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