AC - Polypharmacy

Question 1

What is polypharmacy?

Answer 1

No clear definition

Related to - dosage, number of drugs, indication (appropriate?), efficacy and clinical outcome

Generally >6 medications + >1 that is potentially inappropriate
Some suggest > 4 medications

Question 2

What are possible negative outcomes of polypharmacy?

Answer 2

Adverse drug reactions
Death
Increased risk of falls, incontinence and delirium (esp. if oversedation)
Decrease in physical and cognitive function - impaired ADLs
Cost - public and patient

Question 3

What are some pharmacological changes in pharmacokinetics in elderly & implication for prescribing?

Answer 3

Often require reduced doses as the following can increase serum levels:
- Increased lipiophilic distribution (increased adipose tissue proportion) and decreased hydrophilic distribution (lower total water content)

• Reduced 1st pass hepatic metabolism - decreased metabolism of drug
• Reduced renal excretion - decreased renal mass, blood flow and tubular function

Question 4

What factors in geriatrics can contribute to adherence issues?

Answer 4

Dexterity 
complex medication regimes 
Cognitive impairment 
Increased costs 
Side effects 
Polypharmacy 
Visual impairment 
Dysphagia