Real Life Examples: Polypharmacy and the Prescribing Cascade Part 1 of 2
Real Life Pharmacology - Pharmacology Education for Health Care Professionals
Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist
4.9 • 773 Ratings
🗓️ 23 April 2026
⏱️ 12 minutes
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Summary
Polypharmacy isn’t just about medication count—it’s about cumulative risk and unintended consequences. One of the biggest drivers is the prescribing cascade, where a drug side effect is mistaken for a new condition, and another medication gets added instead of addressing the root cause.
You see this all the time in practice. A patient starts amlodipine and develops edema, then gets placed on furosemide. Or donepezil leads to urinary symptoms, and oxybutynin is added—potentially worsening cognition. These patterns add risk quickly.
In this episode, I’ll break down common examples that I have recently encountered in practice.
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Transcript
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| 0:00.0 | Hey all, welcome back to the real-life pharmacology podcast. I'm your host, Eric Christensen, |
| 0:06.2 | pharmacist. Thank you so much for listening today. This will be a little bit of a special episode. |
| 0:11.7 | I'm going to cover some polypharmacy cases, some prescribing cascade cases that I have seen in my practice. |
| 0:20.5 | I've been taking a few notes over the last three to six months of situations I've seen |
| 0:25.7 | and really just wanted to provide you with some real-life stuff that actually happens. |
| 0:32.5 | So that's what I'm going to focus on today. |
| 0:35.4 | A couple reminders, I've got a board-certified geriatric pharmacist course, tons of hours of content, |
| 0:44.7 | thousands of practice questions as well. |
| 0:47.9 | It's intended to help pharmacists prepare for board-certified geriatric pharmacist Exam, but it's a great review for anybody |
| 0:57.7 | with regard to geriatric. So go check that out at MedEd1.1.com slash store. In addition, I've got a book |
| 1:06.0 | specifically on Polypharmacy. I've been pretty popular,.9 out of five stars. A couple years older now, |
| 1:13.5 | but many of the examples still apply. And it's definitely, the majority of it is very, very relevant |
| 1:19.1 | to practice still today. So you can check that out on Amazon Perils of Polypharmacy, |
| 1:25.3 | available as an audible book, as well as a standard book as well. |
| 1:30.3 | All right, so let's get into some of these cases. |
| 1:33.7 | This is going to be part one of two. |
| 1:36.3 | I've got five that I really wanted to focus on today, and then I'll cover five more. |
| 1:42.6 | I've got jotted down in the next podcast. |
| 1:46.0 | All right. The first one involves dementia medications, specifically colon, excuse me, colonesterase |
| 1:54.6 | inhibitors. A classic example being dinepazil. So these drugs can cause urinary frequency and urinary incontinence. |
| 2:05.3 | They can exacerbate those symptoms by the mechanism and the way they work. If you want to |
| 2:11.2 | more on dinepazil, definitely go back and listen to previous podcasts on that medication |
... |
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