Polypharmacy: Is It Just Me? by Timothy Erickson, MD
Tuesday, November 3, 2009 
Timothy Erickson, MDIs it just me, or have you ever picked up a patient’s chart in the emergency department and noted multiple allergies listed and wanted to nonchalantly place the chart back in the rack before your colleagues noticed? Have you also noted that nearly all patients with more than 10 allergies listed inevitably have somewhat of a challenging personality trait?
Is it just me, or have you noticed patients with a medical list exceeding 20 medications often present with a
complaint of “weak and dizzy”? (Typically presenting at 2am when you’re single covered). I once had a patient prescribed no less than 32 medications- Six pain relievers, 4 antibiotics, 3 antihypertensive agents, 3 stool softeners, 2 thyroid medications, 3 antipsychotics, 2 antidepressants, 2 anticonvulsants, 2 diuretics, 2 oral hypoglycemics, 1 potassium supplement, 1 calcium supplement, and a bottle of Beano. All items were beautifully displayed in a tackle box (fishing lures not included). Miraculously, the patient had normal laboratory data. Despite this, I admitted her with a diagnosis of “polypharmacy” so someone else upstairs in the hospital would sort it all out- The most amazing thing was that the patient was compliant with all these pharmaceutical products. She must have poured them into a large cereal bowel every morning, and spooned them in over warm milk. In defense of the patient, some physician (or physicians) actually prescribed all these medications.
Can anyone out there beat 32 meds in one patient? Overdoses not included…
Reader Comments (8)
I don't think I can beat 32 meds, but last year I had a patient who brought in a ten page written list of her medical history which included IBS, Chronic Fatigue Syndrome, Fibromyalgia, Migraines, RSD, Trigeminal Neuralgia, Sciatica, Seasonal Affective Disorder, Major Depression, and "Chronic Pain Syndrome." Two full pages were devoted to listing allergies to more than 25 different medicines, with the specific side effect that each medicine caused. My favorite was her allergy to Zoloft, for which she wrote, and you just can't make this stuff up..........
"Causes a false sense of well being."
Wouldn't want to risk that..........
One of my partners saw a person with a med list of 56 items. That inculdes OTC meds and topicals. I wouldn't believe it if I hadn't seen it with my own eyes.
I still have the list.
The police brought a young man in a few weeks ago who was exhibiting some erratic behavior and causing a scene on one of the nearby city streets. He was combative and placed in 4-points so I ordered him a little haldol/ativan combo to be given IM. The nurse goes in the room with the syringe and asks the guy if he has any allergies to medications. He looks at the syringe, looks at her and says ... "haldol" with a somewhat suspicious look in his eye. The nurse was on to him, and says, "well, its a good thing you're in the emergency department so we can keep an eye on you if you have an allergy. Anything else?" He looks at the second syringe in her hand. "Ativan."
I can confidently say that after his four hour observation followed by psych admission we can scratch those allergies off the record.
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