SEARCH · PubMed Health

Results for “Polypharmacy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,297 records · Page 72Linked to original sources

PubMed1988

Pulmonary non-tuberculous mycobacterial disease.

We confirmed 3 and identified 7 possible cases of pulmonary non-tuberculous mycobacterial disease. The clinical and radiological features were indistinguishable from those of tuberculosis, although a few thin-walled cavities may have been more suggestive of non-tuberculous disease. Previously described predisposing factors were identified in our patients and included previous fibrocavitating disease, chronic airflow obstruction and bronchiectasis. However, 5 patients had no pre-existing lung disease. The difficulties in treating these patients are discussed and in view of the chronic indolent course, prolonged aggressive polypharmacy is usually not indicated. It is recommended that at least two consecutive sputum specimens be sent for culture and drug resistance testing whenever the disease is suspected. This will help differentiate colonisation from infection and rationalise management.

Aged↗

PubMed1987

Characteristic differences in the use of psychotropic drugs as a stigma of cultural influences.

The study aimed at investigation of the influence of the cultural and racial factors upon therapeutic response of the schizophrenic patients in Libya and Malta. The study revealed high frequency of polypharmacy, liberal use of minor tranquillizers and antiparkinsonian agents, and daily multiple administration of drugs. Long-acting preparations were not administered in Libya, while in Malta they were used in 37.5% of patients. Therapeutic response in both investigated groups were different. The Libyans responded to low doses of regular drugs. Maltese were treated in comparatively higher doses due to combinations of drugs. The number of chronic withdrawn and apathetic schizophrenics was a larger among Maltese and there the disintegration of personality was much more visible.

Cross-Cultural Comparison↗

PubMed1986

A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations.

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.

Aged↗

PubMed1987

Adverse drug reactions in paediatric outpatients.

In accordance with guidelines for a multicentre trial, the incidence and features of adverse drug reactions in a sample of 1327 children attending outpatient consultations have been determined. The incidence was of 0.75% (0.34% - 1.58% with p less than 0.05). The reactions were slight in character and predominantly affected very young female patients. Antibiotics were involved in almost a half of cases, and polypharmacy was used in all of them.

Amoxicillin↗

PubMed1987

[Pharmacotherapy in the aged].

The relatively high incidence of adverse drug reactions in the aged is a consequence of polypharmacy on the one hand and of altered pharmacokinetics on the other, changes of intrinsic or receptor properties (pharmacodynamic factors) are usually not of primary importance. Plasma half-lives increase and total clearance rates of many drugs are reduced due to diminished drug metabolism and renal excretion. With the exception of actively transported substances the amount absorbed from the gastrointestinal tract is not altered. Total body water declines with age, whereas the relative content of adipose tissue increases. Hence, the volume of distribution of hydrophilic drugs may be decreased, that of lipophilic drugs increased. The maintainance dose in old age can be calculated from the changes in plasma half-lives or, preferably, total clearance rates, the initial dose is determined by the changes in the volume of distribution. At present there is no rational basis for the use of geriatric drugs, i.e. agents claimed to retard the process of aging.

Aged↗

PubMed1987

Education in geriatric medicine.

Geriatric medicine, the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in the elderly and with the maintenance of their health became of importance with the advent of the British National Health Service which uncovered an immense amount of illness among older people. This and the future demographic changes prompted the teaching of medical students gerontology i.e., the study of the ageing process and geriatric medicine. Attempts at preventing illness and at diagnosing disease early were made to try to maintain and, where possible, to improve the health of older people by such methods as motivation, pre-retirement training and early ascertainment of illness. Symptoms of disease change with advancing age and diagnosis becomes difficult due to atypical and insidious symptomatology while the common occurrence of multiple pathology can unfortunately encourage polypharmacy. Specialised instruction in geriatric medicine is thus desirable and the recommendation is made that every medical school should create an academic unit in this subject to provide undergraduate and postgraduate teaching about the process of ageing and the clinical problems of older people with additional instruction on the general management of the elderly both in their own homes and in the essential and varied institutional settings. As well as medical students many other groups such as nurses, paramedicals, social workers and all those who care for the elderly benefit from training.

