|
Polypharmacy is the use of four or more medications by a patient, generally adults aged over 65 years.〔(【引用サイトリンク】title=polypharmacy )〕〔Stawicki SP. Polypharmacy and medication errors: Stop, listen, look, and analyze... OPUS 12 Scientist 2009;3(1):6-10.〕 Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes. About 21% of adults with intellectual disability are also exposed to polypharmacy. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, prescribing cascade and higher costs. Polypharmacy is often associated with a decreased quality of life, decreased mobility and cognition.〔 It is well accepted in pharmacology that it is impossible to accurately predict the side effects or clinical effects of a combination of drugs without studying that particular combination of drugs in test subjects. Knowledge of the pharmacologic profiles of the individual drugs in question does not assure accurate prediction of the side effects of combinations of those drugs. Whether or not the advantages of polypharmacy (over monotherapy) outweigh the disadvantages or risks depends upon the particular combination and diagnosis involved in any given case.〔(【引用サイトリンク】title=When Is Polypharmacy an Advantage? )〕 The use of multiple drugs, even in fairly straightforward illnesses, is not an indicator of poor treatment. A perfectly legitimate treatment regimen could include, for example, the following: a statin, an ACE inhibitor, a beta-blocker, aspirin, paracetamol and an antidepressant in the first year after a myocardial infarction. ==Medical uses== Considerations often associated with thoughtful, therapeutic polypharmacy include: # 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;〔Mandell, A.J. and Selz, K.A. 1992 Dynamical systems in psychiatry: Now what? ''Biological Psychiatry'' 32: 299-301.〕 # 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.〔Callahan, J. and Sashin, J. I. 1987 Models of affect-response and anorexia nervosa. ''Ann. N.Y. Acad. Sci.'' 504:241-259.〕 Often certain medications can interact with others in a positive way specifically intended when prescribed together, to achieve a greater effect that any of the single agents alone. This is particularly prominent in the field of anesthesia and pain management - where atypical agents such as antiepileptics, antidepressants, muscle relaxants, NMDA antagonists, and other medications are combined with more typical analgesics such as opioids, prostaglandin inhibitors, NSAIDS and others. This practice of pain management drug synergy is known as an ''analgesia sparing'' effect. As another example, in anesthesia (particularly IV anesthesia and general anesthesia) multiple agents are almost always required - including hypnotics or analgesic inducing/maintenance agents such as Versed or Diprivan, usually an opioid analgesic such as morphine or Demerol, a paralytic such as vecuronium, and in inhaled general anesthesia generally a halogenated ether anesthetic such as sevoflurane or desflurane. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「polypharmacy」の詳細全文を読む スポンサード リンク
|