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PCPs on ‘frontline’ for reducing polypharmacy
NEW ORLEANS — The high prevalence of taking — and negatively reacting — to many medication types among the elderly necessitates thorough discussions on this matter, according to two presenters at the American College of Physicians Internal Medicine Meeting.
“The elderly take the most medications and have the most issues with medications including side effects, drug-drug interactions, and compliance issues,” Birju B. Patel, MD, FACP, AGSF, an internal medicine specialist at Northeast Georgia Diagnostic Clinic and N. Wilson Holland, MD, FACP, AGSP, assistant dean of graduate medical education, Emory University School of Medicine, told Healio Family Medicine in an email interview previewing their presentation.
“In addition, older patients frequently use over-the-counter medications and alternative medications such as herbal and naturopathic medications which can interact with prescriptions as well as have potential harmful side effects,” they said.
Compounding the concern is that many patients have multiple medical providers, several chronic illnesses and frequent hospitalizations, and that the adverse events of one medication are often treated with another medication.
Pills with anticholinergic side effects, such as OTC sleep aids, and bladder relaxants, tricyclics, and quinolones should be avoided as much as possible, they said, adding that the Beers and STOPP criteria can also help ascertain if a medication is potentially inappropriate for a patient.
“Using the adage ‘start low and go slow’ can be helpful when treating nonacute conditions [with medication],” they said. “It’s also very important to estimate glomerular filtration rates to assess renal function as many medications are cleared through the kidneys, and to address renal function and hepatic metabolism.”
The pair acknowledged office visits are not finite but emphasized medications must be weaved in and out of the conversation during the entire time with the patient.
“Discussions on medications should be held early in the office visit to determine if new symptoms are a result of any of the reported medications,” they said. “Match each medication to indication or disease and get rid of the rest. Then at the end of the visit, the health care provider should reconcile all medication changes and provide a list of all medications the patient should be taking with dosage and frequency.” – by Janel Miller
Reference:
Holland NW and Patel BB. “Challenges in geriatric medication management: an interactive, casebased workshop.” Presented at: American College of Physicians Internal Medicine meeting; April 17-21, 2018; New Orleans.
Disclosure: Neither Holland nor Patel report any relevant financial disclosures.