Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
------------------------
Too many drugs, too little oversight
OUR HEALTH

By PATTY LEVINE
Tribune Correspondent

See related story:
Awareness can reduce polypharmacy risks

America has another drug problem, but this one is not associated with
the Colombian drug cartel, street corner drug pushers, or Medicare
prescription coverage. This problem involves polypharmacy -- when the
use of three, four or more prescribed drugs may have side effects that
make the treatment worse than the disease.

Polypharmacy is an increasingly common problem now that so many
Americans are living longer, when persistent physical problems and
chronic ailments often arise.

An article several years ago in The Journal of General Internal Medicine
reported that twice as many medications were prescribed for patients 65
and older than for younger patients, and that seniors used seven times
as many over-the-counter drugs as the general adult population. Various
studies report that between 10 percent and 20 percent of hospital
admissions for older people result directly from adverse reactions to
prescribed medications.

But polypharmacy is by no means limited to the elderly. Although there
are no precise

statistics on the incidence and consequences of polypharmacy, estimates
as high as between 50 percent and 60 percent have been reported in the
general population.

Upping the ante

Pharmacist Maxie Bolden of Memorial Family Pharmacy in South Bend says a
major part of the problem is the American mind-set that insists there
has to be a medical remedy for every ailment. In fact, fully
three-fourths of visits to the doctor in the United States end with a
written prescription.

Another major culprit is the bombardment of direct-to-consumer
advertisements of prescription medicines that urge consumers to "ask
your doctor about." Bolden says that these direct marketing campaigns
leave the doctor caught in a precarious position between patients
clamoring for the newest drug they've seen on TV, and the information
provided by the drug companies and their representatives as to their
products' efficacy and possible adverse effects.

Adding to the problem is a newfound availability of medicines that have
changed status from prescription to over-the-counter. According to the
Consumer Healthcare Products

Association, since the mid-1970s, 89 prescription medicines have
switched, and 38 of these switches have occurred in the past 10 years.
There is a downside to this wave of OTC drugs that occurs when the
physician is removed from the prescription equation. We may not be
familiar with the ingredients in these medicines, and we don't know how
these drugs interact with each other or with prescription drugs we may
already be taking at our doctor's direction.

Multiple factors

Michelle Smith, a clinical pharmacist at Memorial Hospital in South
Bend, says many patients have multiple doctors and use several
pharmacies. This means that no one has oversight of how many and what
kind of drugs a patient is taking, not to mention how these drugs may
interact with each other. Patients may become confused if the pharmacist
fills the prescription with the drug's generic equivalent and the
physical appearance of the drug changes. In addition, variations in drug
dosing patterns serve to confuse the patient, who may end up taking too
much or too little of the drug.

The high cost of drugs and the lack of Medicare or other drug coverage
also may be factors. A study released this past June by Express Scripts,
a drug benefits company, reports that during 2003, spending on
prescription drugs increased by 7.9 percent, with seniors experiencing
the largest cost increases. Bolden says that many patients hoard
leftover drugs and take them on their own if and when symptoms return.
He adds that patients may skip a dose or try to cut up the pill in order
to conserve medication.

 From bad to worse

It is all too easy for polypharmacy to become a witches' brew in which
two or more drugs taken together can interact to cause serious side
effects. Sometimes side effects caused by one or more medications are
then treated with yet another drug that may have side effects of its
own. Seniors are particularly at risk. Because of decreased liver and
kidney function, they metabolize drugs more slowly and have less power
to excrete them, resulting in a buildup of toxic doses.

Then there are the problems that arise from either unpleasant side
effects of a drug or a dosing regimen that becomes too complicated. The
patient may simply stop taking the drug or take it less often than
prescribe.
http://www.southbendtribune.com/stories/2005/03/16/living.20050316-sbt-MICH-D2-Too_many_drugs__too_.sto

Awareness can reduce polypharmacy risks
OUR HEALTH

By PATTY LEVINE
Tribune Correspondent

There are many ways to avoid the pitfalls of polypharmacy:

# Pharmacist Michelle Smith of Memorial Hospital says that the best way
to start is for the patient to act as a responsible partner in his or
her health care. First of all, this means not assuming there is a drug
to solve every symptom. Simple behavioral changes involving diet,
exercise and stress management may be the best remedies for many health
problems. If you have insomnia, a change in caffeine use or bedtime
routines may help as well as a sleeping pill.

# Next, be forward looking and ask questions of both your doctor and
pharmacist. Ask about possible side effects and drug interactions, when
and how to take a medication, what food and drinks to avoid, and whether
a drug is best taken on a full or empty stomach.

