[Polypharmacy is of major concern in cardiology]. / Polypharmazie in der Kardiologie - ein beachtliches Problem bei Synkopen, QT-Zeit-Verlängerung, Bradykardie und Tachykardie.

Quality improvement in cardiology over the past decade focused on management of acute coronary syndrome with invasive and innovative medical therapies, optimizing treatment of congestive heart failure and the development of repair procedures in valvular heart disease. On the other hand cardiologist and the attendant physicians are confronted with changes in the characteristics of patients in the light of demographic facts. Comorbidity and polypharmacy raise the need for clear concepts. Therapeutic and diagnostic tools of geriatric medicine may help in that context.

[Oral anticoagulation and risk of bleeding in elderly patients - the aspect of polypharmacy]. / Blutungskomplikationen bei geriatrischen Patienten unter oraler Antikoagulation - Aspekte der Polypragmasie.

Oral anticoagulant therapy has been shown to be of benefit also in elderly patients in various therapeutic and prophylactic indications. Despite strong evidence in literature, doctors still refuse to prescribe oral anticoagulants to geriatric patients in daily routine. Main reason for this decision is the fear of secondary bleeding complications. According to clinical trial data, distinct risk factors for bleeding attributed to anticoagulant treatment may be determined: age >70 years, female gender, recurrent bleeding events, alcohol/drug abuse, diabetes, anaemia and polypharmacy. The entire article reveals the literature in Medline and Cochrane Library from 1980 to 2009 including the hits "polypharmacy - anticoagulant treatment - elderly patients". It further highlights risk assessment strategies in elderly patients, and possible pharmacokinetic and -dynamic interactions of drugs co-administered with oral anticoagulants.

[Diuretics-related complications in elderly patients]. / Komplikationen durch Diuretikatherapie bei geriatrischen Patienten.

Diuretics are well studied and evaluated for their beneficial use in geriatric patients. However those drugs are often used without taking care of subjects condition or functional impairment. Known side effects of those substances may be increased by combinations of multiple drugs. Polypharmacy is a strong risk factor for the incidence of adverse drug reactions (ADR). ADRs are frequently found in combination with the use of diuretics. The remodelling of human body in aging process and uncontrolled therapeutic strategies seem to be causal for that finding. This article tries to work out the potential risk of the usage of those drugs in geriatric patients and its clinical relevance by using literature published in PubMed.

[Drug-related delirium in elderly patients]. / Medikamenten-induzierte Delirien älterer Menschen.

Drugs have been widely associated with the development of delirium in the elderly and represent the most common reversible cause of this condition. This is of importance since successful treatment depends on identifying the reversible contributing factors. Medications with anticholinergic properties, tranquilizers, analgesics and narcotics are common causes of drug-induced delirium. This article provides practical approach to prevent and recognise this condition, reviews the underlying neurotransmitter imbalances and reconsiders age-related changes of pharmacological effects, which may contribute to the development of delirium.

[Polypharmacy and pain treatment]. / Polypharmazie und Schmerztherapie.

Pain is a frequent symptom in clinical practice. Elderly and chronically ill patients are particularly affected. On account of the high prevalence of polypharmacy among these patients, pharmacological pain therapy becomes a challenge for physicians. Drug side effects and drug-drug interactions have to be taken into account so as to minimize the health risk for these patients. Especially the group of NSAID has a high risk of adverse drug reactions and drug interactions. The gastrointestinal, the cardiovascular, the renal and the coagulation system are particularly affected. Except for the toxic effect on the liver (in a high dose) Paracetamol (acetaminophen) has similar risks, to a minor degree, though. According to current data Metamizol is actually better than its reputation. The risk of potential drug interactions seems to be low. Beside the risk of sedation in combination with other drugs, Tramadol and other opioids such as Pethidin may induce the Serotonin syndrome. In order to avoid dangerous drug interactions and adverse side effects in the case of polypharmacy, it is recommended to prefer individual choices instead of sticking to the pain management as proposed by the WHO.

[Polypharmacy and falls in the Elderly]. / Polypharmazie und Stürze im Alter.

Falls and their consequences are a major problem in geriatric medicine. Main causes are the combination of age-related physiological changes with multimorbidity and subsequent polypharmacy. Elderly patients are more susceptible to adverse drug effects and have less compensatory capacity than younger adults. Therefore careful monitoring of side effects is indicated and prescribing for elderly patients calls for alertness in order to identify symptoms as possible adverse drug effects.