Learning Journal 19

I have decided to shift the focus of my project. Since I am neither a psychologist nor a sociologist, I don't think I am very qualified to study social factors that contribute to high levels of stress in older adults. Instead, since I am a pre-medical student I will focus my research on polypharmacy (the use of multiple medications by a patient) in older adults.

I have read some literature on this subject that has given me background information on the issue of polypharmacy. As adults age, they are likely to have a combination of chronic medical conditions that require medication (i.e. a patient is diagnosed with diabetes, osteoporosis and hypertension). While these medications are warranted for the treatment of particular conditions, there are often considerations that must be taken into account due to the combination of multiple medications. Some of these considerations are pill burden (the high cost of multiple medications), drug-to-drug interactions (pharmacokinetics, pharmacodynamics) within the patient, and lack of coordination between multiple health-care providers (i.e. a patient visits multiple specialists, each prescribing medications).

How can there can be a lack of coordination between health care providers who see the same patient? Doesn't a person had a medical record that can be viewed by any physician?

How much do we know about drug-to-drug interactions (pharmacokinetics, pharmacodynamics) for specific medication combinations?

I read that the odds of being prescribed inappropriate medications increased by 22% for each additional medication prescribed. That seems very high to me. Why does this occur?

Keywords: polypharmacy, pharmacokinetics, pharmacodynamics