Polypharmacy Best Practices

00:00 Hi, I'm Dr. Rhonda Lawes, and I'm going to talk to you in this video series about the best practices for polypharmacy.

00:08 Now, when it comes to medication treatments, more is not always better.

00:12 Now, let's start with the definition of polypharmacy.

00:15 The CDC designs it as the use of five or more prescription medications by any one patient.

00:22 Now, this isn't a new or even uncommon problem.

00:25 It is, however, a very dangerous one.

00:29 Now, this is particularly dangerous in older adults or anyone else who has competing demands on their mental acuities or their physical abilities and has multiple providers that are prescribing for them.

00:41 But before we talk about how we can address polypharmacy, let's take a brief look at who is most at risk and why.

00:49 So, I want you to think about three groups.

00:51 Anyone who has multiple medical conditions, that are managed by multiple subspecialist providers.

00:58 Second group, anyone who has chronic mental health conditions.

01:03 And the third group, anyone residing in a long-term care facility.

01:08 All three of these groups are at an increased risk for polypharmacy.

01:12 So, don't let this just go by you.

01:14 You want to pause and make sure you have these specific populations in mind because one of the tips we're going to talk about later is you want to be on high alert whenever you encounter a client that meets one of these three groups.

01:29 It might seem straightforward why patients with medical problems who have multiple prescribers end up with multiple scripts.

01:36 But what about those with mental illness? Patients who have a mental health diagnosis are often prescribed psychotropic medications.

01:45 Now these psychotropic medications can have some significant adverse effects.

01:50 So in order to address those adverse effects, more medications may be added to mitigate those side effects.

01:58 Many of the psychotropic medications are also associated with things like metabolic syndrome, which may require additional drugs to address that.

02:07 That's how this list grows on and on, and so does the risk for drug interactions.

02:14 Consider the management of osteoarthritis.

02:16 Simple, right? Well, the initial treatment often starts with an NSAID, such as naproxen or ibuprofen.

02:22 However, NSAIDs can result in hypertension, which may require antihypertensive therapy, which may include a one or two drug regimen.

02:31 They can also be hard on a patient's stomach.

02:34 With gastritis being a frequent issue.

02:37 For this, a patient may be prescribed a proton pump inhibitor.

02:41 So, one simple medication turned into potentially three total medications.

02:47 Here's a more complicated example.

02:49 Antipsychotic medications can cause extrapyramidal side effects.

02:53 Now, because of these side effects, a muscarinic receptor antagonist like benztropine may be prescribed.

03:00 Benztropine can cause dry mouth, which may require prescription for a saliva substitute, as well as constipation for which a laxative may be used.

03:09 Additionally, antipsychotic medications can result in significant metabolic effects, such as weight gain and hypoglycemia that can lead to diabetes.

03:18 This would require treatment.

03:20 And this graphic doesn't even take into account the downstream treatments related to diabetes. Think of things like cardiovascular risk that would indicate the need for a statin therapy or renal protection with an ACE or an SGLT-2.

03:36 Many patients with diabetes need these additional medications.

03:40 As you can see, one medication snowballed into multiple medications as a result of managing side effects.

03:48 Well, primarily because they are likely to be more frail or they wouldn't be in the long term care facility.

03:54 They likely have multiple medical and cognitive impairment issues, and all of this together are much more likely to warrant complex pharmacological treatment.

04:05 Now knowing these populations, remember anyone who has Now knowing these populations, remember, anyone who has multiple medical conditions managed by multiple subspecialist providers, has chronic mental health conditions, or is residing in a long term care facility, those are the patient populations i want you to be on high alert for.

04:23 So you'll hear me repeat this, because I want to study along with you as you're preparing this content.