Maybe It's Your Medications How to Avoid Unnecessary Drug
Therapy and Adverse Drug Reactions
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This book contains the opinions and ideas of its author. It is a source of information only and
does not constitute medical advice to the individual reader. Neither the author nor the
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Copyright © 2023 by Hedva Barenholtz Levy, PharmD
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Library of Congress Cataloging-in-Publication Data is available on file.
Cover design by Kai Texel
Cover image: Getty Images
Print ISBN: 978-1-5107-7483-4
Ebook ISBN: 978-1-5107-7484-1
Printed in the United States of America
Contents
List of Tables and Figures
Introduction
Part I: Medication Use in an Aging Population
Chapter 1: The Growing Medication-Use Problem
Chapter 2: Why Older Adults Are Vulnerable to Adverse Drug Events
Chapter 3: Understanding Medication-Related Problems and Medication
Reviews
Part II: The Overmedication Problem
Chapter 4: Defining Polypharmacy
Chapter 5: Consequences of Polypharmacy
Part III: Beyond Prescription Drugs
Chapter 6: Nonprescription Medications: Over-the-Counter Drugs and
Dietary Supplements
Chapter 7: Nondrug Treatment Strategies to Manage Health Conditions
Part IV: Medication Issues that Matter Most to Older Adults
Chapter 8: Medication Adherence
Chapter 9: Understanding Drug Interactions
Chapter 10: Potentially Inappropriate Medications for Older Adults
Chapter 11: High-Risk Medications in Older Adults
Chapter 12: Prescribing Omissions: Under-Prescribing of Important
Medications
Part V: Strategies for Safer Medication Use
Chapter 13: Advocate for Yourself
Chapter 14: Know Your Medications
Chapter 15: Prevent Medication Errors
Chapter 16: Avoid Medication Overload and Inappropriate Polypharmacy
Chapter 17: Take Medications as Instructed
Chapter 18: Choose Nonprescription Products Carefully
Chapter 19: Health and Drug Information on the Internet
Afterword
Glossary
Acknowledgments
Notes
Index
List of Tables and Figures
Chapter 1
Sidebar 1-1: Gerontology vs. Geriatrics
Sidebar 1-2: Paradigm Shifts in Health Care Supporting Patient
Involvement
Chapter 2
Figure 2-1: Five Characteristics that Increase the Risk of Adverse Drug
Events in Older Adults
Figure 2-2: Four Components of Pharmacokinetics
Table 2-1: Age-Related Pharmacokinetic Changes Commonly Seen
and Impact on Medication in Older Adults
Table 2-2: Examples of Medications Impacted by Age-Related
Pharmacodynamics Changes
Sidebar 2-1: Detecting Adverse Events in Clinical Studies
Sidebar 2-2: The Health-Care Team
Chapter 3
Table 3-1: Eight Categories of Medication-Related Problems
Sidebar 3-1: Who Can Benefit from a Medication Review?
Sidebar 3-2: Medicare Part D Medication Therapy Management
Services
Chapter 4
Figure 4-1: Timeline of Growing Awareness of Polypharmacy and
Overmedication Use
Sidebar 4-1: An Example of Polypharmacy: Appropriate or
Inappropriate?
Chapter 5
Figure 5-1: Prescribing Cascade
Chapter 6
Sidebar 6-1: Homeopathic Drugs and Medical Foods
Table 6-1: Examples of Common Dietary Supplements
Table 6-2: Regulation of Over-the-Counter (OTC) Products and
Dietary Supplements
Table 6-3: Examples of Prescription-to-OTC Switches
Table 6-4: Over-the-Counter Products Associated with an Increased
Risk of Adverse Effects in Older Adults
Table 6-5: Examples of Significant Drug Interactions with Dietary
Supplements
Figure 6-1: Over-the-Counter Drug Facts Label
Figure 6-2: Supplement Facts Panel
Table 6-6: Examples of Brand-Name Extension of OTC Products
Chapter 7
Table 7-1: Examples of Nondrug Treatments
Table 7-2: Nondrug Treatment Strategies Specific to Selected Health
Conditions
Table 7-3: Resources on Healthy Behaviors for Older Adults
Chapter 8
Box 8-1: Examples of Ways in which Patients Are Not Adherent with
Their Medications
Table 8-1: Adherence Barriers
Chapter 9
Table 9-1: Drug Interaction Categories
Table 9-2: Serious Drug-Drug Interactions in Older Adults
Chapter 10
Table 10-1: Examples of Potentially Inappropriate Medication Criteria
in AGS Beers Criteria
Table 10-2: Examples of Potentially Inappropriate Medications from
STOPP Criteria
Chapter 11
Table 11-1: Anticoagulant and Antiplatelet Drugs
Table 11-2: Insulin and Oral Hypoglycemic Agents
Table 11-3: Common Drugs with Strong Anticholinergic Properties
Chapter 12
Table 12-1: Examples of Potential Prescribing Omissions from the
Screening Tool to Alert to Right Treatment (START)
Chapter 14
Box 14-1: Eight Essential Items of Medication Information
Chapter 15
Figure 15-1: The Medication Use Process and Safety Checks for Each
Stage
Table 15-1: Examples of Medication Errors
Box 15-1: Ten Tips for Creating a Medication List
Box 15-2: How to Clean Out Your Medicine Cabinet and Dispose of
Old Medications
Chapter 16
Box 16-1: Questions to Help Assess Risk and Benefit of a Medication
Table 16-1: Examples of Adverse Drug Reactions that Can Mimic
Health Conditions
Table 16-2: Selected Medication-Related Items from Choosing Wisely
Chapter 17
Figure 17-1: Example of a Medication List Template
Table 17-1: Medication Adherence Reminder Aids
Box 17-1: Tips and Resources to Reduce Medication Costs
Chapter 19
Box 19-1: Selected Health and Drug Information Websites and
Related Resources
To my husband, Don, for your unending support.
To my mother and father always.
Introduction
I
“ think I’m taking too many pills, but my doctor says I need them all.”
“Is it okay for me to take all of these medications together—and
with these supplements, too?”
“My mom’s behavior just isn’t the same.”
Maybe you can relate to these concerns, being a bit wary about taking
medications. Or perhaps you don’t worry too much about your medications.
“I only take what the doctor prescribes.”
“My doctors all look at my medications.”
“I get my medications every month at the pharmacy.”
Are the medications we take helpful or harmful? Medications have a
very important role in keeping us healthy and extending our lives; there is
no doubt. But when do we cross the line from taking the right number and
mix of drugs to keep us healthy to taking more than are necessary? All too
often an unrecognized adverse drug reaction is mistaken for a new medical
condition, or worse: a symptom of getting older. But who stops to question
the medications?
This book is about safe medication use. It focuses on older adults as
defined in the medical field as anyone age sixty-five and older, but the
principles apply to people of any age who take medications. Older adults
make up the fastest growing segment of our population. They have more
long-term health conditions and take more medication than any other age
group, and medication use is associated with far more problems in older
individuals compared to younger adults.
