I was asked a question the other day about trying to reduce medications in a patient on hospice. More specifically, how to address the use of PPIs. Proton pump inhibitors (PPIs) are some of the most overused medications we see in clinical practice, but hospice...
In this case scenario with gabapentin and metolazone, I lay out how the prescribing cascade can rear its ugly head. SK is a 74-year-old male with a past medical history significant for chronic kidney disease stage 3, type 2 diabetes, hypertension, peripheral...
Mrs. M is an 87-year-old female residing in a skilled nursing facility. Her medication list includes: Apixaban 5 mg BID (for atrial fibrillation) Docusate 100 mg BID Senna 8.6 mg BID PEG 17 g daily Calcium carbonate 500 mg TID Lisinopril 10 mg daily Metoprolol...
Here’s a question that comes up in hospice more than you’d think: Why would a hospice patient be on two antipsychotics at the same time? To the average clinician, this raises immediate concerns—duplication, unnecessary side effects, and polypharmacy in a population...
Counteracting drug effects are all too common in geriatric and polypharmacy patients. I wanted to share common examples that I’ve seen in my practice as a clinical pharmacist. NSAIDs vs. AntihypertensivesCase: A 68-year-old man with hypertension controlled on...
Digoxin is a cardiac glycoside that has a narrow therapeutic window. Because of this, we typically monitor digoxin levels. If levels get too high, we can run into adverse effects. In some cases, particularly geriatric patients, those adverse can be misinterpreted as...