Curriculum↗

PubMed1987

Drug interactions in the elderly.

Polypharmacy and its dangers in the elderly are of increasing concern. The purpose of this study was to determine the incidence of drug with drug, drug with food, and drug with alcohol interactions in a population aged 60 years or greater. Four hundred patients were randomly selected from a university family medicine outpatient clinic population of 4,483 in this age group. A total of 292 drugs were involved for a total of 1,052 potential interactions: 310 drug-food, 316 drug-alcohol, and 426 drug-drug. Interactions were analyzed using The Drug Master computer program and rated as to their clinical significance. Chart review revealed no serious actual interaction for any patient even though potential interactions could be categorized as highly significant for 27 percent of the drug-drug, 11 percent of the drug-alcohol, and 3 percent of the drug-food. Thirty-two percent of the total population were taking five or more drugs concurrently. The mean number of drugs for men was 3.75 and for women 4.22 (P less than .05). Age and race differences were also noted in the number of drugs taken. The most common drugs and their interactions with drug, food, and alcohol are reviewed.

Aged↗

PubMed1985

Patterns of analgesic prescription and consumption in a university-affiliated community hospital.

To assess the patterns of prescription and consumption of analgesic and psychotropic medications, we reviewed the medication records of all 311 adult medical and surgical patients at a university-affiliated community hospital. Acetaminophen combinations and meperidine accounted for 85% of all analgesics prescribed. Analgesic use declined with advancing age. Two or more analgesics were prescribed to 18% of medical patients, compared with 44% in surgical patients. Less than one third of the patients with cancer received analgesics more frequently than every six hours. Nearly all psychotropic prescriptions were for sedative-hypnotics. Our data suggest that (1) physicians prescribe a limited number of analgesics, despite the variety available; (2) elderly patients receive fewer analgesics; (3) polypharmacy occurs often; (4) pain in patients with cancer is probably undertreated; and (5) psychotropic medications are used infrequently for analgesia.

Adolescent↗

PubMed1979

[Antibiotics: interactions with other drugs (author's transl)].

More and more numerous each year, and only rarely beneficial, these are responsible for unexplained therapeutic failures or complications. They may occur at different levels. In the bottle of infusion fluid, the risk is that of neutralisation of varying amounts of the antibiotic. At the physiological stages of pharmacokinetics, there may be reduction of absorption and modification of urinary excretion. The most striking iatrogenic consequences result either from competition for binding to plasma albumins or from induction (or inhibition) of hepatic enzymes responsible for biotransformation (toxic overdose). Within bacteria, these interactions explain synergisms and antagonisms. They should lead to awareness of the multiple dangers of polypharmacy.

Anti-Bacterial Agents↗

PubMed1981

[Side effects of drugs in the geriatric patient (author's transl)].

The probability of experiencing adverse drug reactions increases with age. Polypharmacy, pharmacokinetic changes (altered drug distribution, reduced renal and hepatic drug clearances), unusual pharmacological effects and impaired compensatory mechanisms are the principal reasons for the diminished tolerance of elderly patients to several drugs. Especially neuroleptics, antidepressants, tranquilizers, digoxin, potent diuretics, betablockers, and antiarrhythmics have to be employed with special care. To prevent adverse reactions in geriatric patients, prescriptions should be limited to a few essential drugs, dosage reduced, and dosing regimens simplified. However, therapeutic nihilism can never be justified by old age alone.

Acute Kidney Injury↗

PubMedDate not supplied

Long-term maintenance treatment in chronic schizophrenia. Some observations on outcome and duration.

