

be a side effect of another

medication – prescribing

cascade.

•$$$$$$

Lots of medical problems & being

in America

Using the healthcare system (hospitalizations

too)

Lots of different prescribers

Prescribers don’t like to step on

each other’s toes

Inappropriate use of treatment guidelines

Prescribing cascade

Using multiple pharmacies

In this day and age,

why and how

does this happen?

Other Risk Factors

• Older Age

• Female Gender

• Lower Education Level

• Low knowledge of your medical

conditions

• Being afraid to ask your

prescriber questions, challenge

them or report side effects

Other Risk Factors (continued)

• Being unaware of side effects – although the

internet is not always accurate, FYI

• Not taking medications as prescribed and NOT

being honest about it (they’ll only increase your

dose or add another medication)

• Not being a vigilant consumer of healthcare

services, I’m not buying a pair of shoes from a

salesperson who doesn’t listen to me, why the

heck would I take medical advice from someone

like that!?

Are you alone?

• Kind of…

• Born alone, die alone, swallow your own

medications alone…BUT you are not alone in

how you got to this point of taking

too many medications.

• What can you do?

What can you do?

• Take responsibility, research, ask questions

» Know all of your ACTIVE diagnoses and HISTORY of

illnesses – and document it.

» Know what each drug you take is for (who cares if you

pronounce it wrong?)

» Have an up-to-date drug list, take it with you to every

doctor’s appointment.

» Question your doctors and your pharmacist and also

make them accountable.

• Service industry, you are a medical consumer, don’t

be too American.

» Try to go to only one pharmacy.

» Mail order…well, I talk fast…

What is the approach?

• First, this isn’t a secret that only healthcare

professionals know.

• BUT many don’t take the time to do it.

• AND some actually haven’t taken the time to learn

about it or apply it to their practice.

• I expect my healthcare providers to THINK

CRITICALLY and take other issues into account

outside their specialty.

What is the approach?

The newer term for it is:

“de-prescribing”

Basically, have your doctors

work with you to get rid of

medications you don’t need.

What is the process?

Inform

• You tell them - Let all your prescribers know what you are taking (OTC, herbals, supplements, health drinks and prescriptions) and any side effects you are having – BE SPECIFIC (e.g., my mom)

• They tell you- What each is for and side effects (pharmacist can help)

Rights

• Ensure that you have the right drug for the right condition at the right dose

• Do you want more drugs at the wrong dose or less drugs at the right dose?

• Low and slow, but still go VS. being safe

No-No’s

• If there is no benefit or no reason for the drug, ask the prescriber to tell you how to discontinue it (many drugs have to be TAPERED – e.g., blood pressure, antidepressants)

What is the process?

Safety

• Are you on the safest medications for YOU? You are unique (e.g., my friend’s mom).

• IF NOT, see if a safer drug can be substituted (e.g., Beers List)

• You are not a number (treat the person not the number)

Be less American

• Ensure that you are not unintentionally or intentionally prompting your prescriber to give you a pill for every complaint you have – you may be contributing to your own prescribing cascade.

1

• Unless it is costly, try to see if you can get once a day dosing for the majority of your medications

Accept Change

• Over time, your body changes (not just puberty folks)

• The way your body metabolizes and gets rid of drugs changes – your dose or regular drugs may have to be changed or reduced (let your doctor know you know this)

You + Your Prescriber + Any Family or

Caregivers + Your Pharmacist

1. Tylenol PM 2 tablets by mouth at bedtime

for insomnia (person chose this)

2. Amitriptyline 50 mg by mouth at bedtime

for depression, pain and insomnia (Nurse

practitioner)

3. Celexa 40 mg by mouth daily for

depression (psychiatrist)

4. Abilify 5 mg by mouth daily for depression

(psychiatrist)

5. Multivitamin 1 tablet by mouth daily for

anemia (?)

6. Tamsulosin 0.4 mg PO every other day at

bedtime for benign prostatic hypertrophy

(urologist)

7. Cosopt (dorzolamide/timolol) 1 drop in

each eye BID for glaucoma (eye doctor)

8. Acetaminophen 325 mg, take 2 tablets by

mouth every 4 to 6 hours as needed for

pain or fever (person chose)

9. Ibuprofen 200mg tablet, take 2 tablet by

mouth every 4 to 6 hours as need for joint

pain (PCP)

11. Hydrochlorothiazide 50 mg by mouth

every morning for high blood pressure

(cardiologist)

12. Coreg 25 mg by mouth twice a day with

breakfast and dinner for high blood

pressure (cardiologist)

13. Lisinopril 20 mg by mouth for high blood

pressure (cardiologist)

14. Clonidine patch 0.3 mg/24 h, apply 1

patch every 7 days for high blood

pressure (average daily blood pressure =

105/70; last doctor’s office blood pressure

115/78) (?)

15. Simvastatin 80 mg by mouth nightly for

high cholesterol (last lipid panel indicates:

total cholesterol = 170, LDL = 70, HDL =

31, Triglycerides= 89) (cardiologist)

16. Red yeast rice 2 capsules by mouth

nightly for cholesterol (person chose)

17. Sleepy Tea – herbal tea for relaxation and

sleep as needed

14-16 Doses a day NOT including the weekly patch and as

needed use of acetaminophen or ibuprofen or the tea

4 different prescribers plus what person chooses to take

Example Case Study, 65 year old male - Common

Q&A Session

Thank You