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Why is it important to consider a patient's polypharmacy when obtaining a chief complaint or medical...

Why is it important to consider a patient's polypharmacy when obtaining a chief complaint or medical history?

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Answer #1

Taking multiple drugs or herbal supplements at the same time without proper medical advice despite of their actual need is called as Polypharmacy.

It is important to consider a patient's polypharmacy when obtaining patient history or chief complaint due to following factors:

  1. To determine/prevent any drug interactions: Taking multiple drugs or herbal supplements at the same time can lead to unintended drug interactions For example: antagonism (Glucagon-Insulin, Hydrochlorothiazide + Traimterene etc), synergism (Tyramine + Monoamine oxidase inhibitors, Acetylcholine + Physostigmine), additive effect (Aspirin + paracetamol, Amlodipine + atenolol)
  2. To identify any potential iatrogenic diseases: Polypharmacy can be the underlying cause (iatrogenic effects) for the chief complaint and taking history of medications will help in ascertaining the diagnosis. For example, antipsychotics such as Haloperidol can induce Parkinsonism, Angiotensin Converting Enzyme inhibitors cause cough, Gentamicin can result in nephrotoxicity, High ceiling diuretics can result in Hypokalemia etc
  3. To eliminate adverse effects: Polypharmacy can lead to serious adverse effects, by taking a thorough history of medications will help in differentiating adverse effects from clinical manifestations of a disease
  4. To prevent failure of drug regimen: Polypharmacy can lead to unintended reactions (tachyphylaxis, tolerance, idiosyncrasy) which can result in patient non compliance and failure of the current therapy.
  5. To plan optimized clinical course for current condition: By taking a thorough history of patient's polypharmacy, a physician can plan the drug regimen such that there is no repetition of the drugs, drug interaction or unwanted drug effects. There by it helps in planning the clinical course of treatment.
  6. To improve patient compliance: A patient's polypharmacy can help to know the knowledge and the degree of compliance of the patient towards therapy. Hence, further actions can be planned to achieve patient compliance.  
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