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PubMed2002

Polypharmacy, age, and scheduled surgery.

STUDY OBJECTIVE: To test the hypothesis that there is a correlation between the age of patients who present for scheduled surgery and the number of drugs taken by these patients. DESIGN: Prospective clinical study. SETTING: Outpatient admissions. PATIENTS: 150 ASA physical status I, II, and III patients 40 years of age or older, scheduled for outpatient surgery. INTERVENTIONS: None. MEASUREMENTS: Age, medical history, and prescription and nonprescription medications of these patients were recorded. MAIN RESULTS: There was no significant difference among number of drugs taken by patients in different age groups [40 to 49 years: 3.2 +/- 3.1 (average number of drugs taken, standard deviation); 50 to 59 years: 3.6 +/- 3.1; 60 to 69 years: 4.0 +/- 2.9; 70 to 79 years: 4.4 +/- 2.7; 80+ years: 3.7 +/- 2.2]. CONCLUSIONS: Medical condition, which may, in part, be a function of biological age and not chronological age, is the primary determinant of the number of medications taken by patients presenting to an outpatient clinic for scheduled surgery.

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PubMed2004

[Lethal polypharmacy in a patient with arterial hypertension].

HISTORY: A 86-year-old man was referred as he developed a ventricular escape rhythm and severe hypotension. Although external cardiac pacing was begun, the patient subsequently needed intubation as of progressive cerebral deterioration. It turned out that the patient had been treated with a combination compound including hydrochlorothiazide 50 mg, amilorid 5 mg and timolol 20 mg daily for several years. A second combination compound including verapamil 180 mg and trandolapril 2 mg daily was added 5 days prior to hospitalisation due to insufficient control of arterial hypertension. INVESTIGATIONS: At admission, the patient was comatose without focal neurological findings. Laboratory analysis revealed lactic acidosis and severe hyperkalemia. No evidence for acute coronary syndrome was found. TREATMENT AND COURSE: Hyperkalemia was successfully treated using calcium gluconate, insulin and glucose. External heart pacing and circulatory support using epinephrine were ceased after conversion into a stable sinus rhythm. Renal failure however did not resolve. CT-scans of the brain were performed on the third day as of protracted coma. They showed extended infarction in the area of the left arteria cerebri media with beginning brain edema. Although mechanical ventilation could be stopped as of sufficient respiration, the patient died on the sixth day. CONCLUSION: The presented case describes probably drug-associated severe hyperkalemia and bradycardic arrhythmia, hypotension and (eventually preexisting) normuric renal failure.

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PubMed2004

Polypharmacy in HIV: impact of data source and gender on reported drug utilization.

Drug use in HIV is complex and may involve multiple therapeutic and nontherapeutic agents including prescription, over-the-counter, complementary and alternative medicine, and social/recreational drugs. This study was designed to assess the extent of such drug use in HIV-infected men and women. One hundred four adults were recruited through the HIV Ontario Observational Database from HIV outpatient clinics throughout Ontario, Canada. Patient demographics and data on drug use and physician awareness of drug use were collected through in-person interviews and medical chart review. All patient interviews and 96% of medical charts revealed the use of at least one drug. Eighty-five percent of patients reported use of antiretroviral medications; nearly 70% used highly active antiretroviral therapy. Patients used significantly more drugs by patient report (15.7 +/- 7.7) than by medical chart review (8.4 +/- 5.0) reporting up to 39 drugs per person. Pill burden was substantial, averaging 20.7 +/- 12.5 and ranged up to 69 "pills-per-day." Patient-reported physician awareness of drug use was highest for prescription drugs and lowest for social/recreational drugs; correspondingly agreement between medical chart and patient report ranged from 80% for antiretrovirals to 10% for non-prescribed drugs. The drug and pill burden faced by patients with HIV is considerable. Prevalence of use for specific drug classes varied with both data source and gender while number of drugs used differed only by data source. Our findings emphasize the complexity of pharmacotherapy in HIV and the need for comprehensive drug assessment, particularly because of the risks of drug-drug interactions and decreased adherence secondary to therapeutic complexity.

Adult↗
PubMed2006

Polypharmacy and prescribing quality in older people.

OBJECTIVES: To evaluate the relationship between inappropriate prescribing, medication underuse, and the total number of medications used by patients. DESIGN: Cross-sectional study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: One hundred ninety-six outpatients aged 65 and older who were taking five or more medications. MEASUREMENTS: Inappropriate prescribing was assessed using a combination of the Beers drugs-to-avoid criteria (2003 update) and subscales of the Medication Appropriateness Index that assess whether a drug is ineffective, not indicated, or unnecessary duplication of therapy. Underuse was assessed using the Assessment of Underutilization of Medications instrument. All vitamins and minerals, topical and herbal medications, and medications taken as needed were excluded from the analyses. RESULTS: Mean age was 74.6, and patients used a mean+/-standard deviation of 8.1+/-2.5 medications (range 5-17). Use of one or more inappropriate medications was documented in 128 patients (65%), including 73 (37%) taking a medication in violation of the Beers drugs-to-avoid criteria and 112 (57%) taking a medication that was ineffective, not indicated, or duplicative. Medication underuse was observed in 125 patients (64%). Together, inappropriate use and underuse were simultaneously present in 82 patients (42%), whereas 25 (13%) had neither inappropriate use nor underuse. When assessed by the total number of medications taken, the frequency of inappropriate medication use rose sharply from a mean of 0.4 inappropriate medications in patients taking five to six drugs, to 1.1 inappropriate medications in patients taking seven to nine drugs, to 1.9 inappropriate medications in patients taking 10 or more drugs (P<.001). In contrast, the frequency of underuse averaged 1.0 underused medications per patient and did not vary with the total number of medications taken (P=.26). Overall, patients using fewer than eight medications were more likely to be missing a potentially beneficial drug than to be taking a medication considered inappropriate. CONCLUSION: Inappropriate medication use and underuse were common in older people taking five or more medications, with both simultaneously present in more than 40% of patients. Inappropriate medication use is most frequent in patients taking many medications, but underuse is also common and merits attention regardless of the total number of medications taken.

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