Polypharmacy – An Interesting Term For Managing Medicine
For managing medicine: Polypharmacy. This was a new term to me, so I tried to find a working definition, which turned out not to be as easy as you might think. One definition was a patient who is using more than five different prescriptions on a daily basis, while another definition was a patient who is using multiple prescriptions to alleviate the symptoms of one disease. Yet another definition was simply a patient taking more than one medication in a 24 hour period.
So….whichever definition you decide to agree with, this term—polypharmacy—definitely fits with my parents. Pop was on a staggering number of medications on a daily basis for a wide range of problems. Mom, on the other hand, is on virtually nothing for her health, but is now taking some medications to offset the symptoms of dementia and disorientation.
You Are Not A Doctor…
Through the years with Pop, I had multiple doctors ask me if I was in medicine, because I did enough research to sound legitimate in conversations with them. I would always reply that I was nothing but a loving daughter, which was absolutely true. Learning about managing medicine was just part of that. Do not fall into the trap of thinking you are better versed or more informed than the medical team you have hired. They are the professionals, and you are simply a supporting role in that relationship.
…but you are an expert
However, you should be considered an equal partner in that relationship. Since you are as well-read as possible, and you have been involved in every aspect of your loved one’s care, your voice should carry weight with the medical professionals. If it doesn’t, you need to find a new medical team for your person.
The Four Basic Types Of Prescription Medicines
When it comes to managing medicine: I have never actually done any research on medications, the types and reasons to use them. Honestly, I’ve just taken— or given my parents—whatever medications were prescribed by the doctor. For the most part, I haven’t complained or asked to be removed from a prescription. Except for Pop on Coumadin. I think you know how much I hate that one.
So I was surprised that there are really only four basic types of prescription medicines. I really thought it was more broad based and general, but here they are:
Pain Reliever
In my experience the most common type of drug my parents have used, pain relievers are very broad, and can be used for a wide range of problems. Fortunately, over-the-counter types of pain relievers are often enough to help your loved one get through a tough day, since these types generally available will carry less side effects, and be significantly less expensive than the average prescription. Common types: Acetaminophen, nonsteroidal anti-inflammatory, aspirin.
Tranquilizer
We are a family of sleepers, so we have never had any problems with getting rest. However, both of my parents used calming, tranquilizer medications through the years. This type of medication does not induce drowsiness, but can relieve anxiety—which is what we used it for. For Pop, near the end he had tremendous stress and needed to take oral droplets of a tranquilizer. Mom is on a tranquilizing medication every evening at her facility. She gets quite agitated as she “sun downs” in the evenings, and needs to take this pill so she can relax and get some rest. Common types: Xanax, Valium and Ativan
Stimulant
We have absolutely no experience with this class of prescription drug. Designed to speed up messages from the brain to the body, these pills can make a person feel more awake, more alert and more engaged in their surroundings. Common types: Adderral and Ritalin
Sedative
This class of drugs is used the opposite of stimulants, and slows down the activity of your central nervous system, diminishing the messages going from brain to body. Used minimally in dementia patients, we haven’t had to use a sedative with either of my parents. Common types: Barbiturates and opioids
Prescription Types
There are also different types of prescriptions that you need to be aware of while managing your loved one’s medicine. There are two:
Acute
This is a “one-off” prescription you receive from your doctor. For example, you go in for a Urinary Tract Infection and the doctor prescribes an antibiotic. When you are done with that course of treatment, you are finished. These are non-recurring, not continuous prescriptions designed to treat a specific, short-term ailment.
Repeat
Repeat prescriptions refers to the things that your loved one is taking over a prolonged period of time, to help alleviate the symptoms of an ongoing illness or problem. These types of prescriptions are renewable, often without a repeat visit to the doctor for diagnosis. This type of prescription will make up the bulk of the pills your loved one takes, and these are the medications you need to report to other physicians treating your person.
Why Is Polypharmacy Potentially Damaging?
