Polypharmacy In Mainstream Medicine

Episode 15: Download and Share my Cheat-Sheet for Mixing Dangerous Prescription Medications. Polypharmacy is a term used to describe the interaction of multiple medications with increased risk of adverse outcomes including disability and death. The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines1. Each class of medication carries different risks that can be additive and potentiate adverse events. Two Hundred Thousand – 400,000 people don’t die every year due to medical mistakes globally. Pressure from the US government led doctors to drastically cut back the use of opiates in the past several years. The next target is Benzodiazepines sometimes still necessary for relief of severe anxiety, at least until someone decides to start achieving Physical, Mental, Spiritual and Emotional balance. https://vimeo.com/1129164156?share=copy&fl=sv&fe=ci Download & Share the Ambassador Slides Handout. The standard of care for anxiety disorders The standard of care for anxiety disorders is psychotherapy and an antidepressant. Medications such as benzodiazepine-related (alprazolam, diazepam, lorazepam, clonazepam, zolpidem, etc.), gabapentin, propranolol, hydroxyzine and buspirone are frequently used off-label for breakthrough anxiety or panic episodes. Also, chronic insomnia is best treated with a specific protocol for Cognitive Behavioral Therapy for Insomnia (CBT-I). Primary care prescribe approximately 90% of all psychiatric medications in the U.S.A., but they take a symptom-based approach to make the anxiety temporarily abate. In psychiatry, the goal is to overcome the emotional dysregulation and improve resiliency for future stressors. Chronic benzodiazepine use no longer has a place in the psychiatric standards of treatment. The risks of dementia, IQ point loss, insomnia, prolonged PTSD, chronic anxiety, dependency, risk of death, and avoidance of psychotherapy outweigh the temporary benefits of this class of nervous system depressants. Below is a list of contraindications (Do Not Mix) and summary of class-specific side effects in attempt to prevent harm, originally published as an excerpt from Clinical Handbook for Psychiatric Urgent Care in the USA, Daniel M. Williams, M.D., P.A. List of common side effects in acute settings of polypharmacy. This is what your doctor is worried about: Why We Fight Alcohol: Active alcohol use is a risk factor for medication adverse events. Combining medications with alcohol can result in respiratory depression, failure to maintain a secure airway, aspiration pneumonia, respiratory failure, coma and death. Benzodiazepines: Work on the GABA receptors just like alcohol. As such, they kill brain cells and are associated with insomnia, doubling the risk of dementia at any age, cognitive loss, persistent anxiety, physical and psychological dependence, and addiction. Examples: Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), Xanax (alprazolam), Ambien (zolpidem), Temazepam, Oxazepam, Zaleplon. Benzodiazepines handoutDownload Buprenorphine: Subutex contains only buprenorphine but Suboxone contains naloxone in addition to buprenorphine (naloxone helps protect people from an inadvertent opioid overdose). So long as there is naloxone present, there is practically no abuse potential, but it makes no sense to take it with a bunch of other controlled substances. I've seen people take full opiates in the parking lot and walk-in to start the buprenorphine induction protocol. Subutex is a sublingual tablet and Suboxone is a film that you put under your tongue. Subutex was approved in 1981 and Suboxone has been available since 2002. Both Subutex and Suboxone can be initiated early by a doctor as part of an opioid treatment program. The brand name Subutex has been discontinued in the U.S. but it is available as generic buprenorphine sublingual tablets. Methamphetamine: This stimulant can cause psychosis, irritability and anger, and other forms of mood and thought disorders. Acutely, heart attacks, strokes, seizures and psychosis are some of the most dangerous interaction when mixing meth with other substances. Opiates: Opiates stop the respiratory drive so the diaphragm stops moving, the main way people die on overdoses with fentanyl and heroine, etc. Prescription opiates are just as dangerous when abused or mixed with other medications or alcohol. Stimulants: Stimulants can include prescription and nonprescription. By definition, they increase adrenaline and dopamine in the frontal cortex in the brain. Therefore, combining stimulants with some other medications can exacerbate the background risk of hypertension, palpitations, arrhythmia, even leading to stroke and death. Examples: Methylphenidate, Adderall, methamphetamine, cocaine. A good example of this is the recently outlawed Dos Locos beer that added a stimulant to an alcoholic beverage that resulted in deaths. THC. Tetrahydrocannabinol (THC) is the main psychoactive agent and neurologic pain relief from the cannabis plant. There are no known overdoses or deaths due to THC in the history of mankind. There are 500 endocannabinoids and terpenes with ancient, healing benefit. That said, it can cause syncope, dizziness, sleepiness, drowsiness, forgetfulness and amotivational syndrome. 1 Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017 Oct 10;17(1):230. doi: 10.1186/s12877-017-0621-2. PMID: 29017448; PMCID: PMC5635569.