[Verse 1]
An elder arrives with a paper bag full,
Fourteen prescriptions, each bottle a pull
On the body's slow pharmacokinetics—
Absorption, distribution, hepatic arithmetic
Creatinine climbs while albumin depletes,
The drug levels rise in those narrowing streets
Polypharmacy blooms like a prescribing cascade,
Each remedy spawning the next in the trade
[Chorus]
Three medications, three to remember:
Benzodiazepines cloud and dismember,
Antipsychotics carry a black-box decree,
SSRIs tip sodium, bones, and coagulation free
Three cautions, three warnings, three written in amber—
The Beers Criteria, clinician's chamber
[Verse 2]
The SSRI quiets the sorrow within,
But hyponatremia lurks underneath the skin,
Platelets grow sluggish, the bruising expands,
And orthostasis loosens the grip of old hands
A benzo prescribed for a sleepless refrain
Becomes the very architecture of brain—
Dependence constructs itself column by column,
Falls in the nighttime, confusion most solemn
[Chorus]
Three medications, three to remember:
Benzodiazepines cloud and dismember,
Antipsychotics carry a black-box decree,
SSRIs tip sodium, bones, and coagulation free
Three cautions, three warnings, three written in amber—
The Beers Criteria, clinician's chamber
[Verse 3]
The antipsychotic, a sedating decree,
Dementia plus dopamine blocked equals mortality—
Cerebrovascular hazard, the black box declared,
Yet off-label behaviors leave prescribers ensnared
And anticholinergic burden accumulates:
Oxybutynin, diphenhydramine, the fog that saturates
Steroids ignite mania, beta-blockers depress,
Levodopa conjures hallucinations dressed
In ordinary clothing—opioids sedate and confuse,
Alcohol doubling every sedative's bruise
[Bridge]
The therapist holds no prescription pad,
But notes the tremor, the shuffling gait gone sad,
Tracks the nodding mid-session, the thirst unquenched,
The word-retrieval faltering, the conversation wrenched
She asks what was added, what doubled, what stopped,
She names the side effect that others have dropped,
Then carries the question with clinical care
Straight to the prescriber—collaboration declared
[Chorus]
Three medications, three to remember:
Benzodiazepines cloud and dismember,
Antipsychotics carry a black-box decree,
SSRIs tip sodium, bones, and coagulation free
Three cautions, three warnings, three written in amber—
The Beers Criteria, clinician's chamber
[Outro]
So count every bottle, read each interaction,
Adherence and side effects warrant your action
The elder's pharmacopeia is yours to observe—
Not to prescribe, but to notice, to question, to serve