Abstract

Elderly patients are at a high risk of developing chronic diseases, including cardiovascular disease, cancer, dementia, and diabetes. Additionally, many elderly individuals experience multimorbidity, having more than one chronic condition, contributing to the phenomenon of polypharmacy. This case report aims to analyze polypharmacy therapy in elderly patients with concurrent decreased kidney function and elevated liver enzymes. Polypharmacy in elderly patients with decreased kidney and liver function necessitates a comprehensive study to assess both its benefits and potential side effects. Monitoring should be implemented to detect any emergence of side effects or drug interactions resulting from the prescribed therapy. According to the 2023 Beers Criteria, elderly patients with reduced kidney function face an elevated risk of drug-related side effects, potentially leading to prolonged hospital stays and increased medical costs.

There is no Figure or data content available for this article

References

• Organization WH. Ageing and health in the Southeast Asia Region. World Health Organization.
• Rizzuto D, Melis RJF, Angleman S, Qiu C, Marengoni A. Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults. J Am Geriatr Soc. May 2017;65(5):1056-1060. doi:10.1111/jgs.14868
• Tan JL, Eastment JG, Poudel A, Hubbard RE. Age-Related Changes in Hepatic Function: An Update on Implications for Drug Therapy. Drugs Aging. Dec 2015;32(12):999-1008. doi:10.1007/s40266-015-0318-1
• Remelli F, Ceresini MG, Trevisan C, Noale M, Volpato S. Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clin Exp Res. Sep 2022;34(9):1969-1983. doi:10.1007/s40520-022-02165-1
• Adams ML. Differences Between Younger and Older US Adults With Multiple Chronic Conditions. Prev Chronic Dis. Sep 7 2017;14:E76. doi:10.5888/pcd14.160613
• McGilton KS, Vellani S, Yeung L, et al. Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review. BMC Geriatr. Oct 1 2018;18(1):231. doi:10.1186/s12877-018-0925-x
• Hamidah KF, Rahmadi M, Meutia F, et al. Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia. Pharm Pract (Granada). Oct-Dec 2022;20(4):2735. doi:10.18549/PharmPract.2022.4.2735
• Hosoi T, Yamana H, Tamiya H, et al. Association between comprehensive geriatric assessment and polypharmacy at discharge in patients with ischaemic stroke: A nationwide, retrospective, cohort study. EClinicalMedicine. Aug 2022;50:101528. doi:10.1016/j.eclinm.2022.101528
• Novaes PH, Da Cruz DT, Lucchetti ALG, Leite ICG, Lucchetti G. The “iatrogenic triad”: polypharmacy, drug–drug interactions, and potentially inappropriate medications in older adults. Int J Clin Pharm. 2017;39:818-825. doi:10.1007/s11096-017-0470-2
• Faisal S, Zairina E, Nathishuwan S, Khotib J, Kristina SA, Nugraheni G. Prevalence and Predictors of Excessive Polypharmacy in Geriatric Inpatients: A Retrospective Cross-Sectional Study in Indonesia. J Prim Care Community Health. Jan-Dec 2023;14:21501319231178595. doi:10.1177/21501319231178595
• Rakesh KB, Chowta MN, Shenoy AK, Shastry R, Pai SB. Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital. Indian J Pharmacol. Jan-Feb 2017;49(1):16-20. doi:10.4103/0253-7613.201036
• Rathore A, Sharma R, Bansal P, Chhabra M, Arora M. Knowledge, attitude, and practice of medical interns and postgraduate residents on American Geriatric Society updated Beers criteria. J Educ Health Promot. 2023;12:1. doi:10.4103/jehp.jehp_769_22
• Tang J, Wang K, Yang K, et al. A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study. BMC Geriatr. Jan 25 2023;23(1):44. doi:10.1186/s12877-023-03743-2
• Soetikno V, Effendi I, Nafrialdi N, Setiabudy R. A survey on the appropriateness of drug therapy in patients with renal dysfunction at the Internal Medicine Ward FMUI/Dr. Cipto Mangunkusumo Hospital. Medical Journal of Indonesia. 2009;18(2):108-13. doi:10.13181/mji.v18i2.348
• Munar MY, Singh H. Drug dosing adjustments in patients with chronic kidney disease. Am Fam Physician. May 15 2007;75(10):1487-96.