# When prescribing a drug, physicians should provide, both orally and in
writing, the name, purpose, dosage and possible side effects. Patients
also should be told if they may experience any immediate unpleasant
symptoms that will resolve with time, as well as when they should
contact their doctor. Patients should be given a time frame for
improvement. For drugs that treat hidden symptoms such as high blood
pressure, patients should be kept informed of their progress, or lack of
progress, toward the treatment goal.

# Make sure your physician has a complete list of every drug and dose
you are taking. Over-the-counter drugs, vitamins and herbal remedies
also must be included because these may have side effects or can even
interfere with the efficacy of a prescribed drug. Double-check with your
doctor before you take any new nonprescription drugs. Another safeguard
is to ask your doctor to share your medical and drug record with any
other doctors you may be seeing.

# Choose a pharmacy carefully and stay with that one pharmacy. The
American Pharmaceutical Association recommends that a pharmacy have a
system for monitoring all the drugs you are taking -- a patient
medication profile. This profile should include a concise health
history, any demonstrated allergies or adverse drug effects, and a
complete list of all over-the-counter and prescription medications you take.

# All prescriptions should be filled and taken as prescribed. Taking too
little or too much of a prescribed drug -- not following doctor's orders
-- is a major cause of problems. If complicated dosing schedules pose a
difficulty and many drugs need to be taken at different times, ask the
doctor if an adjustment -- such as a switch to extended release
medication -- can be made.

# If the drug has side effects you cannot tolerate, tell your doctor.
Many times, another medication can be substituted or other changes made
to solve the problem.

Even certain foods, according to Memorial Family Pharmacy pharmacist
Maxie Bolden, can interact with the drugs you take. For example, green,
leafy vegetables high in Vitamin K, which promotes clotting, can
interact with blood-thinning drugs. Your best bet, he says, is to "treat
anything that goes into your mouth as potentially dangerous."

Off your drugstore shelf
The following are seven popularly used over-the-counter drug classes,
along with information on what they do and possible side effects,
according to the American Pharmaceutical Association and pharmacist
Maxie Bolden of Memorial Family Pharmacy:

Antacids and acid blockers: Antacids neutralize or reduce the amount of
acid present in the stomach. Acid blockers prevent the stomach from
making acid in the first place. Antacids such as Maalox and Mylanta
prevent the absorption of antibiotics such as tetracyclines and
fluoroquinolones. Some acid blockers interfere with the metabolism of
calcium channel blockers for heart disease, anti-convulsants and
anti-coagulants.

Antihistamines: These drugs reduce the intensity of allergic reactions,
particularly in the nasal passages. Some produce drowsiness and reduced
response time. Certain antihistamines can aggravate a benign enlargement
of the prostate gland present in many older men.

Decongestants: These drugs shrink blood vessels in the nose, reducing
stuffiness and sinus pain. Because they constrict the blood vessels,
they can limit the effectiveness of drugs for high blood pressure and
diabetes.

Cold formulas: These drugs have multiple ingredients such as cough
suppressants, anti-histamines, decongestants and pain relievers in one
formula. There is a danger of overdose if cold formulas are used in
conjunction with other drugs for treatment of cold symptoms. You also
may be taking medicine needlessly for symptoms you don't have.

Aspirin: Aspirin works on aches, pain and fever. It helps prevent heart
attacks and strokes by keeping platelets in the bloodstream from forming
clots. Because of its ability to prevent the formation of blood clots,
aspirin, even in low doses, should not be used by people using
anti-coagulants unless they are under the care of a doctor.

Acetaminophen: Tylenol is probably the best-known brand-name for this
class of over-the-counter drug used for pain control and to reduce
fever. Acetaminophen taken in large doses may impair liver function,
which would affect patients taking anti-coagulants.

Ibuprofen/Naproxin: Ibuprofen and Naproxin belong to a class of
medications called nonsteroidal anti-inflammatory drugs (NSAIDS). They
are used for the relief of pain and the reduction of fever. Use of two
or more of these drugs at the same time should be avoided because of the
risk of an additive effect. Aspirin should be used with caution when
NSAIDs also are taken because of the anti-coagulative action of both
drugs and the increased risk of stomach upset. NSAIDs have been reported
to affect anti-hypertensive drugs and also to interact with some
psychiatric, cancer and arthritis drugs.

http://www.southbendtribune.com/stories/2005/03/16/living.20050316-sbt-MICH-D2-Awareness_can_reduce.sto
--
Kathrynne Holden, MS, RD < [log in to unmask] >
"Ask the Parkinson Dietitian"  http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/

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