Un problema farmacológico

• Autores: Patricia Martínez Arias, José Antonio López Freire, Blanca Sanz Pozo
• Localización: Medicina general, ISSN-e 0214-8986, Vol. 7, Nº. 4, 2018
• Idioma: español
• Títulos paralelos:
  • A pharmacological problem
• Enlaces
  • Texto completo
• Resumen
  • español

    Varón de 62 años de edad, que acude por alteración de la marcha y caídas frecuentes en el último mes. Tiene antecedentes de hipertensión arterial, miocardiopatía hipertrófica obstructiva, alcoholismo, hernia discal intervenida con secuelas (entre las que destaca el dolor crónico), episodio de pérdida de memoria en contexto de trastorno depresivo, insomnio y trastorno adaptativo.

    Tras una valoración integral, se consigue aclarar la raíz del problema: la polifarmacia es el origen de dichas alteraciones.

    Se instaura un tratamiento, que resulta ser muy efectivo: valorar el riesgo/beneficio y suspender la medicación innecesaria. Por tanto, a raíz de este caso, se evidencia la importancia del abordaje adecuado de la polifarmacia en el paciente anciano, así como la herramienta al alcance del médico de familia para solucionar o evitar muchos efectos adversos: la deprescripción.

  • English

    A 62-year-old man attended due to impaired gait and frequent falls in the last month. He has a history of hypertension, obstructive hypertrophic cardiomyopathy, alcoholism, herniated disc that required surgery with subsequent sequelae such as chronic pain, memory loss episode in the context of depressive disorder, insomnia and adaptive disorder. Therefore, the patient is under treatment with several drugs, which are indicated for the treatment of each of these pathologies. However, they are 8 drugs with their potential adverse reactions and interactions that must be taken into account, especially in the elderly patient, more susceptible to suffer them.

    The alteration presented by the patient required multiple assessments and a wide differential diagnosis. Among the possible pathologies, syncope of cardiogenic or neurogenic cause, geriatric syndromes, traumatological pathology, psychiatric syndromes, etc., had to be excluded.

    After an integral assessment and several normal complementary tests, the origin of the problem is the polypharmacy. A treatment is established, which is very effective: assess the risk/benefit and stop the unnecessary medication. So, the importance of the adequate management of polypharmacy in the elderly patient is evident, as well as the tool available in primary care to solve or avoid many adverse effects: deprescription.