Polypharmacy in Elderly

Firstly, the ranking of the medications, which are described in the case, has to be presented. In this instance, the hierarchy of the most inappropriate medication has to be generated. The utilization of some of the medications is unacceptable for the elderly due to the increased adverse effects on health and interactions with other medicines (Fick et al., 2003). The following order of the medications from the least to increased severity can be considered Celecoxib (indigestion), Duloxetine (nausea), Aspirin (higher potential for bleeding), Valsartan (recent stroke), Morphine, Simvastatin (confusion), Cyclobenzaprine, Benazepril (tiredness), Pregabalin (dizziness), Diphenhydramine (dizziness), Atenolol (falls), Amitriptyline (dizziness and confusion), and Citalopram (falls).

Additionally, rational prescribing is critical to avoid the adverse consequences of the diseases (Sink & Atkinson, 2015). The majority of drugs tends to be involved in active interactions with each other. For instance, Morphine and Amitriptyline increase the pain relief effect and are the critical reasons for confusion and falls while used simultaneously (Shiloh, Stryger, Weizman, & Nutt 2006). The relationships of other drugs also increase the influence on the medical condition by causing side effects.

Furthermore, some of the drugs cannot be used when some of the diseases take place, as they might worsen the current health condition of the patient. In the context of the presented case, drugs such as Aspirin and Valsartan influence the patient’s condition related to hypertension, as they might be the main cause of the CVA. Additionally, a combination of Diphenhydramine, Atenolol, Amitriptyline, Citalopram, and Simvastatin worsens the condition related to dementia by increasing confusion and dizziness of a patient. The presence of these aspects could be considered as the core definer of the presence of falls, which take place frequently.

The primary goal of this paper is to evaluate the relevancy of the medications for the elderly. In this instance, the list of the least to the most inappropriate medications is established by focusing on the interactions of the drugs and using the ranking of the pertinence. Medications have different side effects and levels of danger to the elderly due to the presence of various diseases (Fick et al., 2003). In this case, the relevant order from the least to most is Duloxetine, Celecoxib, Aspirin, Morphine, Valsartan, Cyclobenzaprine, Benazepril, Simvastatin, Diphenhydramine, Atenolol, Citalopram, and Amitriptyline.

It could be said that the side effects are present due to the interactions of the different types of drugs. The relationship between dissimilar kinds of drugs should be considered as high significance since it might deteriorate the current conditions of the patient. For instance, Pregabalin, Diphenhydramine, and Amitriptyline cannot be used at the same time, as the components drugs increase the side effects such as dizziness, falls, and tiredness. Additionally, Valsartan and Morphine have a high influence on the functioning of the heart, as the components of these drugs create high pressure while being used at the same time.

Lastly, in this instance, the interactions of the medicines and diseases also affect the condition of a patient and his ability to improve. The rational prescribing has to take into account various characteristics to avoid the severe situation, which occurred in the presented case (Sink & Atkinson, 2015). For instance, Citalopram is used to treat depression, but it might be a primary reason for falls for people, who have problems with blood pressure, stroke, and similar health issues (Opler, 2005). Additionally, the doses have to be limited to individuals with depression.


Fick, D., Cooper, J., Wade, W., Waller, J., Maclean, R., & Beers, M. (2003). Updating the Beer’s criteria for potentially inappropriate medication use in older adultsresults of a US consensus panel of experts. Internal Medicine Journal, 163(22), 2716-2724.

Opler, L. (2005). The complete pill guide. New York, NY: Barnes & Noble Publishing, Inc.

Shiloh, R., Stryger, R., Weizman, A., & Nutt, D. (2006). Atlas of psychiatric pharmacotherapy. New York, NY: Taylor & Francis Group.

Sink, K., & Atkinson, H. (2015). Principles of rational prescribing. Web.