The authors reports on several studies of his own, namely two discontinuation studies and a survey of all known schizophrenic patients in a defined catchment area for a period of two years. Of the 140 patients prescribed a long-acting neuroleptic (LAN), 83% were still receiving injections after 2 years. Some 70% were responders, but 50% were rated on the lowest point of social functioning on a relative's scale. The discontinuation studies followed up patients for up to 4 years after discontinuing LAN. For a first schizophrenic illness the highest relapse rate is in the first year (29%), but thereafter (2-4 years it remains fairly constant (3-6%), which points to the need for more long term studies. Patients who had received depot therapy for a minimum of 1 year have a better survival rate than patients discontinuing LAN after a shorter period. For chronic schizophrenia the highest relapse rate is in the first year (60%), but falls each year over the next three years (11% in the second year, 5% in 2-4 years). There is no difference of outcome with increased duration of medication within the four year periods on medication studied. The adoption of LANs in the United Kingdom over the past 13 years is in the author's opinion the most important single improvement in the treatment of schizophrenia; but in the absence of any clear indication that LANs can be discontinued after even 4 years, the emphasis must remain on their proper use: personalised prescriptions (dose reduced with time down to the lowest possible dosage) and caution against unnecessary polypharmacy.

Antipsychotic Agents↗

PubMedDate not supplied

The use of long-acting neuroleptics in the acute psychoses.

Out of 120 inpatients treated with long-acting neuroleptics (LANs) between May 1977 and May 1978, the authors have selected 43 patients with clear-cut acute psychotic symptoms and high doses or frequent injections of fluphenazine decanoate: 19 schizophrenics, 13 schizoaffective psychoses and 11 manics. The average single dosage was 32 to 37 mg depending on the diagnostic category; the average weekly dosage was 45 to 55 mg; the average frequency of injections was one every 5 to 7 days. Drug combinations could be greater reduced. On discharge, all long-acting treatments were discontinued in manics, against some 60% of schizophrenics and schizoaffective psychoses. Among the advantages of LANs, the authors mention optimum pharmacokinetics (hence, lower doses), increased compliance from the part of the patient (less hostility thanks to decreased administrations than with oral medications), avoidance of cases of intestinal malabsorption, lowered financial burden (less treatment units, fewer admissions, shorter duration of hospitalization, less polypharmacy.

Acute Disease↗

PubMed1984

Psychogeriatrics.

Many elderly manifest "functional" psychiatric symptoms that are not necessarily associated with a dementing process. The vast majority of these psychiatric syndromes are amenable to treatment if it is instituted early. Early treatment may prevent institutionalization. Of all age groups, the elderly have the highest suicide rate. The possibility of suicide must be evaluated and openly discussed. Drug abuse and alcoholism should also be considered. The elderly respond to much smaller doses of psychopharmacologic agents and are very sensitive to the side effects of these drugs. Polypharmacy, decreased compliance, and drug-drug interactions are common occurrences in the elderly. Not all psychiatric reactions of the elderly require pharmacologic intervention. Many respond to psychotherapy, which should be used more frequently than has been the practice in the past.

Affective Disorders, Psychotic↗

PubMed1978

Macro-monitoring: a step toward rational psychopharmacotherapy.

A 15-item checklist was used to monitor the drug therapy of 516 patients in five clinical settings. The primary purpose of this study was to determine the extent of irrational drug use in these several settings. After gathering baseline data, two similar clinical units were selected for a six-month follow-up to determine the impact of drug consultation by an expert clinical psychopharmacologist. In the unit where drug consultation was provided, there was a significnat reduction in extended antiparkinsonian agent use (p less than 0.001), multiple daily dosage (p less than 0.001), inappropriate anxiolytic use (p less than 0.01), polypharmacy (p less than 0.001) and too rapid change in medication (p less than 0.01). The unit that did not have drug consultation continued to have a high percentage of patients receiving drugs in an inappropriate manner. Although the consultant had a significant impact on drug use, it was recognized that such consultation is not feasible for most psychiatric facilities. The checklist itself is a systematic tool that can be used to identify prescribing practices of questionable appropriateness. If used properly by the pharmacist, the checklist can serve as a supportive system to assist the physician in providing better patient care.

Drug Information Services↗

PubMedDate not supplied

[Allergic reactions in patients with peptic ulcer; incidence of food and drug allergy].

