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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

Polypharmacy

Assignment #2
Student: Marie Belcourt

Focus: Polypharmacy and Drug Interactions


 * 1) How you searched for a source (search strategy – where you went to find it).

Pub med search: Advanced search using MeSH terms “polypharmacy” and “drug interactions” then applied filters “5 years”, “Systematic Reviews”, and “Practice Guidelines”. I also sorted by best match. This received 82 results.

2. What potential sources were identified and considered (give examples of 1 or 2).

a. Merel, S. E. and Paauw, D. S. (2017), Common Drug Side Effects and Drug‐Drug Interactions in Elderly Adults in Primary Care. J Am Geriatr Soc, 65: 1578-1585. doi: 10.1111/jgs.14870

b. Stewart D., Mair A., Wilson M., Kardas P., Lewek P., Alonso A., et al. (2017) Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opinion on Drug Safety, 16(2):203-213. doi:10.1080/14740338.2017.1265503

3. Why the source was chosen (what made it better than other choices).

My source (“Common Drug Side Effects and Drug‐Drug Interactions in Elderly Adults in Primary Care”) was chosen because it had information relating to both the prevalence of drug

interactions in polypharmacy and how metabolic changes can affect drug-drug interactions

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.

a. It is a narrative review and therefore a secondary source

b. The information is up to date as it was published in 2017

c. Peer-reviewed and published in a reputable journal

5. How do you plan to use the source for improving the article?

To update the statistics on the amount of drug interactions in polypharmacy. I also plan to use it to add two sentences to the article. One that explains pharmacokinetic changes seen in elderly patients and how that relates to drug interactions, and another to expand upon the warfarin drug interaction example.

Proposed Change
New additions in bold and deletion of original text is in strikethrough text:

''Every medication has potential adverse side-effects. With every drug added, there is an additive risk of side-effects. Also, many medications have potential interactions with other substances. 15% of older adults are potentially at risk for a major drug-drug interaction.[18] Older adults are at a higher risk for a drug-drug interaction due to the increased number of medications prescribed and metabolic changes that occur with aging. When a new drug is prescribed, the risk of interactions increases exponentially. Doctors and pharmacists aim to avoid prescribing medications that interact; often, adjustments in the dose of medications need to be made to avoid interactions. such as with warfarin, as it may lose its effect '' For example, warfarin interacts with many medications and supplements that can cause it to lose its effect.

Rationale for Proposed Change
The statistic on the number of drug-drug interactions in adults is important to give context on the extent of contraindications, but it never states why it only includes older adults. My proposed change adds an explanation to why we focus on older adults when talking about drug-drug interactions (2). The other proposed change is to remove “such as with warfarin, as it may lose its effect” to a separate sentence and add in that warfarin can interact with both medications and herbal supplements. I believe this makes the sentence easier to read and puts more emphasis on warfarin’s interactions. This is important because warfarin is one the most common drugs that contributes to drug-drug interactions (1,2).

References:


 * 1) Stewart D., Mair A., Wilson M., Kardas P., Lewek P., Alonso A., et al. (2017)  Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opinion on Drug Safety, 16(2):203-213. doi:10.1080/14740338.2017.1265503
 * 2) Merel, S. E. and Paauw, D. S. (2017), Common Drug Side Effects and Drug‐Drug Interactions in Elderly Adults in Primary Care. J Am Geriatr Soc, 65: 1578-1585. doi:10.1111/jgs.14870

One controversy in my proposed changes is the explanation of why older adults have increased drug-drug interactions. Specifically, if this should be included in the special populations section instead. I ultimately decided it better fits in the contraindications introduction paragraph because the introduction is more focused on why drug-drug interactions happen whereas special population was focused on identifying the special populations and strategies to migrate risk in those populations.

Critique of Source
The sources I chose (Merel & Paauw, 2017) was a high-quality narrative review. Although narrative reviews provide a high level of evidence, there is also possible bias and aren’t as rigorous as a systematic review. Areas of concern for my source include articles were selectively chosen/no indication of how articles were chosen, no evaluation of the strength of the articles, and the review was guided by the authors' personal experience. These all can lead to potential bias. These issues did play a role in deciding whether to use this source, but ultimately looking at the areas in the review that provide evidence for my proposed changes had high-quality studies cited. This included citing a meta-analysis and a randomized control trial that provided high levels of evidence.

Feedback

1.Assignment #2 was well done and explained.

2.Assignment #3: Your proposed change is well done and written. I believe that separating the warfarin to another sentence strengthen the paragraph. It would have been useful to find an updated source for the sentence "when a new drug is prescribed, the risk of interactions increases exponentially".

As for the area of controversy, I would argue that one possible controversy is whether it is the number of drugs and/or perhaps the TYPES of drugs prescribed that worsen the drug-drug interactions.

Your critique of the source was well articulated. Do you know if only English articles were chosen in the narrative review? If so, this could also introduce bias into the review.

Agata Szlanta