Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Polypharmacy and Deprescribing

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In one line

·Five or more medicines at once raise the risk of dangerous drug interactions, side effects, and falls—especially in older adults.

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Normal physiology

·Normally, each medicine you take has a clear job—one lowers blood pressure, one steadies blood sugar, one thins the blood to prevent clots—and your liver breaks them down while your kidneys flush out the waste, keeping levels safe and steady.

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What goes wrong

·The problem starts when medicines pile up without anyone reviewing the whole list. Each new symptom gets a new pill instead of asking whether an old pill caused it. Doctors from different offices don't always talk to each other, so nobody sees the full picture. Over time, the liver and kidneys get overwhelmed, drug levels climb too high, and medicines start crashing into each other—blocking, boosting, or canceling each other's effects.

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Hallmark signs

·Taking five or more medicines at the same time (prescription, over-the-counter, or supplements)
·Confusion, dizziness, or falls that started after a new medicine was added
·Trouble keeping track of doses, missing doses, or taking the wrong pill
·New or worsening symptoms that look like a disease but are actually a side effect (for example, shaking, slow movement, or trouble peeing)
·Feeling tired, weak, or foggy-headed all the time
·Stomach upset, nausea, or bleeding in the gut
·Kidneys or liver not working as well (seen on blood tests)
·Going to the hospital or emergency room because of a medicine problem

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Red flags · escalate now

·New confusion, severe dizziness, or a fall—especially after starting or changing a medicine
·Black or bloody stools, vomiting blood, or severe belly pain (signs of stomach bleeding)
·Very slow heart rate, chest pain, trouble breathing, or fainting (possible toxic levels or dangerous interaction)
·Sudden shaking, stiff muscles, or trouble moving (may be medicine-induced parkinsonism or serotonin syndrome)
·Cannot pee, severe constipation, or blurry vision with a racing heart (anticholinergic overload)

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Workup

·Serum creatinine and estimated glomerular filtration rate (eGFR)
·Liver function tests (ALT, AST, bilirubin, albumin)
·Medication reconciliation review (compare patient's actual pill bottles, pharmacy records, and electronic medical record)
·Beers Criteria or STOPP/START screening tool applied to the patient's medicine list
·Serum drug levels for narrow therapeutic index medicines (digoxin, phenytoin, lithium, theophylline, vancomycin)
·Complete blood count (CBC)
·Anticholinergic burden score (calculated from the patient's medicine list)

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Treatment

·Medication reconciliation: collect ALL medicines (prescription, over-the-counter, supplements, herbal products) from the patient, family, and pharmacy records, then compare them to the medical chart
·Apply the Beers Criteria (AGS) or STOPP/START tool to flag high-risk medicines based on the patient's age, kidney function (eGFR), liver function, and other conditions
·For each medicine, ask and write down: (1) Is this still needed for a current condition? (2) Is it working — are symptoms better? (3) Is it safe in this person's kidneys, liver, and age? (4) Does keeping it match what the patient wants for their life?
·Slowly taper and stop high-risk deprescribable medicines (benzodiazepines, proton pump inhibitors, beta-blockers, SSRIs, opioids, anticholinergics) using published tapering schedules, not cold-turkey
·Simplify the schedule: switch to once-daily dosing when safe (example: long-acting metoprolol instead of short-acting three times a day), use a pill organizer or blister pack, print a one-page chart of what to take when
·Involve a clinical pharmacist in the deprescribing plan, review the medicine list at every visit, and tie each remaining medicine to a specific written goal in the chart (example: 'atorvastatin — goal LDL < 70 for secondary prevention after heart attack')

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NCLEX trap

·Ask at every visit: Does the patient still need it? Does it work? Is it safe now? Does it match their goals? Stop it if the answer is no to any question.
·Stop or lower the drug causing the side effect first. Do not add another drug — that grows polypharmacy and makes it worse.
·Slow down. Use deprescribing lists (Beers, STOPP). Stop beta-blockers, benzodiazepines, PPIs, SSRIs, and opioids slowly to avoid rebound harm. Work with the patient.
·Check kidney and liver labs at every visit. Old organs cannot clean out 10+ drugs. Adjust doses or stop drugs if organs are weak.
·Work with a pharmacist. Use pill organizers. Make the schedule simple — one pill once a day if you can. Align cost and confusion with the patient's life.
·Count everything — prescription, OTC, vitamins, herbs, eye drops, creams. Polypharmacy happens in the home, not just on the prescription pad.

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