Polypharmacy In The Child And Adolescent Population

Modern medicine is one of the greatest advances in human history. Diseases that used to eradicate significant portions of a population can now be quickly managed with antibiotics or prevented with vaccines. Problems like cancer and AIDS can be managed, at least giving people a fighting chance to live. People of different abilities can seek the help they need too in ways that would not have been possible even 100 years ago. Medicine still lags behind the technological advancements of the past couple of centuries, and this problem can sometimes lead to complicated healthcare situations.

Taking care of children is one of the most important aspects of society, and when a child becomes ill, the right medical professionals need to step in and help. Sometimes, a child may need medication, and sometimes that child may need multiple medications at once. Complications can arise out of these situations for a number of reasons. Medicines may act synergistically or otherwise act in strange or harmful ways when combined, especially in the system of a young person. The child may have multiple ailments happening at once that require the use of multiple medications, or a doctor may see value in combining medications to treat an ailment, which would require extensive knowledge of the medicines being used and how they would interact with each other in a kid. The treatment can extend to mental health too, both in calmer settings and in emergency situations that result in emergency room visits or psychiatric holds (Saldaña et al., 2014). There could also be room for pharmacists to lend their knowledge to tough situations and help doctors make a group decision.

There is also a growing problem of chronic illnesses popping up more in youth populations. Some conditions that were not as well understood in the past are now diagnosed more often. Societal trends are leading to an increase in some chronic illnesses in unprecedented ways. One of the best examples if the increase in kids with Type II diabetes, a condition that is usually only seen in older populations. These new developments pose new challenges for doctors who need to figure out courses of action for treatment and management (Olashore & Rukewe 2017). It is also not uncommon for some conditions like autism to come with comorbidities, like attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder. Each one of these situations can be unique in their own ways, so doctors not only need to have a general sense of how to treat multiple conditions at once but need to determine what would be most appropriate for a given patient and how the medicines may interact with each other and interact with each individual person.

Many of the treatment options that include polypharmacy do not have much evidence behind them but rather rely on a doctor’s intuition and knowledge. “With the limited availability of evidence-based protocols and practice guidelines, clinicians often rely on their best clinical judgment when managing pharmacotherapy for pediatric patients with multiple and/or complex disease states,” (Horace & Ahmed, 2015). Science can be difficult enough, and there is only so much time and so many resources. There are not many studies that would take into account specific situations where polypharmacy would be needed. One extreme example comes to a girl who could not even stay awake and was drooling during a medical admission interview, and “she was concurrently on 10 psychotropic medications and 12 additional medical medications,” (Bellonci, Baker, Huefner, & Hilt, 2016, p. 2).

Getting kids off of polypharmacy can be tough because it is not just one medication. At a younger age, the body and brain are developing too and are much more susceptible to changes. Putting a kid on multiple drugs at once can dramatically alter the chemical makeup of the person’s brain and cause dependencies. Doctors would also need to figure out treatments for these patients that would substitute for what the drugs were doing.

References

Bellonci, C., Baker, M., Huefner, J. C., & Hilt, R. J. (2016, December). Deprescribing and its application to child psychiatry. Child and Adolescent Psychopharmacology News, 21(6), 1-9. doi:10.1521/capn.2016.21.6.1

Horace, A. E., & Ahmed, F. (2015, August 21). Polypharmacy in pediatric patients and opportunities for pharmacists&#: IPRP. Retrieved from https://doi.org/10.2147/IPRP.S64535

Olashore, A. A., & Rukewe, A. (2017, May 10). Polypharmacy among children and adolescents with psychiatric disorders in a mental referral hospital in Botswana. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424412/

Saldaña, S. N., Keeshin, B. R., Wehry, A. M., Blom, T. J., Sorter, M. T., DelBello, M. P., & Strawn, J. R. (2014, August). Antipsychotic polypharmacy in children and adolescents at discharge from psychiatric hospitalization. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165554/