Posts Tagged excessive medication

Deprescribe — too many medications

bottle_of_medsMany patients take too many medications which leads to unnecessary side effects, drug interactions and high cost.  Yet physicians sometimes fight just to get patients to take necessary medications.  Two examples:

  1. Provider:  How many medications are you taking?
    Patient:  Including vitamins I think fifteen.
    Provider:  What? I only have two medications on my list.
    Patient:  I restarted all the medications I was taking before you hospitalized me plus all the new prescriptions from when I left the hospital and I added some vitamins.
  2. Patient:  I stopped that medication because I thought it was causing my hair to fall out.
    Provider:  Your heart medication does not cause hair to fall out.  And, even if it did you could die without it.

The medications you take should be reviewed at each visit so you and the provider consider which are truly needed and why.  The provider who gives the patient a prescription is responsible to make sure there is no interaction or duplication with ongoing treatment.  Yes, that means cardiologists and dentists also.  A proactive patient should simply ask, “Is that new medication compatible with all of my existing medications and does it replace one of the existing medications?

The highest risk situation for evaluation of medications happens when alternate providers become involved.  Like a hospital doctor, an ER doctor or a specialist.  They tend to add medications without fully considering the existing medications, often thinking the primary provider will resolve any drug issues — too bad when a fill-in primary provider steps into the mix.

An article in the Washington Post January 28, 2017 by Dr. Ranit Mishori advises the following questions for providers and patients to consider together about medications:

● What is this medication, and why am I taking it?
● Are there non-pharmacologic options to treat this condition?
● How long do I need to be on it?
● What are the benefits of continuing to take it?
● What are the possible harms of using that medication?
● Do any of my medications interact with any another?
● Can I lower the doses of any of these medications?
● Which of my medications are more likely to be nonbeneficial considering my age, my other medical conditions and my life expectancy?
● Are there any medications I can get off completely?

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The Perils of Over-Treatment — diabetes and hypertension

excessToo much treatment is dangerous just like too little treatment.  Treating blood pressure too early or too aggressively increases the risk of death.  Treating elderly patients with diabetes with too much medicine increases episodes of low blood sugar that damage the brain and leads to broken bones from falling.

In 2014 the national guidelines for blood pressure treatment were changed to allow a higher blood pressure.  Similarly, a recent study found increased mortality for elderly patients treated too strongly for diabetes.

This is not rocket science.  Imagine a blood pressure medication that could lower the blood pressure to any level.  Knowing that zero blood pressure means you are dead, it stands to reason there is a point where treating blood pressure goes from helpful to dangerous.  Same for blood sugar.

Sometimes this problem is called “treating the test“.  In essence prescribers just look at the numbers and write a prescription, but ignore symptoms of weakness or spells of altered consciousness.  Hypertension and diabetes are good examples but this happens with lots of other conditions.

Examples of over-treatment include treating a sore throat with antibiotics, treating mild asthma with oral steroids, or treating an elevated lyme serology test with antibiotics.  It takes time to make a correct diagnosis and time to explain treatment to patients — some health care providers simply don’t take the time to do either.

Most drugs have a “therapeutic windowopenwindow.  As long as the window is open the patient gets benefit.  But, the window closes due to side effects and advanced age.

If a person is over 80 or in poor health excessive medical treatment is a substantial risk.  In this group even the thought of a low cholesterol diet is foolhardy.   It’s all about risks and benefits.

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