• Shargel L, Yu ABC. Applied Biopharmaceutics & Pharmacokinetics. McGraw-Hill Companies; 2012.
• Nuryati. Farmakologi. Kementerian Kesehatan RI; 2017.
• Oktaviani I. Aspek Farmakokinetika Klinik Obat-obat Yang Digunakan Pada Pasien Sirosis Hati. 2012.
• Villén N, Guisado-Clavero M, Fernández-Bertolín S, et al. Multimorbidity patterns, polypharmacy and their association with liver and kidney abnormalities in people over 65?years of age: a longitudinal study. BMC Geriatr. Jun 12 2020;20(1):206. doi:10.1186/s12877-020-01580-1
• American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. Jul 2023;71(7):2052-2081. doi:10.1111/jgs.18372
• Patel E, Rosemond D, Afzal A. Ondansetron induced torsades de pointes. Clin Case Rep. Aug 2019;7(8):1557-1558. doi:10.1002/ccr3.2251
• Lacy CF, Amstrong LL, Goldman MP, Lance LL. Drug Information Handbook, 17th edition. Lexi-Comp Inc. ; 2009.
• Phan H, DeReese A, Day AJ, Carvalho M. The dual role of domperidone in gastroparesis and lactation. Int J Pharm Compd. May-Jun 2014;18(3):203-7.
• Irawati S. Penatalaksanaan Gastroesophageal Reflux Disease (GERD). Rasional. 2013;11(1)
• Thompson Coon J. Goodman and Gilman’s the Pharmacological Basis of Therapeutics. Focus on Alternative and Complementary Therapies 2010;7(2)doi:10.1111/j.2042-7166.2002.tb05480
• Rismayanthi C. Terapi insulin sebagai alternatif pengobatan bagi penderita diabetes. Medikora. 2010;(2)doi:10.21831/medikora.v0i2.4680
• Hahr AJ, Molitch ME. Management of diabetes mellitus in patients with chronic kidney disease. Clin Diabetes Endocrinol. 2015;1:2. doi:10.1186/s40842-015-0001-9
• Tandra H. Segala Sesuatu Yang Harus Anda Ketahui Tentang Diabetes. PT Gramedia Pustaka Utama; 2007.
• Sica DA. Aldosterone and volume management in hypertensive heart disease. Elsevier; 2014:323-332.
• Setiawati A, Nafrialdi. Obat Gagal Jantung dalam Gunawan SG,dkk. Farmakologi dan Terapi. Ed.5. Departemen Farmakologi dan Terapi Fakultas Kedokteran Universitas Indonesia; 2007.
• Stevenson LW. Design of therapy for advanced heart failure. Eur J Heart Fail. Mar 16 2005;7(3):323-31. doi:10.1016/j.ejheart.2005.01.004
• Hanon O, Baixas C, Friocourt P, et al. Consensus of the French Society of Gerontology and Geriatrics and the French Society of Cardiology for the management of coronary artery disease in older adults. Arch Cardiovasc Dis. Dec 2009;102(12):829-45. doi:10.1016/j.acvd.2009.09.004

There is no Supplemental content for this article.

How to Cite This

Article Metrics

Copyright and Permissions

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Publishing your paper with Jurnal Teknologi Laboratorium (JTL) means that the author or authors retain the copyright in the paper. JTL granted an exclusive reuse license by the author(s), but the author(s) are able to put the paper onto a website, distribute it to colleagues, give it to students, use it in your thesis etc, even commercially. The author(s) can reuse the figures and tables and other information contained in their paper published by JTL in future papers or work without having to ask anyone for permission, provided that the figures, tables or other information that is included in the new paper or work properly references the published paper as the source of the figures, tables or other information, and the new paper or work is not direct at private monetary gain or commercial advantage.

JTL journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. This journal is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. This license lets others remix, transform, and build upon the material for any purpose, even commercially.

JTL journal Open Access articles are distributed under this Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA). Articles can be read and shared for All purposes under the following conditions:

• BY: You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
• SA:  If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.

Data Availability