Peer replies

1-Alberto :

Polypharmacy is an area of concern for many patients, especially the
elderly.  Elderly patients are at a greater risk for adverse drug
reactions (ADRs) because of the reduced drug clearance associated with
aging and because of metabolic changes (Boris, Cafiero & Smith,
2014).  Some risk factors associated with polypharmacy are potential of
drug-drug interactions because it is further increased by use of
multiple drugs.  Another risk factor is hip fractures, associated with
adverse drug reactions and losing balance or fainting (Boris, Cafiero
& Smith, 2014).  Polypharmacy may sometimes lead to “prescribing
cascades.”4 Prescribing cascade is said when signs and symptoms
(multiple and nonspecific) of an ADR is misinterpreted as a disease and a
new treatment/drug therapy is further added to the earlier prescribed
treatment to treat the condition (Piere & Farrell, 2012).

       In my practice working with the elderly population, to reduce
the incidence of polypharmacy medication, patients are evaluated on a
monthly basis.  Additionally, a single drug is be prescribed instead of
multiple drugs for the treatment of a single condition, if possible.
 Another strategy we use is staring medication with the lower drug
dosage and slowly increasing as indicated.

           A strategy that seems to be effective, according to
research, is prescribe drugs that can be given once or twice a day
instead of prescribing drugs that require to be taken three times a day
(Thomas, Liao, & McCliar, 2016).  The reasoning behind this is to
lower the risk of forgetting to take the medication or taking the
medication together with other drugs.  Another strategy that can be
employed is that if the drug taken has no therapeutic beneficial effect
or clinical indication it should be eliminated. Unessential drugs should
be identified and eliminated prescribed by different health care
providers for the same condition/disease (Thomas, Liao, & McCliar,
2016).

2-maceda 

Polypharmacy refers to the effects of taking multiple medications
concurrently to manage coexisting health problems, such as diabetes and
hypertension (Piere & Farrell, 2014).  Too often, polypharmacy
becomes problematic, such as when patients are prescribed too many
medications by multiple healthcare providers working independently of
each other. Also, drug interactions can occur if no single healthcare
provider knows the patient’s complete medication picture. Nurses have a
unique opportunity to help identify patients at risk for inappropriate
polypharmacy and to educate patients and families about risk reduction.
Nurses can use strategies such as patient teaching and consistency in
care plan (Piere & Farrell, 2014). 

Some of the risk factors of polypharmacy are age and chronic
conditions.  The elderly are more sensitive to the effects of certain
drugs, particularly those that affect the central nervous system.  As a
consequence, drug classes such as benzodiazepines should be used with
caution, and if absolutely necessary, then at a reduced dose to minimize
the risk of falls and other adverse events (Thomas, Liao & McCliar,
2016). In addition, age is associated with decreased regulatory
functions, therefore anti-hypertensives can more easily result in
postural hypotension and opiates in respiratory depression.
 Communication barriers often go undetected in health care settings and
can have serious effects on the health and safety of patients. Limited
literacy skills are one of the strongest predictors of poor health
outcomes for patients (Thomas, Liao, & McCliar, 2016).  If the
patient is deaf, can’t see or is illiterate there are various strategies
the nurse can use for example, advise the patient to bring someone with
them to the visit.  Nurses who are responsible for checking patients in
should be friendly and helpful. The length and number of forms patients
are asked to fill out should be limited.

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