According to the data derived in the course of studying the allergological anamnesis and disease clinical picture, 70% of 241 patients with peptic ulcer manifested different allergic reactions. Elevation of IgE blood content recorded in 47% of 173 patients examined also attested to the high rates of allergization among this patients' population. Analysis of the prevalence of food and drug allergy among the 241 patients aged 16 to 65 years demonstrated the allergies to occur in 25 and 30% of patients, respectively. At the same time the food allergy was encountered more frequently among young patients aged 16-25 years, while the allergic reactions to the drugs were more typical for patients aged 50 to 65 years. About one-third of patients manifested the reactions to 2 or more different allergen groups (food, drug and others). The prevalence of different types of allergy in peptic ulcer patients increases with age. This particularly marks drug allergy which in the group of patients over 50 years occurred 3 times as often as in patients aged 16-25 years (in 54 and 19%, respectively). The data obtained suggest that polypharmacy which is almost permanently given to peptic ulcer patients is of paramount importance in the genesis of drug allergy, whereas the constitutional-hereditary and alimentary factors play the leading part in the genesis of food allergy.

Adolescent↗

PubMedDate not supplied

[Principles of pharmacotherapy in geriatrics].

This article examines the pharmacokinetics and pharmacodynamics of drugs under the aspects of senile changes in organs and systems in the neurohumoral regulation and in metabolism. It gives reasons for the inadequacy of polypharmacy in the treatment of elderly and old people and for the need of a strict individualization. The retarded reactivity of the organism of old people, their increased susceptibility and reduced tolerance of the effects of drugs necessitate smaller dosages of drugs in geriatrics in comparison with the generally usual dosages, especially at the beginning of treatment. The multitude of exogenous and endogenous changes in the organism, that go hand in hand with the process of aging, leads in old people to an increased susceptibility to more frequent and pronounced secondary effects caused by drugs. Of special importance in the prevention of a possible intoxication by drugs are, in the case of elderly people, the proper composition of food, the water balance and the electrolyte metabolism.

Aged↗

PubMed1981

Prescribing patterns for epilepsy.

All prescriptions for anticonvulsants written over a four month period for patients in the Wellington area were identified. Of 1479 patients receiving anticonvulsants, 139 were suspected of receiving medication for conditions other than epilepsy. The prevalence of treated epilepsy in Wellington is 4.1 per 1000 population. Thirty-eight percent of patients were on multiple anticonvulsants, which compares favourably with reports of excessive polypharmacy in Europe. However, there was excessive reliance on standard anticonvulsant doses, given at frequent intervals regardless of probable rates of metabolism. Failure of compliance, as assessed by the time intervals between collection of drugs, was shown by 21 percent of patients.

Adult↗

PubMed1981

[Problems of psychotropic drugs in psychopharmacotherapy].

This is the summary of the lecture that the author, as a clinical psychiatrist, gave to the Japanese researchers of basic psychopharmacology who are not involved in clinical medicine. I. The author considers the problems of psychotropic drugs in Japan in 2 categories: those unique to Japan (1-5) and those related to psychotropic drugs in general (6-9). 1. "Arbitrary" administration (i. e., the prescription is different with each psychiatrist, therefore standardization is necessary). 2. Polypharmacy (i. e., unreasonable combination is made). 3. Many different drugs with similar effect (therefore, new drugs should be controlled). 4. "Stereotype" of doctor's prescription for long-term use. 5. Limited prescription due to health insurances. 6. Doubtful effect on long-term prognosis of chronic schizophrenics. 7. Psycho-social burden of patients taking drugs continuously. 8. Undesirable effects like prolongation of depressive episode, lowered mental activity, or blunting of affect. 9. Side effects such as dependence, tardive dyskinesia, malignant syndrome, or teratogenecity. II. Tardive dyskinesea, malignant syndrome and teratogenecity are explained in detail. III. The author expresses the wishes for future development of psychotropic drugs as follows: 1. Good balance of "effect", "side effect", and "price" of clinical drugs. 2. Introduction of safe long-acting drugs which promote social rehabilitation of mental patients. 3. Development of more specifically effective drugs. 4. Convenient way of measurement of drug serum level. 5. Contribution to understanding of pathogenesis of mental disorders through researches on effects and side effects of drugs. Finally, the author stresses the necessity of more cooperation between clinical and basic medicine.

Abnormalities, Drug-Induced↗