我的药物会让我生病吗?

面试官: 你感觉不舒服. Did you ever consider for a second it could be the medication you're taking to try to feel better that could actually be making you feel worse? 大发娱乐将在下一期《大发娱乐》中讨论这个问题.

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面试官: Dr. 马克Supiano 是犹他大学老龄化研究中心的执行主任. Sometimes medications can cause more problems than they can actually fix especially if you have multiple medications, 处方药和非处方药相互作用不好.

多种药物

Dr. Supiano, let's talk about multiple medications and some of the things you've seen as far as how that makes you feel worse and what you would recommend.

Dr. Supiano: 这在老年人中尤为突出, because older people tend to have more medical conditions that we now have wonderful evidence basis of the benefits of medications to treat those conditions.

当大发娱乐把这些条件加起来, 如果你开始有三个, 四个, 五种慢性病, 每一种情况你都要服用三到五种药物, that multiplier effect increases your risk of having an adverse medical event or a side effect from the interactions between those medications.

So older people that we treat are more likely to be on more medications and are therefore at higher risk for exactly these kinds of problems.

面试官: So is it the raw numbers that's causing the problem or is it the actual what's in the medication doesn't like what's in another medication or both?

服用12种或更多药物

Dr. Supiano: 文献表明，这只是你服用药物的数量. 神奇的数字是如果你服用超过12种药物, and as you mentioned earlier that is a combination of both prescription medications as 好吧 as any over the counter medications that you may be taking, 如果这个数字大于12, 几乎100%的可能性会发生药物和药物之间的相互作用.

面试官: 哇. 所以大发娱乐说的是你可能服用的任何一种止痛药, 咳嗽药, 比如草药呢？?

Dr. Supiano: Sedatives or hypnotics or sleep aids that you might be taking over the counter, all of those.

史考特: 那草药补品之类的呢?

Dr. Supiano: 当然，犹他州是草药补充剂的热床. So we are very aware of that and really need to be careful about the potential interactions between some of those supplements and prescription and other medications.

和你的药剂师或初级保健医生谈谈

面试官: 所以如果你吃了一大堆药, 让专业人士重新评估一下可能是个好主意. 我认为我的 药剂师 知道还是我的医生已经知道了. 情况并非总是如此吗?

Dr. Supiano: 如果你只去一家药店, 如果他们有你所有处方药的准确记录, 现在有系统可以筛选最令人反感的药物-药物相互作用. Most physicians are likewise aware of that but there are other subtleties that individuals trained in geriatrics are more likely to pick up.

Another component is the geriatrics is a team sport and as part of our medical home for example we have a 老年制药.D who has additional expertise to be able to identify the appropriate medications for older people.

另一个原因是你的药剂师或医生, 如果他们缺乏老年医学专业知识，他们可能不会对此敏感, is that there are changes in aging in how the body gets rid of medications that can increase your risk of having the side effects. So if you're not adjusting the dose of the medication appropriately for that person's age or their kidney function that there may be toxic levels of the medication that accumulate and cause these side effects.

面试官: 所以你真的不能设置它然后忘记它? 听起来，你经常会重新评估自己?

Dr. Supiano: So I tell patients if they have been on the same drug for many years and it can't be causing problems, 好吧, if you're 20 years older now your body is metabolizing that medication differently and the levels are going to be higher than they were 20 years ago, 所以现在可能会产生问题.

药物相互作用的不良反应症状

面试官: What might be an indication to somebody that they are actually having some sort of adverse reactions through medication interaction?

Dr. Supiano: Great question and this is really a challenge and particularly since many of these side effects, 有人可能会想, “嗯, 我只是变老了, 所以我第二天当然会觉得很累，或者我有这种特殊的症状,比如便秘. 他们可能认为这只是变老的一部分，可能不会把它归咎于药物.

所以大发娱乐教导大发娱乐的学员，每当有人出现新的症状, 大发娱乐需要先问, “这可能是由现有药物引起的吗？?“大发娱乐真正想要避免的是用另一种药物治疗这种新症状, 因为这又增加了药物的种类.

It becomes a vicious cycle and you just keep adding on more and more medications and you get more and more side effects, 病人并没有好转.

面试官: So how big of a difference can it make if you identify that there's some sort of a medication-medication problem?

Dr. Supiano: If we can identify someone with side effects from a different medication and the term for this is Polypharmacy, if we identify what that side effect is and either reducing those medications or eliminate it, 停药，病人就会好起来, 这是一个胜利.

我可以告诉你, Scott that in my career of some decades now I am confident that I've made more people better by stopping the medication that is causing one of the side effects, 而不是开始服用药物来治疗慢性疾病.

面试官: That's a powerful statement and a statement to probably keep in mind that more is not necessarily better.

Dr. Supiano: 特别是如果它引起了这些副作用之一, it's a very grateful patient if you can identify that offending medication and eliminate it from their medication list and their symptoms improve.

面试官: 如果我觉得我有这种反应，我下一步该怎么做?

下一个步骤

Dr. Supiano: So a comprehensive evaluation to review those medications by someone trained to identify these problems would be the first step.

面试官: 所以我的初级保健医生不是那个人?

Dr. Supiano: 可能是. 我认为主要的原则是, 虽然大发娱乐经常这样做, 需要做的是药物胸腔活检. 这是老年人的手术. You need to go in and biopsy the medications and the way we do that is not with the needle but we ask people when they've come in for their initial evaluation to get a grocery bag and fill it up with all the prescription bottles, 这就是所谓的棕色袋子技巧.

如果一个购物袋不够大, 你装上两个或者, 三个, 或者四个，把他们都带进来，还有大发娱乐的药房.D will sit down and look at each one of those prescriptions and review them and make sure that they're appropriate by with indication, 通过剂量和审查这些潜在的副作用.

面试官: 正如大发娱乐在另一个播客中所说的, 如今, 即使你很年轻，你有很多多种药物可以大发娱乐你. 你不需要成为一个年长的人.

Dr. Supiano: 正确的, so this syndrome of Polypharmacy is not unique to age and our team including geriatrician providers and our 老年制药.D能够熟练地评估病人的潜在问题.

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