Prescribing cascade in an elderly woman

This case illustrates the dynamics of a drug prescription cascade. Elderly persons are the most at-risk population for prescribing cascades, since they are oen polymedicated. In this population, health problems frequently encountered, such as constipation, edema or urinary incontinence, oen overlap with the adverse eects of medications.1,6 This patient was diagnosed with hypertension in the ambulatory setting and was prescribed an antihypertensive drug. A few weeks later, the woman experienced a dose-dependent adverse eect of the dihydropyridine calcium channel blockers. She had not been diagnosed with any medical cause of edema, such as heart failure, venous insufficiency or hypoalbuminemia. Peripheral edema is the result of vasodilation of local peripheral arterioles, probably induced in this case by amlodipine, since it was not present prior to the initiation of the drug. The prevalence of peripheral edema for calcium channel blockers is 8.9% and is higher in women. It is therefore important to consider them as a likely cause of peripheral edema, especially in women.7,8 1. Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997;315(7115):1096-9.2. Onder G, Bonassi S, Abbatecola AM, et al. High prevalence of poor quality drug prescribing in older individuals: a nationwide report from the Italian Medicines Agency (AIFA). J Gerontol A Biol Sci Med Sci 2014;69:430-7.3. Hajjar ER, Caero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 2007;5:345-51.4. Al Hamid A, Ghaleb M, Aljadhey H, et al. A systematic review of hospitalization resulting from medicine-related problems in adult patients. Br J Clin Pharmacol 2014;78:202-17.5. Salvi F, Marchetti A, DAngelo F, et al. Adverse drug events as a cause of hospitalization in older adults. Drug Saf 2012;35(suppl 1):29-45.6. Kalisch LM, Caughey GE, Roughead EE, Gilbert AL. The prescribing cascade. Australian Prescriber 2011;34:162-6.7. Health Canada. Product monograph. Amlodipine. Base de donnes sur les produits pharmaceutiques (online). Available: http://webprod5.hc-sc.gc.ca/dpd-bdpp/info.do?code=78282&lang=fra Web End =2333&lang=fra (accessed May 28, 2015).10. Fick D, Semla T, Beizer J, et al. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriat Soc 2012;60: 616-31.11. Salahudeen MS, Hilmer SN, Nishtala PS. Comparison of anticholinergic risk scales and associations with adv