Browsing by Subject "Polypharmacy"
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Item A 12-Year Retrospective Study of the Prevalence of Anticholinergic Polypharmacy and Associated Outcomes Among Medicare Patients with Overactive Bladder in the USA(Springer, 2021) Campbell, Noll L.; Hines, Lisa; Epstein, Andrew J.; Walker, David; Lockefeer, Amy; Shiozawa, Aki; Medicine, School of MedicineBackground and objective: Antimuscarinics, drugs with anticholinergic properties, are frequently prescribed for overactive bladder, and anticholinergic burden is associated with adverse events. The "Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults" (Poly-ACH) measure was developed by the Pharmacy Quality Alliance and is used by the Centers for Medicare and Medicaid Services. Using the Poly-ACH measure, we assessed the prevalence of anticholinergic polypharmacy among Medicare patients in the USA with overactive bladder and determined associations between polypharmacy and medical conditions, care, and spending. Methods: This was a retrospective cohort study of Medicare beneficiaries with overactive bladder (coverage period: 2006-2017). Anticholinergic polypharmacy, measured by the Poly-ACH, was defined as concurrent use of two or more anticholinergics, each with two or more prescription claims on different dates of service for ≥ 30 cumulative days. Change in annual frequency of anticholinergic polypharmacy was assessed using logistic regression. Associations between anticholinergic polypharmacy over 3 years and falls, fractures, mental status, and medical care spending were assessed with longitudinal regression models. Results: In total, 226,712 patients contributed 940,201 person-years of follow-up after overactive bladder diagnosis. The share of patients meeting the Poly-ACH definition was 3.3% in 2006 and 1.7% in 2017. Women and nursing home residents had higher risks of anticholinergic polypharmacy. Having 1 year or more of positive Poly-ACH status in the 3 years prior was associated with higher rates of all outcomes. Conclusions: Anticholinergic polypharmacy was uncommon among older adults with overactive bladder. Prevalence was higher among women and nursing home residents, and it was associated with negative outcomes, highlighting potential longitudinal implications of anticholinergic burden.Item Clinical and Quality of Life Benefits for End-Stage Workers' Compensation Chronic Pain Claimants following H-Wave® Device Stimulation: A Retrospective Observational Study with Mean 2-Year Follow-Up(MDPI, 2023-02-01) Trinh, Alan; Williamson, Tyler K.; Han, David; Hazlewood, Jeffrey E.; Norwood, Stephen M.; Gupta, Ashim; Medicine, School of MedicinePreviously promising short-term H-Wave® device stimulation (HWDS) outcomes prompted this retrospective cohort study of the longer-term effects on legacy workers’ compensation chronic pain claimants. A detailed chart-review of 157 consecutive claimants undergoing a 30-day HWDS trial (single pain management practice) from February 2018 to November 2019 compiled data on pain, restoration of function, quality of life (QoL), and polypharmacy reduction into a summary spreadsheet for an independent statistical analysis. Non-beneficial trials in 64 (40.8%) ended HWDS use, while 19 (12.1%) trial success charts lacked adequate data for assessing critical outcomes. Of the 74 final treatment study group charts, missing data points were removed for a statistical analysis. Pain chronicity was 7.8 years with 21.6 ± 12.2 months mean follow-up. Mean pain reduction was 35%, with 89% reporting functional improvement. Opioid consumption decreased in 48.8% of users and 41.5% completely stopped; polypharmacy decreased in 36.8% and 24.4% stopped. Zero adverse events were reported and those who still worked usually continued working. An overall positive experience occurred in 66.2% (p < 0.0001), while longer chronicity portended the risk of trial or treatment failure. Positive outcomes in reducing pain, opioid/polypharmacy, and anxiety/depression, while improving function/QoL, occurred in these challenging chronic pain injury claimants.Item Comorbidity of attention deficit hyperactivity disorder in a patient with epilepsy: Staring down the challenge of inattention versus nonconvulsive seizures(Elsevier, 2024-02-01) Miller, Derryl J.; Komanapalli, Hannah; Dunn, David W.; Neurology, School of MedicineEpilepsy is a heterogeneous disorder of recurrent seizures which often is comorbid with anxiety, depression, attention deficit hyperactivity disorder (ADHD), intellectual disability (ID), and other psychiatric manifestations. Treating both epilepsy and behavioral symptoms from psychiatric disorders can result in polypharmacy with interactions of medications leading to both worsened efficacy of antiseizure medications due to psychotropic effects and worsening of psychiatric symptoms due to antiseizure medication side effects. We aim to suggest pragmatic strategies for the neurologist in the diagnosis and management of comorbid ADHD in patients with epilepsy based on the International League Against Epilepsy (ILAE) Pediatric Commission guidelines and additional literature review. The screening tool of choice for the symptoms of ADHD is validated in the country of practice and written in the language of the family, though various screening tools and advantages and disadvantages of each will be discussed. Once ADHD is diagnosed, recent safety data suggest that Methylphenidate, Amphetamine, and Atomoxetine are generally safe for patients with epilepsy. We present a case of a child with epilepsy and ADHD and discuss the clinical signs, symptoms, and strategies for treatment as well as when to refer to child psychiatry.Item Corrigendum: Polypharmacy to Mitigate Acute and Delayed Radiation Syndromes(Frontiers Media, 2021-08-25) Gasperetti, Tracy; Miller, Tessa; Gao, Feng; Narayanan, Jayashree; Jacobs, Elizabeth R.; Szabo, Aniko; Cox, George N.; Orschell, Christie M.; Fish, Brian L.; Medhora, Meetha; Medicine, School of Medicine[This corrects the article DOI: 10.3389/fphar.2021.634477.].Item Editorial: Ongoing advancements in the research of radiation- induced toxicity and the development of interventions to protect and/or mitigate its effects(Frontiers Media, 2024-08-21) Cui, Wanchang; Plett, P. Artur; Sharma, Guru Prasad; Kerns, Sarah; MacVittie, Thomas J.; Medicine, School of MedicineItem Polypharmacy Among Prescription Drug Users(The Center for Health Policy, 2017-08-01) Omenka, Issac; Greene, Marion S.Polypharmacy, i.e., the misuse of multiple prescription drugs or prescription medication with other substances, is highly problematic. Whether unintentional or deliberate, misuse of multiple drugs can lead to adverse effects including addiction; drug-drug interactions; and overdose, potentially resulting in death. Polypharmacy is not uncommon; almost 84 percent of prescription drug misusers receiving substance abuse treatment in Indiana reported using at least one additional substance, most commonly alcohol or marijuana.Item Polypharmacy Among Prescription Drug Users(The Center for Health Policy, 2017-08-01) Omenka, Issac; Greene, Marion S.Polypharmacy, i.e., the misuse of multiple prescription drugs or prescription medication with other substances, is highly problematic. Whether unintentional or deliberate, misuse of multiple drugs can lead to adverse effects including addiction; drug-drug interactions; and overdose, potentially resulting in death. Polypharmacy is not uncommon; almost 84 percent of prescription drug misusers receiving substance abuse treatment in Indiana reported using at least one additional substance, most commonly alcohol or marijuana.Item Polypharmacy to Mitigate Acute and Delayed Radiation Syndromes(Frontiers Media, 2021-05-17) Gasperetti, Tracy; Miller, Tessa; Gao, Feng; Narayanan, Jayashree; Jacobs, Elizabeth R.; Szabo, Aniko; Cox, George N.; Orschell, Christie M.; Fish, Brian L.; Medhora, Meetha; Medicine, School of MedicineThere is a need for countermeasures to mitigate lethal acute radiation syndrome (ARS) and delayed effects of acute radiation exposure (DEARE). In WAG/RijCmcr rats, ARS occurs by 30-days following total body irradiation (TBI), and manifests as potentially lethal gastrointestinal (GI) and hematopoietic (H-ARS) toxicities after >12.5 and >7 Gy, respectively. DEARE, which includes potentially lethal lung and kidney injuries, is observed after partial body irradiation >12.5 Gy, with one hind limb shielded (leg-out PBI). The goal of this study is to enhance survival from ARS and DEARE by polypharmacy, since no monotherapy has demonstrated efficacy to mitigate both sets of injuries. For mitigation of ARS following 7.5 Gy TBI, a combination of three hematopoietic growth factors (polyethylene glycol (PEG) human granulocyte colony-stimulating factor (hG-CSF), PEG murine granulocyte-macrophage-CSF (mGM-CSF), and PEG human Interleukin (hIL)-11), which have shown survival efficacy in murine models of H-ARS were tested. This triple combination (TC) enhanced survival by 30-days from ∼25% to >60%. The TC