While your loved one absolutely needs every one of those medications in the cabinet, it is important that you be aware of the potential problems associated with polypharmacy. Some of the things you need to keep in mind are listed here:
Adverse effects
The cause of up to 25% of geriatric medical admissions, adverse effects refers to harm caused by drugs prescribed at normal levels. For example, Sweet Husband was prescribed a statin medication which, while widely used at that dosage, immediately interacted negatively with his liver, which put him in the hospital. These types of effects can’t be predicted, and can cause long-term damage if not caught.
Drug Interactions
While each of the agents (drugs) are doing their job for your person, it is quite possible that the combination of the two or more drugs will produce an unexpected and unwelcome symptoms. This is why keeping a completely updated medication list is extremely important when seeing new doctors.
Use Of Complementary Medications
This is something all of us do on a regular basis—you’ve got a headache so you head for the over-the-counter pain reliever without thinking. Complementary medications also includes the use of herbal or home remedies. Unfortunately, use of nonprescription complementary medications can cause unwelcome and very damaging side effects.
Transitions Of Care
This has definitely been the toughest thing for me to monitor through the years. We have been admitted to the hospital only to have them say they didn’t carry one of Pop’s medications, so they simply changed his prescription and we were left informed all of the doctors after the hospital stay. The same thing has happened multiple times while in rehabilitation for both of my parents, and is further reason you always need to be an advocate for them, and keep careful records.
You Need To Keep Track
I’ve repeated this piece of advice multiple times, but it bears repeating once again. Your records of the prescriptions your parent is on now—and what they have been on in the past—may just save their life. Refer to Sweet Husband’s experience with a statin—and he was in his 40’s at the time. Prolonged use of that drug could have permanently damaged his liver, and that is extremely important information for me to take moving forward with his care
Old School
Pop carried a small piece of paper in his wallet with his current medication list on it. It worked for him, and he kept it updated every time something changed. Most people aren’t like Pop and won’t update it regularly enough. Further, this list doesn’t list previous drug interactions or problems, which could be extremely relevant information to have.
Using Technology
This is definitely the better option, because I can keep a current list of medications for Mom, while still being able to refer back to previous medications she was on. In particular, I can tell every doctor exactly WHY she stopped taking a certain medication, so they can make an informed decision. Keeping medication lists in my Google drive puts it in my hand anywhere I have internet through my phone, making my visits to doctors easier and much more informed.
How Often To Revisit
It’s important to update the list whenever anything changes or happens with regard to prescription medications. While I was updating Pop’s list on a monthly basis during the height of his illnesses, Mom’s list hasn’t changed in easily 18 months.
Use The Quarterback
We’ve talked about the importance of having a fantastic General Practitioner in your corner, and this is extremely important when concerns about drug interactions and problems might arise. It was she who caught the problem with Sweet Husband within days of him starting to take the statin that didn’t react well with his body. Anytime things changed with Pop’s specialists, I would immediately call the office and have them amend Pop’s drug list in their records, so it was always up to date.
Managing Medicine: Is Your Loved One Overmedicated?
With Mom in a memory care facility, I had concerns about them overmedicating her to make her “easier” for them to deal with. This absolutely has not happened, but it is important to be aware of your loved one’s normal and expected mood and personality so you can intervene if they appear to be fundamentally changed by a medication that was prescribed.
While the doctors will see overmedication through certain symptoms, you will see it in their daily interactions and moods. Don’t be afraid to step in and advocate for medication changes if you feel they are warranted.
After all, Mayor, you are an expert.
THANK YOU FOR READING THIS FAR
Wow! You made it! Thank you for reading about managing medicine!
Hey, since you’re here! You may as well check out the 5 M’s of geriatric care, here, or if you’ve read that, check out a life-saving TV channel, here! Or maybe you want to hear more about Pop, here. Or, check out our other topics here! Either way, I appreciate you!
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Resources
http://www.nortonmedicalcentre.nhs.uk/PrescriptionTypes.html
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