Then we get into what I call the domino effect. This is where a patient is given one medication that may have some side effects, which cause the use of a second medication, which may have side effects and so on and so on.

The example I like to use is hydrochlorothiazide, a very simple compound used to treat mild to moderate hypertension. As we all know hydrochlorothiazide can cause a little bit of hypokalemia so the patient may be prescribed KCL just to replace that. Sometimes a patient's uric acid level may go up and precipitate a gouty attack, so we add zyloprim or some kind of medication.

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