Oct. 28, 2022

Poly-Pharmacy

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Poly-Pharmacy
Poly-Pharmacy
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Clarence and Stan chat with Dr. Rhonda Chakolis about polypharmacy.

Dr. Ronda Chakolis

  • Licensed pharmacist with ParmD degree
  • Independent contractor
  • Previous pharmacist at CVS for 13 years 
  • Member of MN Board of Pharmacy 
  • MPH from American Public University 
  • PharmD degree from University of Minnesota College of Pharmacy 
  • BA in history from Augsburg College 
  • Published “Cultural Competency in a Pharmacy Ethics Course” 

 

Research

  • What is Polypharmacy?
    • The use of multiple drugs to treat diseases and conditions 
      • Also referred to as “multimorbidity” 
    • More common among older adults who have multiple chronic conditions
      • Examples: arthritis, diabetes, hypertension, asthma, coronary heart disease
      • Aging can cause the kidneys to take longer to clear medications and metabolize them 
    • Can occur at both the patient level and the medical system level 
      • “...poor medical record keeping can lead to polypharmacy if discontinued medications are not removed from the record and are refilled automatically or if a physician receives an automated refill request for a discontinued medication” (American Family Physician) 
  • Fast Facts
    • 83% of adults in their 60s and 70s in the United States have used at least one prescription drug in the last month and one-third has used five or more prescription drugs in the last month (CDC)
    • Patients taking five to nine medications have a 50% chance of an adverse drug interaction (US Pharmacist)
    • Patients have a 100% chance of an adverse drug interaction when they are taking 20 or more medications (US Pharmacist)
    • Polypharmacy accounts for almost 30% of all hospital admissions and is the fifth leading cause of death in the U.S. (US Pharmacist)
  • What are the risks? 
    • Managing multiple medications can be difficult to track, hard to manage, and expensive 
      • Can be a burden on the patient and family in order to understand each prescription, the provider, staying on top of refills, knowing the side effects for each medication, etc. 
    • Taking multiple medications increases the risk of adverse reactions and/or drug interactions 
      • Examples: falls, cognitive impairment, misdiagnoses, emergency room visits, etc. 
    • Adults living in long-term care facilities are often at higher risk because they are typically more frail and have multiple medical issues 
    • Younger adults with chronic conditions such as diabetes, heart, disease, and fibromyalgia may experience polypharmacy 
    • Patients with mental health conditions are often prescribed several medications at once 
  • Deprescribing
    • Discontinuing medications, decreasing dosage, changing medications, etc. 
    • Recommended as a tool to reduce the risk of adverse reactions and financial difficulty 
    • Challenges of deprescribing: time constraints, lack of support, patient resistance 
  • Additional Questions for Dr. Chakolis
    • Are there disparities in polypharmacy among different populations? (i.e. race, gender, etc.) 
    • Which drugs are most commonly used in polypharmacy? 
      • And, which drugs are the leading “culprits” of adverse reactions in polypharmacy? 

Sources