was then combined with proven medical countermeasures for GI-ARS and DEARE, namely enrofloxacin, saline and the angiotensin converting enzyme inhibitor, lisinopril. This combination of ARS and DEARE mitigators improved survival from GI-ARS, H-ARS, and DEARE after 7.5 Gy TBI or 13 Gy PBI. Circulating blood cell recovery as well as lung and kidney function were also improved by TC + lisinopril. Taken together these results demonstrate an efficacious polypharmacy to mitigate radiation-induced ARS and DEARE in rats.Item Polypharmacy, Over the Counter Medications, and Aromatase Inhibitor Adherence in Early-Stage Breast Cancer(Springer, 2024) Joyce, Elizabeth; Tao, Xueting; Stearns, Vered; Hayes, Daniel F.; Storniolo, Anna Maria; Kidwell, Kelley M.; Henry, N. Lynn; Medicine, School of MedicinePurpose: Polypharmacy is associated with negative health outcomes and decreased medication adherence. Polypharmacy is common in cancer populations, but few studies have evaluated the relationship between polypharmacy and aromatase inhibitor (AI) adherence. No studies have evaluated the relationship between over-the-counter (OTC) supplements and AI adherence. Our primary hypothesis was that polypharmacy would be associated with increased risk of premature AI discontinuation. Methods: This exploratory analysis used data from the Exemestane and Letrozole Pharmacogenetics (ELPh) trial, a prospective, multicenter, randomized controlled trial that enrolled participants from 2005 to 2009. Included patients were female, postmenopausal, with stage 0-III breast cancer, who had completed indicated chemotherapy, surgery, and radiation. Participants were randomized to adjuvant exemestane or letrozole and completed serial clinical examinations and questionnaires for two years. Concomitant medication data were collected prospectively. Cox proportion models were used for statistical analysis of the relationship between polypharmacy, OTCs, medication class, and AI adherence. Results: In the 490 analyzed participants, use of any prescription medications at baseline was associated with decreased risk of premature AI discontinuation (HR 0.56, p = 0.02). Use of selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and norepinephrine reuptake inhibitors (SNRIs) at baseline was associated with decreased risk of premature AI discontinuation (HR 0.67, p = 0.04). Use of any OTCs was not associated with AI discontinuation. Conclusion: Baseline use of prescription medications but not OTCs was associated with increased AI persistence. Future research is needed to understand how this can be utilized to promote AI adherence.Item Prescription and Other Medication Use in Pregnancy(Wolters Kluwer, 2018-05) Haas, David M.; Marsh, Derek J.; Dang, Danny T.; Parker, Corette B.; Wing, Deborah A.; Simhan, Hyagriv N.; Grobman, William A.; Mercer, Brian M.; Silver, Robert M.; Hoffman, Matthew K.; Parry, Samuel; Iams, Jay D.; Caritis, Steve N.; Wapner, Ronald J.; Esplin, M. Sean; Elovitz, Michal A.; Peaceman, Alan M.; Chung, Judith; Saade, George R.; Reddy, Uma M.; Obstetrics and Gynecology, School of MedicineOBJECTIVE: To characterize prescription and other medication use in a geographically and ethnically diverse cohort of women in their first pregnancy. METHODS: In a prospective, longitudinal cohort study of nulliparous women followed through pregnancy from the first trimester, medication use was chronicled longitudinally throughout pregnancy. Structured questions and aids were used to capture all medications taken as well as reasons they were taken. Total counts of all medications taken including number in each category and class were captured. Additionally, reasons the medications were taken were recorded. Trends in medications taken across pregnancy and in the first trimester were determined. RESULTS: Of the 9,546 study participants, 9,272 (97.1%) women took at least one medication during pregnancy with 9,139 (95.7%) taking a medication in the first trimester. Polypharmacy, defined as taking at least five medications, occurred in 2,915 (30.5%) women. Excluding vitamins, supplements, and vaccines, 73.4% of women took a medication during pregnancy with 55.1% taking one in the first trimester. The categories of drugs taken in pregnancy and in the first trimester include the following: gastrointestinal or antiemetic agents (34.3%, 19.5%), antibiotics (25.5%, 12.6%), and analgesics (23.7%, 15.6%, which includes 3.6%; 1.4% taking an opioid pain medication). CONCLUSION: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common.