Doannghi.dl

Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Below is a list of our suggestions. Text in italics will be removed from the original article. References that we will insert are cited here, existing citations are indicated only by square brackets and reference numbers:

We propose to replace the following content in the Polypharmacy#Medical Uses section:

Considerations often associated with thoughtful, therapeutic polypharmacy include: 1. Drugs given for a single somatic locale act on biochemical mechanisms present throughout the body such that their nonlinear interactions can produce an (unknown except empirically) global physiological state of health;[16] 2. The more independent variables, "handles", to manipulate, the greater the likelihood of finding and stabilizing a small available parametric space of healthy function while minimizing unwanted effects.[17]

While polypharmacy is typically regarded as undesirable, prescription of multiple medications can be appropriate and therapeutically beneficial in some circumstances. “Appropriate polypharmacy” is described as prescribing for complex or multiple conditions in such a way that necessary medicines are used according to best evidence to preserve safety and well-being. Polypharmacy is clinically indicated in some conditions, including diabetes mellitus, but should be discontinued when evidence of benefit from the prescribed drugs no longer outweighs potential for harm (described below in Contraindications).

We propose to replace the following content in the Polypharmacy#Contraindications section:

Polypharmacy is associated with an increased risk of falls in the elderly. Certain medications are well known to be associated with the risk of falls, including cardiovascular and psychoactive medications. The use of four or more of these medicines is known to be associated with a significantly higher, cumulative risk of falls. Although often not practical to achieve, withdrawing all medicines associated with falls risk can halve an individual's risk of future falls.

Polypharmacy is associated with an increased risk of falls in the elderly. Certain medications are well known to be associated with the risk of falls, including cardiovascular and psychoactive drugs. There is some evidence that the risk of falls increases cumulatively with the number of medications.

We propose to replace the following content in the Polypharmacy#Contraindications section:

Every medication has potential adverse side-effects. With every drug added, there is an additive risk of side-effects. Also, many medications have potential interactions with other substances. 15% of older adults are potentially at risk for a major drug-drug interaction.[18] When a new drug is prescribed, the risk of interactions increases exponentially. Doctors and pharmacists aim to avoid prescribing medications that interact; often, adjustments in the dose of medications need to be made to avoid interactions, such as with warfarin, as it may lose its effect.

Every medication has potential adverse side-effects. With every drug added, there is an additive risk of side-effects. Also, many medications have potential interactions with other substances. 15% of older adults are potentially at risk for a major drug-drug interaction.[18] Older adults are at a higher risk for a drug-drug interaction due to the increased number of medications prescribed and metabolic changes that occur with aging. When a new drug is prescribed, the risk of interactions increases exponentially. Doctors and pharmacists aim to avoid prescribing medications that interact; often, adjustments in the dose of medications need to be made to avoid interactions. For example, warfarin interacts with many medications and supplements that can cause it to lose its effect.

We propose to insert the following content into the Polypharmacy#Pill burden section:

Barriers faced by both physicians and patients have made it challenging to apply deprescribing strategies in practice. For physicians, these include fear of consequences of deprescribing, the prescriber’s own confidence in their skills and knowledge to deprescribe, the feasibility of deprescribing, and the complexity of having multiple providers. For patients, attitudes or beliefs about the medications, fears and uncertainties surrounding deprescribing, and influence of physicians, family, and the media are also reported barriers to deprescribing.

We propose to replace the following content in the Polypharmacy#Pill burden section:

For instance, adults with multiple common chronic conditions such as diabetes, hypertension, lymphedema, hypercholesterolemia, osteoporosis, constipation, and clinical depression can often be prescribed more than a dozen different medications daily.

For instance, adults with multiple common chronic conditions such as diabetes, hypertension, lymphedema, hypercholesterolemia, osteoporosis, constipation, inflammatory bowel disease, and clinical depression can often be prescribed more than a dozen different medications daily.

We propose to insert the following content into the Polypharmacy#Pill burden section:

The use of memory tricks has also been seen to improve adherence and reduce pill burden in several countries. These include associating mealtimes with medications with mealtimes, recording the dosage on the box, storing the medication in a special place, leaving it in plain sight in the living room, or putting the prescription sheet on the refrigerator. The development of applications has also shown some benefit in this regard.

We propose to insert the following content into the Polypharmacy#Intervention section:

Deprescribing was also deemed feasible and effective in other settings such as residential care, communities and hospitals. This preventative measure should be considered for anyone who exhibits one of the following: (1) a new symptom or adverse event arises, (2) when the person develops an end-stage disease, (3) if the combination of drugs is risky, or (4) if the disease doesn’t get worse if the patient stops taking the drug.

Thank you. We appreciate your time and welcome any feedback or suggestions Jnt91 (talk) 02:29, 19 November 2019 (UTC)

Welcome!

Hello, Doannghi.dl, and welcome to Wikipedia! My name is Ian and I work with the Wiki Education Foundation; I help support students who are editing as part of a class assignment.

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If you have any questions, please don't hesitate to contact me on my talk page. Ian (Wiki Ed) (talk) 01:36, 22 November 2019 (UTC)