Poly-Pharmacy

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

• https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adults
• https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-017-0621-2
• https://www.aafp.org/pubs/afp/issues/2019/0701/p32.html
• https://www.uspharmacist.com/article/polypharmacy
• https://www.yalemedicine.org/news/polypharmacy