"POLYPHARMACY -- WATCH OUT FOR THAT PILL POPPIN' MADNESS"

                   By John R. Woodward, M.S.W.
      Center for Independent Living of North Florida,. Inc.

     "Polypharmacy," "iatrogenic illness" -- they're fighting words
among doctors.
     An "iatrogenic illness" is one caused by your medical care.
If you go into the hospital for surgery and get exposed to
pneumonia, that's an iatrogenic illness. If your doctor prescribes
a drug that makes you sick, that's an iatrogenic illness, too.
     "Polypharmacy" is a specific type of iatrogenic illness, one
in which too many medications are prescribed for you. Some drugs
should not be taken in conjunction with each other because they
have conflicting effects, and some drugs shouldn't be taken in
combination because they have the same effects. If you take
diuretics to lower your blood pressure, you shouldn't take
steroids, which raise your blood pressure. (These situations are
called "interactions" in the legal drug trade.) On the other hand,
you don't want to be taking, say Tegritol, Valium and Librium
together. All three of these drugs are tranquilizers, and if you
stack them one on top of another, their combined effect will leave
you dopey and helpless. (Many disabled people who try to become
independent find that overtranqualization fatigues them and muddles
their thinking, erecting a "chemical barrier" inside them that
becomes yet another barrier to independence.)
     Once, when I made rounds with the residents at our local
hospital, a member of their training faculty told me that
"polypharmacy" was a factor in 15% of their Emergency Room
admissions -- and 65% of their ER admissions of elderly and
disabled patients. Think of it! The culprits were mostly "Docs-in-
a-box" who prescribed for patients with whom they had no long-term
relationship, and specialists who prescribed for conditions within
their specialty without adequately checking on their patients'
other meds. Older and disabled patients, who take more medications,
are the most frequent victims of polypharmacy. Ironically, they are
also the patients with the most physical vulnerability.
     Never take a new drug without asking your pharmacist about its
side effects and interactions with other drugs. It sounds trite and
hokey -- the stuff of endless "friendly pharmacist" commercials -
- but it's good advice nonetheless. Ideally, your doctor should
take time to check your other meds for possible interactions and
brief you on side effects, but we know that doctors usually think
they're too busy and you're not bright enough for that. Your
pharmacist can save you a lot of pain and expense -- and, maybe,
your life.
     Learn to use the Physician's Desk Reference in your local
library. If the PDR seems too technical, there should be other
books on the shelves about prescription drugs, written for the lay
person. Be aware that it's worth it to learn to read the PDR,
though, because books for the general public frequently omit
listings of the interactions.
     One more safeguard you should take: next time you see your
doctor, find an excuse to throw the word "polypharmacy" into the
conversation. When doctors here you use technical terms like that,
they know they're dealing with a consumer of medical care, and not
a passive "patient."
     It never hurts to let them know they're being watched.

           Reprinted with Permission from MOUTH, 3/92

  This document may be distributed freely in electronic format.