3. Organ dysfunction : ○ Hyperpolypharmacy can affect the liver and kidney function. ○ Processing multiple drugs makes him feel dysfunctional. 4. Reduced treatment efficacy : ○ Some medications counteract each other. ○ Mr. Smith’s conditions remain controlled, but he doesn’t always feel well. 5. Psychological impact : ○ Anxiety about medication interactions and side effects affects his mental health. ○ A comprehensive review of Mr. Smith’s medications is essential, by his primary care physician and a clinical pharmacist. Conclusion There is good news, and there is bad news. The good news is that modern medicine has researched and developed pharmacological therapeutic treatments and protocols that extend longevity, address symptoms, improve quality of life, and provide much-needed relief to aspects of human suffering. The bad news is that this proliferation of cutting- edge solutions has perpetuated the belief and behavior that relies on these treatments to deliver immediate fixes and solutions to aspects of disease without pausing to address potential side effects and negative outcomes. These side effects and negative outcomes have created the challenges of polypharmacy, hyperpolypharmacy, and for many, a prescription cascade. In some patients with multimorbidity, the prescription cascade actually creates new presentation of disease that may end up with inaccurate diagnoses in tandem with duplication of medication and inappropriate treatment for symptoms that are outcomes of pharmaceutical interaction that present as disease. In addition to the challenges of prescription cascade, there Recommendations 1. Deprescribing : are the challenges of polypharmacy, which include: ● Adverse drug events, which can be mild or complex ● Drug to drug interactions ● Decreased medication adherence—missed doses, interference with medication regimen ● Misdiagnosis ● Exacerbation of symptoms Throughout the world, there is an intricate tapestry relative to healthcare, finding the balance to empower patients to manage chronic conditions while they recognize that any and all medicinal substances can impact the trajectory of their condition. The correlation or interplay between multimorbidity, polypharmacy, and/or hyperpolypharmacy creates a complex narrative that can extend disease management into unnecessary straights, with new symptoms, side effects, and potentially disease. The concept of polypharmacy, the concurrent use of multiple medications—prescription, over the counter, and supplemental—can appear to serve as lifelines, but left unmanaged and unmonitored can create challenging and catastrophic outcomes. For older adults who are more vulnerable and frail, in particular those in nursing home settings, medications can alleviate symptoms, prevent exacerbation, improve outcomes, and extend longevity, but the integration of certain medications such as antipsychotics can cause reactions that are life threatening. It is imperative that healthcare professionals in those environments work to manage medications, address symptoms and side effects, and help patients maintain their respective functionality.
○ He could benefit from the oversight of a case manager as he goes through deprescribing. ○ Prioritize quality of life over quantity of pills. 2. Healthcare coordination : ○ Encourage communication among specialists. ○ A coordinated and unified approach ensures better patient outcomes. 3. Patient education : ○ Mr. Smith needs clear instructions on when and how to take each medication. ○ Simplify his regimen to improve adherence. ○ He may consider moving into a community in which he can maintain independence while receiving support services. The gravity of polypharmacy requires the collective input of the care team, caregivers, and patients. In the situations in which the patients are unable to manage their own care, it is incumbent on the attention and commitment of clinicians and staff who commit to do no harm. Patients whose experience with polypharmacy is due to a respective life managing multiple chronic condition, their multimorbidity creates an existence often driven by the confusion presented by multiple doctors, advisors, pharmacists, and other individuals providing them with information relative to managing their well-being. Much of the information can be contradictory, medication can be duplicated, and messaging can be conflicting. Proper, ongoing medication reviews and reconciliation will help to empower the patient to feel that they are being treated properly while empowering them to remain active and engaged in their disease management. It could be challenging for anyone, especially if they feel unwell, to carry the burden of multiple medications, dosing schedules, potential side effects, and known risk factors. The combination of challenges can increase anxiety and depression levels, further exacerbating the situation and creating a cycle that is disruptive and difficult to change. For patients juggling medications reaching the level of hyperpolypharmacy, 10 or more daily medications including prescription drugs, over-the-counter medications, and supplements, medication management becomes even more challenging, as the risks increase with the potential for adverse events. The fine line between therapeutic benefit and potential harm becomes more difficult to balance and requires the partnership of trusted clinicians for successful outcomes and improved quality of life. In this course, the learner has addressed multimorbidity that involves some chronic conditions including cancer, diabetes, pregnancy, and heart disease. While there are many celebrations in medicine that have enabled patients to recover and thrive, there must also be the recognition that for some patients with multimorbidity there are additional risks that can be triggered with the presumption that there are quick fixes for pain and other symptoms. Educating healthcare professionals, patients, and caregivers is vitally important for disease management, risk avoidance, and opportunity to maintain a quality of life that is meaningful. Healthcare professionals must recognize the critical importance of medication reconciliation, if not the patient may be left grappling with unforeseen consequences. As the world faces notable growth of the over-65 cohort, it is time to begin to speak of the importance of engagement in one’s wellness throughout their life, not just when they
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Book Code: MTX1326
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