TUTORIAL

NURS 3015 Care of the Older Adult

TOPIC : Polypharmacy



Objectives :

a. Define polypharmacy using several sources
b. Explain the reasons for polypharmacy
c. Describe how ageing affects response to drugs
d. Explore the dangers of polypharmacy
e. Describe measures to prevent polypharmacy

DEFINITION
Polypharmacy

Refers to the effects of taking multiple medications concurrently to
manage co-existing health problems, such as diabetes and hypertension
Concomitant use of multiple drugs, including both prescription and over-
the-counter (OTC) medications
Defined as the prescription , administration, or the use of more
medications than are clinically indicated to give a patient

Connotation is that there are too many medications involved

This includes:

the use of a medication that has no apparent indication,

continuing use of a medication after a condition has been resolved

use of a medication to treat the side effects of another medication

use of an inappropriate dose

use of duplicate medications because the same drug has been prescribed
by more than one prescriber (patients may not be aware of the different
names (e.g. generic and one or more brand names) used for the same
medication

self-medication with OTC medications or herbal remedies to treat the

same condition or to manage symptoms of an adverse drug effect.

REASONS FOR POLYPHARMACY
(may include one or all of the factors listed below)

multiple pathology

the use of repeat prescriptions, which may result in a lack of direct

patient contact between the prescriber or pharmacist

computerized records not being updated after home visits where

prescriptions are issued

poor communication between healthcare providers

lack of knowledge about ageing

use of National Institute for Health and Clinical Excellence (NICE) and
NSF guideline

RESPONSE OF AGEING TO DRUGS

Age-related physiological changes alter the ways in which drugs are handled by
the body.
Pharmacokinetics describes what happens to a drug in the body
from the point of administration, absorption, distribution,
metabolism, and excretion


Pharmacodynamics - describes what the drug does to the body;
refers to the biologic and therapeutic effects of drugs at the site of
action or on the target organ. Some of the

**Both pharmacodynamics and pharmacokinetics may be altered by
the body
NOTE : Generally, older people have fewer problems in the area of drug
absorption than with distribution, metabolism, and excretion of drugs.

Age-related changes that are relevant to pharmacokinetics include:
-

reduced renal function

reduced liver function

reduced ratio of body fat to water

delayed stomach emptying

Age related factors that are relevant to pharmacodynamics include:
-

toxicity of the drugs and interactions between different drugs

site of action

side effects

response of the body to the drugs

The effect of altered biophysiology may result in the older person
being unable to tolerate the medications prescribed to them in the
recommended doses.
CHANGE

IMPACT ON DRUG THERPY

Drier oral mucosa

May be difficult to swallow tablets and

capsules

Decreased albumin concentration

Protein-bound drugs may cause

delayed distribution and higher
concentrations

Less total body fluid

May result in higher blood levels of

CHANGE

IMPACT ON DRUG THERPY

water - soluble drugs

Less muscle mass

Absorption of usual adult dose of IM

drugs at single injection site may be
difficult

Increased adipose tissue

Fat soluble drugs may accumulate in

greater amounts

Reduction in number of nephrons,

Some drugs that are predominantly

glomerular filtration rate, renal

eliminated in unchanged form

blood flow, creatinine clearance

(digitalis, penicillin) may be eliminated

tubular reabsorption

more slowly

Decreased secretion in GI tract,

Absorption may be slightly reduced

lower gastric pH
Reduced circulation to lower bowel

Suppositories may take longer to melt

and vagina
Reduced liver size, decrease in

Some drugs (acetaminophen) may be

forms of hepatic metabolism

metabolized more slowly and may

have longer half-life. Because of a long
half-life, some drugs may stay in the
system for quite a while after the drug
has been stopped causing a delayed
adverse reaction

Source: Eliopoulos, C. Gerontologic Nursing Philadelphia:J.B. Lippincott (2010)

They may experience side effects and the combinations of medicines taken
together may cause iatrogenesis
e.g. some drugs can cause confusion, increase the risk of falls or reduce salivary
secretions

DANGERS OF POLYPHARMACY

greater risks of adverse reactions and drug interactions

severely affect quality of life and well-being

affects compliance to medication

PREVENTION OF POLYPHARMACY

use of the same pharmacy to fill all prescriptions so that the pharmacist
can check for duplication or drug interactions.

Encourage patient to notify all prescribing clinicians about what other

drugs they are taking

Nurse should take a complete history of all the drugs prescribed

Information about other drugs and remedies should also be elicited from
the patient since they may be the basis for significant interactions with
drug therapy

An indication of drugs that have been discontinued highlight with a

fluorescent highlighter

Every effort should be made to keep the number of medicines prescribed

to a minimum and that clear and simple regimes are created and
reviewed regularly

Recommendation: medicine reviews are undertaken every 6 months

when the patient is prescribed more than four medicines - to evaluate
effectiveness and changing needs

REFERENCES

Bretherton, A. (2003). Polypharmacy and older people. 99(7) 54 Retrieved from

http://www.nursingtimes.net/Journals/2012/11/09/i/r/a/030429Poly

pharmacy-and-older-people.pdf

Eliopoulos, C. (2010). Gerontological Nursing. 7th ed . Phiadelphia:Lippincott,

Williams & Wilkins

Tabloski, P. (2014). Gerontological Nursing 3rd.ed. New York:Pearson

Woodruff, K. (2010). Preventing Polypharmacy in older adults. American Nurse

Today, 5(10). Retrieved from

http://www.medscape.com/viewarticle/732131_1