What's In Your (Parents') Medicine Cabinet?

Medications are a double-edged sword.  Used properly in the right dose for the right purpose, they can decrease pain and all-cause mortality.  Used improperly in the wrong dose or for an "inappropriate" purpose, they can cause harm.  Ideally, we would take better care of ourselves than we currently do such that we no longer require oral hypoglycemic, anti-hypertensive, and lipid lowering agents.  Unfortunately, most of us choose the easier path, which is to say, we pop pills.

On the other hand, there are many situations in which medications play a key role, no matter our lifestyle.  For instance, antibiotics are appropriate for strep throat (when it's truly due to streptococcus and not a virus) and urinary tract infections (not just asymptomatic bacteriuria in a non-pregnant patient).

However, what's "appropriate" to one person (patient, physician or both) might not be considered "appropriate" to someone else.  For instance, beta blockers are standard of care in those with heart disease.  However, they are also anathema to those with asthma.  But what about patients who have both conditions?  Family physicians regularly see and help these complicated but real patients decide which disease process gets higher priority when it comes to conflicting medications.

Complicating this issue is that of polypharmacy, rightly/wrongly prescribed in those with multiple comorbidities.  8 years ago, the Beers list of potentially inappropriate medications (PIM) for use in the elderly was updated from its original expert opinion consensus.  Unfortunately, even in its updated form, the list did not have an evidence-base upon which to support it.  Worse, the list of PIMs did not coincide with studies of adverse drug events (ADE).  But at least it made us think twice about our prescribing habits for the elderly.

Earlier this summer, STOPP (the Screening Tool of Older Persons' potentially inappropriate Prescriptions) was developed based upon 329 ADEs in 600 patients requiring hospitalization.  Ironically, the medications noted in STOPP were not found to be the cause of hospitalization in 5,077 cases identified by the National Electronic Injury Surveillance System as published last week in NEJM.  Instead, the authors noted that warfarin (33.3%), insulin (13.9%), oral anti-platelet agents (13.3%), and oral hypoglycemic agents (10.7%) accounted for the vast majority of ADE-related hospitalizations.  In fact, medications on the Beers & STOPP list accounted for only 1.2% of hospitalizations.  

So as part of your annual family tune-up, review your parents' medications list with them and make sure they need what they're taking, especially if their list includes any of the four classes mentioned above.

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