ATLANTA—In a session at the 2019 ACR/ARP Annual Meeting, Susan Chrostowski, DNP, assistant clinical professor at Texas Woman’s University College of Nursing, Dallas, told the audience that she’d had a visit with a patient and asked how he was doing.
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“Not too good,” he said, explaining that his chest hurt.
“What’s the matter with your chest?” she asked. The man replied it had to do with the airbag going off.
“Why did the airbag go off?” asked Dr. Chrostowski, increasingly perplexed.
The man said he “didn’t know what happened,” but all of a sudden a car just came right toward him. Dr. Chrostowski noticed on the man’s long list of medications that he had recently stopped taking the anti-seizure drug phenytoin and asked why he’d done that. He replied that another doctor said he might be able to get off the medication, but to check with his neurologist about it. Instead, the man, not wanting to be bothered with a neurology visit, simply stopped taking the medication, and the car wreck was likely related to a seizure he had while driving.
Challenges of Polypharmacy
The exchange underscores the challenges medical professionals face in helping patients navigate confusing and burdensome polypharmacy. Often, they can’t keep track of when they’re supposed to take their medications or how much to take—or even know why they’re taking them in the first place. Efforts to keep things straight are complicated by other factors, such as in the case above, when one doctor suggests a patient stop taking a medication but the patient doesn’t follow the proper procedure to do so.
“These are some of the problems we encounter,” said Dr. Chrostowski.
Kam Nola, PharmD, MS, professor and vice chair of pharmacy practice at Lipscomb University College of Pharmacy, Nashville, Tenn., said a standard definition of polypharmacy does not exist and the definitions used tend not to account for what is appropriate multiple medication use and what is inappropriate.
The term has assumed a negative connotation—she herself thought about polypharmacy negatively in preparing the talk, but that is not the best way to think about it, she emphasized.
“One key point that I want to make when it comes to polypharmacy is that it is not this negative connotation,” Dr. Nola stated. The objective should be to streamline the process so the needs of the patient and care goals are met.
Drs. Nola and Chrostowski mentioned patients they’ve seen who are on 20 or even 30 medications. When they’re asked to bring them all in for a review, they sometimes put them all in shopping bags—purses aren’t big enough.