Polypharmacy

Question 1

Polypharmacy meaning

Answer 1

Polypharmacy is the concurrent use of multiple medications by a patient.

Question 2

Polypharmacy according to WHO

Answer 2

The administration of many drugs at the same time or the administration of an excessive number of drugs

Question 3

Among which age group is polypharmacy common?

Answer 3

It is frequent among the elderly with about 40% prevalence due to the fact that they often suffer from chronic diseases with concomitant pathologies.

Question 4

Minor polypharmacy

Answer 4

2-4 medicines

Question 5

Major polypharmacy

Answer 5

More than 5 medicines

Question 6

Hyperpolypharmacy

Answer 6

More than 10

Question 7

Classes of polypharmacy

Answer 7

Appropriate

Inappropriate

Question 8

Inappropriate polypharmacy

Answer 8

When one or more drugs are prescribed that are not needed because:
- there is no evidence-based indication or indication has expired
- One or the combination of several drugs cause unacceptable adverse drug reactions (ADRs).

Question 9

Appropriate polypharmacy

Answer 9

Here, all drugs are prescribed for the purpose of achieving specific therapeutic objectives.
- drug therapy has been optimized to minimize the risk of ADRs
- the patient is motivated and able to take the drug

Question 10

Types of polypharmacy

Answer 10

Same class
Multi-class
Adjunctive
Augmentation

Question 11

What are fixed dose combinations?

Answer 11

Fixed dose drug combinations (FDCs), are combinations of two or more active drugs in a single dosage form.

Question 12

Rules for FDCs

Answer 12

1. Two drugs to be combined should have approximately equal plasma half life
2. The ratio of doses of each component should depend on apparent volume of distribution and plasma concentration

Question 13

Advantages of FDCs

Answer 13

• Convenience in dose schedule
• Better patient compliance because pills are reduced
• Enhanced effect of the combinations
• Minimization of side effects
• Improve compliance in treatment of chronic infectious diseases

Question 14

Disadvantages of FDCs

Answer 14

• The dose of any component cannot be adjusted independently.
• Pharmacokinetics must not be widely different.
• Difficulty in identifying a drug with harmful/beneficial effects.
• Price hike if unnecessary drugs are included.
• Incompatible pharmacodynamics
• Inadequate amounts

Question 15

Same-class polypharmacy

Answer 15

Use of more than one medication from the same class

Question 16

Multi-class polypharmacy

Answer 16

Use of more than one medication from different classes for the same symptom cluster

Question 17

Adjunctive polypharmacy

Answer 17

Use of one medication to treat the side-effects of another medication from a different class

Question 18

Augmentation polypharmacy

Answer 18

Use of one medication at a lower dose along with another medication from a different class in full therapeutic dose for the same symptom cluster.

Question 19

Examples of same-class polypharmacy

Answer 19

Selective serotonin reuptake inhibitors (SSRIs) like citalopram, fluoxetine, paroxetine, vilazodone

Question 20

Examples of multi-class polypharmacy

Answer 20

Angiotensin Converting Enzyme (ACE) Inhibitors + Calcium Channel Blockers

Captopril + Verapamil
Enalapril + Isradipine
Fosinopril + Felodipine

Question 21

Examples of adjunctive polypharmacy

Answer 21

Antibiotics + Multivitamins + Probiotics