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YOUR SYMPTOMS MAY BE YOUR PHARMACEUTICAL · Your Daily Dose

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  Speaker 1: Good afternoon, everybody. It is September 18th, 2026. A study
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  Speaker 1: of nearly 2.3 million older adults found that one medication
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  Speaker 1: is often followed by another for a problem the first
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  Speaker 1: drug caused. We're going to take a look at that
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  Speaker 1: and give you some insight on this. Stay tuned. Hi,
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  Speaker 1: and welcome to Health Talk with Dr. Lin, your daily dose.
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  Speaker 1: The information you hear on this show is informational. It's
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  Speaker 1: not meant to diagnose or treat any disease. Any kind
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  Speaker 1: of complete health conditions must be checked out and discussed
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  Speaker 1: with your primary care physician. Get ready for the good
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  Speaker 1: news of the day. God bless you folks. And here
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  Speaker 1: is Dr. Lent. Our daily devotional today comes from the
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  Speaker 1: book of Matthew chapter 6. Seek to please me above
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  Speaker 1: all else. Let that goal be your focal point as
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  Speaker 1: you go through the day. Such a mindset will protect
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  Speaker 1: you from scattering your energy to the winds. The free
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  Speaker 1: will I bestowed on you comes with awesome responsibility. Each
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  Speaker 1: day presents you with choice after choice. Many of these
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  Speaker 1: decisions you ignore and thus make by default. Without a
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  Speaker 1: focal point to guide you, you can easily lose your way.
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  Speaker 1: That's why it's so important to stay in communication with me,
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  Speaker 1: living in thankful awareness of my presence. You inhabit a fallen,
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  Speaker 1: disjointed world where things are constantly unraveling around the edges.
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  Speaker 1: Only a vibrant relationship with me can keep you from
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  Speaker 1: coming unraveled too. Stay tuned. ¶ ¶ Thank you. 727-916-4215
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  Speaker 1: An 87-year-old man went to the hospital with COVID-19. This
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  Speaker 1: is going back a ways. As he went in, keep
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  Speaker 1: in mind, 87, COVID. His memory was a little shaky
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  Speaker 1: on a good day. They didn't say before, after, during.
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  Speaker 1: The doctors gave him steroids to treat the illness. While
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  Speaker 1: in the hospital, he grew confused. At night, he tried
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  Speaker 1: to climb out of bed. He fought the staff. A
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  Speaker 1: sitter was posted at his bedside. Dr. George Henaway, a
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  Speaker 1: geriatrician who directs the Center for Successful Aging at MedStar
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  Speaker 1: in Baltimore, was called in. The man had already been
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  Speaker 1: given a dose of medication to control his agitation. Now
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  Speaker 1: we're up to three. His team looked at the history
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  Speaker 1: of his stay. They lowered the steroid dose and moved
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  Speaker 1: it to morning. Gradually, he returned to baseline. We were
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  Speaker 1: able to discontinue the sitter and get him up and
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  Speaker 1: walking again. The choice between treating the new symptom and
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  Speaker 1: looking at the last prescription is familiar fork, and geriatric care.
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  Speaker 1: The study of 2.3 million older adults published on September
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  Speaker 1: 10th in the British Medical Journal quantified how certain patterns
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  Speaker 1: of medication appear. Researchers started with 65 suspected drug pairings.
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  Speaker 1: They found 24 in which one medicine was often followed
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  Speaker 1: by another to treat a known side effect of the first.
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  Speaker 1: That deserves to be underlined and highlighted in orange. My
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  Speaker 1: orange highlighter. The strongest link mirrored doctor's patient, a steroid
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  Speaker 1: and an antipsychotic. The records show which drug came first,
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  Speaker 1: not why the second one was prescribed. Researchers could not
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  Speaker 1: say how many of these pairings were true prescribing cascades.
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  Speaker 1: A prescribing cascade happens when a side effect of one
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  Speaker 1: medication is mistaken for a new health problem. Ontario's public
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  Speaker 1: health program keeps a record of prescriptions dispensed to older residents.
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  Speaker 1: Researchers use those records to study the 2.3 million community-dwelling
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  Speaker 1: adults 66 and older. They started with 65 possible prescribing
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  Speaker 1: cascades identified by an international panel of experts. Then they
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  Speaker 1: asked three questions of each pairing. Is the first drug
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  Speaker 1: widely used? Does the second drug follow often? And does
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  Speaker 1: it follow more often than expected? 24 combinations received three
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  Speaker 1: affirmative answers. Many of them are in American medicine cabinets.
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  Speaker 1: Iron pills topped the list. Nearly 12% of older adults
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  Speaker 1: who started iron receiving a prescription laxative within a year,
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  Speaker 1: one in eight. Statins came next. This could be highlighted again. Iron, statins.
