Top Causes

Polypharmacy can arise from different situations. One of the primary causes of polypharmacy is the use of duplicate medications. Clinical guidelines for chronic diseases like hypertension, diabetes, and chronic obstructive pulmonary disease often require using two or more drugs in the same pharmacologic class. For example, multiple antihypertensives are typically used to treat hypertension.

Another common contributor to polypharmacy is what is known as a prescribing cascade. In this situation, a drug administered to a patient causes adverse event signs and symptoms that are inaccurately interpreted as a new condition for which an additional medication is then prescribed. In these cases, the second drug can increase the adverse reaction to the first drug or place the resident at risk for additional adverse reactions. Some of the drugs most commonly involved in prescribing cascades are:

• Opioids
• NSAIDs
• Antihypertensives
• Antibiotics
• Drugs for dementia

For example, calcium channel blockers prescribed to treat hypertension may cause peripheral edema, which can be interpreted a new condition for which diuretics are prescribed.