It is very important to assess disease states prior to adding new medications.  A 73 year old male has terribly dry skin.  The dry skin is leading to some itching.  His past medication history includes A-Fib, hypothyroidism, BPH, constipation and osteoarthritis. His current medications include:

• Warfarin
• Levothyroxine
• Miralax
• Senna
• Finasteride
• Acetaminophen

His primary provider decides to add hydroxyzine 25 mg three times per day to help relieve him of the itching.  What wasn’t assessed in this case was the TSH.  Hypothyroidism is a potential cause of dry itchy skin and should be part of the assessment in this scenario before adding an anticholinergic medication that can exacerbate this patient’s BPH and constipation.  Hypothyroidism can also contribute to constipation.

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