Polypharmacy and the Role of Physical Medicine and Rehabilitation
- 21 March 2012
- Vol. 4 (3), 198-219
- https://doi.org/10.1016/j.pmrj.2012.02.012
Abstract
Polypharmacy and inappropriate prescribing practices lead to higher rates of mortality and morbidity, particularly in vulnerable populations, such as the elderly and those with complex medical conditions. Physical medicine and physiatrists face particular challenges given the array of symptoms treated across a spectrum of conditions. This clinical review focuses on polypharmacy and the associated issue of potentially inappropriate prescribing. The article begins with a review of polypharmacy along with relevant aspects of pharmacokinetics and pharmacodynamics in the elderly. The adverse effects and potential hazards of selected medications commonly initiated and managed by rehabilitation specialists are then discussed with specific attention to pain medications, neurostimulants, antipsychotics, antidepressants, antispasmodics, sleep medications, and antiepileptics. Of particular concern is the notion that an adverse effect of one medication can mimic an indication for another and lead to a prescribing cascade and further adverse medication events. Appropriate prescribing practices mandate an accurate, current medication list, yet errors and inaccuracies often plague such lists. The evidence to support explicit (medications to avoid) and implicit (how to evaluate) criteria is presented along with the role of physicians and patients in prescribing medications. A brief discussion of "medication debridement" or de-prescribing strategies follows. In the last section, we draw on the essence of physiatry as a team-based endeavor to discuss the potential benefits of collaboration. In working to optimize medication prescribing, efforts should be made to collaborate not only with pharmacists and other medical specialties but with members of inpatient rehabilitation teams as well.Keywords
This publication has 104 references indexed in Scilit:
- Use of Antidepressant Medications and Risk of Fracture in Older WomenCalcified Tissue International, 2011
- Managing Medications in Clinically Complex EldersJAMA, 2010
- The role of prophylactic anticonvulsants in moderate to severe head injuryInternational Journal of Emergency Medicine, 2010
- Medicare Part D's Exclusion of Benzodiazepines and Fracture Risk in Nursing HomesJAMA Internal Medicine, 2010
- In search of an ideal analgesic for common acute painAcute Pain, 2009
- Use of Prescription and Over-the-counter Medications and Dietary Supplements Among Older Adults in the United StatesJAMA, 2008
- Eligibility Criteria of Randomized Controlled Trials Published in High-Impact General Medical JournalsJAMA, 2007
- Clinical Practice Guidelines and Quality of Care for Older Patients With Multiple Comorbid DiseasesJAMA, 2005
- Hospitalization and Death Associated With Potentially Inappropriate Medication Prescriptions Among Elderly Nursing Home ResidentsArchives of Internal Medicine, 2005
- Medication Undertreatment in Assisted Living SettingsArchives of Internal Medicine, 2004