Medical and medication history According to the Guide to Physical Therapist Practice (APTA, 2014), each new patient examination should include a discussion of the patient’s over-the-counter (OTC) and prescription medications. When taking the medical history of a new patient, the therapist should keep in mind the most common comorbidities found in Boissonnault’s outpatient study (1999; see Table 1) and the medications commonly used to treat those conditions. There should be a clear and obvious link among the primary diagnosis, any comorbidities, and the medication usage reported. Any discrepancy between the medical condition(s) and medication(s) reported should be clarified with the patient and physician. In addition, the possibility of polypharmacy should be investigated, especially in elderly patients. The World Health Organization defines polypharmacy as the concurrent use of five or more prescription medications (Wang et al, 2015). However, numerical definitions of polypharmacy do not account for the comorbidities present in the individual. conditions treated with prescription medications and the likelihood that a new patient is taking one or more of these medications. The use of prescription drugs in the United States is often reported in terms of total dollars spent on a particular medication. However, those data are often distorted by the price of the drug and the availability (or lack) of a generic alternative. For example, in 2009 more money was spent on antipsychotic drugs than on any other class of medications (Bartholow, 2010), but in terms of the number of prescriptions, none of the
As a result, a more contemporary and clinically useful definition of polypharmacy would be when a patient takes multiple medications that may have no current indication, uses multiple medications for the same problem, uses inappropriate doses of medication, and/or concurrently uses medications with known interactions (Masnoon et al., 2017). Polypharmacy is common among older adults with approximately 50% of older adults taking at least one or more medications that is not currently medically necessary (Maher et al., 2014; Wang et al., 2015; Masnoon, Shakib, Kalish-Ellett, & Caughey, 2017). Wang et al. (2015) showed that in adults 80+ years of age the prevalence of polypharmacy was 70%. Research has clearly demonstrated a strong link between the presence of polypharmacy and negative clinical outcomes such as adverse drug reactions, falls, disability, and mortality (Maher, Hanlon, & Hajjar, 2014; Masnoon et al., 2017; Wang et al., 2015). antipsychotic medications were among the 20 most frequently prescribed drugs. While dollar sales are important to pharmaceutical companies, most relevant to the therapist is the frequency with which the medications are used. As a result, this discussion of prescription drug use is based upon the number of prescriptions, not the dollar sales. A list of the 20 medications most frequently prescribed in the United States can be found in Table 17 (Kane, 2017). This list of the top 20 prescription medications is based upon data from 2015, the most recent year for which data was available at the time of publication.
The most frequently prescribed medications in the united states Therapists should be familiar with medications that are most frequently prescribed in the United States. This information provides therapists with insight into the most common medical
Table 17: Top 20 Products in the U.S. Market by Number of Prescriptions Dispensed in 2017 Drug Name Prescriptions Class of Medication: Targeted Condition 1. Lisinopril 115,508,573 ACE inhibitor: Hypertension 2. Levothyroxine 99,992,248 Thyroid hormone replacement: Hypothyroidism 3. Metformin 86,125,658 Biguanide: Hyperglycemia (type 2 diabetes) 4. Simvastatin 81,518,801 Statin: Hypercholesterolemia (cholesterol lowering) 5. Atorvastatin 74,227,208 Statin: Hypercholesterolemia (cholesterol lowering) 6. Metoprolol 72,320,918 Beta-1 blocker: hypertension, angina 7. Omeprazole 71,929,303 Proton (H+) pump inhibitor: Ulcers and GERD 8. Hydrocodone (generic Vicodin) 68,756,036 Synthetic opioid: pain, coughing; Acetaminophen: pain, fever 9. Amlodipine 63,722,510 Calcium channel blocker: hypertension 10. Hydrochlorothiazide 50,428,398 Diuretic: hypertension 11. Albuterol 48,189,599 Beta-2 agonist: SOB, breathing difficulty 12. Gabapentin 39,361,473 Anticonvulsant: seizure disorder (epilepsy) 13. Sertraline 37,723,879 Selective serotonin reuptake inhibitor: depression 14. Losartan 37,330,149 Angiotensin II receptor antagonist: hypertension 15. Furosemide 37,104,417 Diuretic: hypertension 16. Azithromycin 31,988,786 Antibiotic: infections 17. Acetaminophen 31,926,190 Analgesic: pain; Antipyretic: fever 18. Atenolol 30,837,679 Beta-1 blocker: hypertension, angina
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