Carroll Hospital physician gives guidance for managing multiple medications

Polypharmacy is a term referring to a person taking five or more medications at once, a state most common, though not exclusive, to older adults, according to Dr. Nicole Cimino-Fiallos, director of the Geriatric Acute Care Suite in the Carroll Hospital emergency department.

“As medicine has advanced, we have gotten better at controlling chronic medical conditions,” Cimino-Fiallos said. “As patients age, they tend to accumulate more diagnoses, and as we age, some of our medical problems become harder to manage. It requires more medications to keep them under control.”


That’s an upside, she notes, because there are medications to control these conditions. But there can be downsides to polypharmacy as well.

“As we add more medications, you’re just going to have more interactions,” Cimino-Fiallos said. “Most estimates suggest that one-third of elderly patients are taking more than five medications regularly, and the risk of medication interactions is much higher in elderly patients.”

A common scenario that serves as an example, she said, is a patient who may come to the emergency department after suffering a heart attack.

Certified Physician Assistant Kevin Walsh has been named Carroll Hospital's Advanced Practice Provider of the Year.

“When that patient leaves the hospital they are probably going to be on a statin for high cholesterol, they will probably be on at least one if not two blood pressure medications, they will be on a daily aspirin and maybe a blood thinner,” Cimino-Fiallos said. “So they come in for one problem, but in order to best manage that problem and prevent it from happening again, they will probably leave the hospital on at least four medications.”

Those medications are vital in managing that hypothetical patient post-heart attack, according to Cimino-Fiallos, but they can also have side effects patients should be aware of.

“Some of these medications can lower your blood pressure too quickly, putting you at risk for falling, feeling light headed, dizzy, those kinds of things,” she said. “Aspirin and blood thinners put you at risk for bleeding, so those patients, combined with the stress of being hospitalized are at risk for stomach ulcers and things of that nature.”

So what should a patient and their caregivers do? First of all, Cimino-Fiallos said, it’s important to keep a list of all the medications you take, including any supplements.

“They should ask their doctor to review this at every follow up visit,” she said. “If patients come to the emergency department, they need to also have that list with them and make sure the emergency physician is aware of all the medications they are taking so that everyone is on the same page.”


Physicians should also take note and look for opportunities to reduce a patients medication load, according to Cimino-Fiallos.

“One of the themes we see is that people get started on the medications in the hospital and then there’s no drive to get them off the medications at some point,” she said. “They end up staying on medications they may not need in the long term.”

Another thing patients can do is ask their doctor for non-drug interventions, Ciminio-Fiallos said. Asking about and reviewing sleep hygiene before jumping right to a sleeping pill, as an example.

Lastly, people should remember that pharmacists are experts on medications and a valuable resource for medication management, according to Cimino-Fiallos.

“Carroll Hospital actually offers free consultations with a pharmacist on an out-patient basis,” she said. “They will review your list and will tell you if you have any potential interactions or dangerous medications.”

Information on and appointments with the hospital’s Medication Therapy Management Clinic are available by calling 410-871-6118.