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  Speaker 1: The third was a pairing that will matter to families
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  Speaker 1: caring for someone with dementia. About one in 10 people
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  Speaker 1: who started a cholinesterase inhibitor for Alzheimer's, were prescribed a
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  Speaker 1: sleep aid within that year. That's number four. The sequence
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  Speaker 1: caught the attention of Judith Baser, a clinical pharmacist. Older
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  Speaker 1: patterns will find familiar to anyone who's watched a parent's
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  Speaker 1: pill organizer fill up. About 75% of those who started
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  Speaker 1: a calcium channel blocker, such as amlodipine, a common blood
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  Speaker 1: pressure drug, caused you to swell up, then the water pill.
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  Speaker 1: Nearly 1 in 18 new steroid users were given a
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  Speaker 1: sleep aid. 1 in 15 who started an anti-inflammatory such
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  Speaker 1: as naproxen got a stomach protector. What surprised me most
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  Speaker 1: was not the specific cascades themselves, but the scale of
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  Speaker 1: the problem. The study moved prescribing cascades from a conceptual
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  Speaker 1: issue to a measurable one. The study often leaves part
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  Speaker 1: of the medicine cabinet invisible. It did not count over-the-counter drugs,
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  Speaker 1: which the researchers said may mean cascades are undercounted. Many
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  Speaker 1: people are not prescribed iron. They go to the pharmacy
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  Speaker 1: and pick up a bottle of iron. Those purchases leave
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  Speaker 1: no prescription trail. The same is true of pain meds.
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  Speaker 1: Sometimes they develop aching muscles after starting a statin by
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  Speaker 1: simply buying ibuprofen. The study would never see it. Asked
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  Speaker 1: how much larger the anti-inflammatory cascades might be once the
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  Speaker 1: over-the-counter is counted. I would suspect it's much larger, they said.
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  Speaker 1: In older adults, side effects often look like aging. Dizziness, swelling,
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  Speaker 1: urinary symptoms, fatigue, insomnia, constipation are all common complaints. Without
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  Speaker 1: careful medication review, it's easy to assume a new diagnosis
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  Speaker 1: is responsible when the medication list may hold the answer.
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  Speaker 1: The statin finding drew more skepticism. Nearly 11% of people
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  Speaker 1: who started a statin later received a prescription pain reliever.
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  Speaker 1: I think that one surprised me the most, was the
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  Speaker 1: statin pain reliever concept. I think it's a stretch to
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  Speaker 1: consider that these things are just causal. Other side effects,
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  Speaker 1: dry cough from an ACE inhibitor such as lisinopril is
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  Speaker 1: one of those common ones. Dr. Aaron Troy, a clinical
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  Speaker 1: research fellow in cardiology, said that patients who develop a
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  Speaker 1: cough after starting lisinopril should be asked whether the drug
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  Speaker 1: could be responsible. Depression is another blind spot. About 1
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  Speaker 1: in 16 new opioid users and 1 in 19 new
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  Speaker 1: beta blocker users were prescribed an antidepressant within a year.
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  Speaker 1: Another one to highlight. Opioid users. Calendar hides the trail too.
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  Speaker 1: Researchers noted some cascades emerge quickly while others take months.
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  Speaker 1: Time is probably the biggest barrier. Older adults may have
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  Speaker 1: long medication lists and several specialists prescribing at different times.
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  Speaker 1: Reconstructing when a symptom began and what changes just before
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  Speaker 1: it can be difficult in a short office visit. The
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  Speaker 1: prescription records cannot show why a second drug was added.
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  Speaker 1: The study identified patterns in association, not individual prescribing decisions.
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  Speaker 1: Sometimes a second drug is exactly what the person needs. Dr.
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  Speaker 1: Beiser pointed to iron. Constipation is expected, she said. Not really,
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  Speaker 1: not if you use the right form of iron. So
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  Speaker 1: a laxative may be added on purpose. The same often
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  Speaker 1: happens with opioids after surgery. I'd rather see if we
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  Speaker 1: can get rid of the swelling by making a switch
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  Speaker 1: rather than adding another medication. Study authors say they want
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  Speaker 1: prescribing software to flag possible cascades and pharmacists to review
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  Speaker 1: them in practice. I don't think we have the prescribing
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  Speaker 1: cascades built into our prescribing software at this point. So
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  Speaker 1: what can a patient do? When a new symptom appears,
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  Speaker 1: start by asking what changed just before it. A drug
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  Speaker 1: started days or weeks earlier may be easy to forget.
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  Speaker 1: Then look at the whole list. The patients can ask
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  Speaker 1: for an appointment specifically to review their medications. The doctor
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  Speaker 1: recommends bringing in the actual bottles, including over-the-counter drugs and supplements.
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  Speaker 1: He has seen why it matters. One patient who came
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  Speaker 1: in with weakness was taking two cholesterol meds, even though
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  Speaker 1: he had been told to stop one. He found old
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  Speaker 1: prescriptions still in Again, it could be the pharmaceutical. It's intriguing.
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  Speaker 1: It's one of the reasons why, as a pharmacist, I
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  Speaker 1: like to stay abreast of what's going on with the patients.
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  Speaker 1: Because this is more common than I think. It's more
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  Speaker 1: common than they think. So if you have questions like that,
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  Speaker 1: could this be a side effect? Is there something that
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  Speaker 1: could help me? Give a call. 727-916-4215.