A significant clinical medication review for everyone today, where I pick out a couple areas of concern to me and you can help do the rest by adding any comments/thoughts/questions below! There’s plenty to pick on in this one, so I may need a little help to cover everything! – Also reminder that new subscribers can get free unlimited access to my 20 minute webinar on the 10 Commandments of Polypharmacy – just look on the right side of the page to subscribe. As always with these med list reviews, your priorities are going to depend upon what is going on with your patient, so this is really more of an educational exercise to help get your mind right in trying to identify medication related problems!
The first concern that jumped out at me that I’d look to investigate is the Ritalin indication. Also, the fact that Ritalin is being used in combination with Klonopin and potentially the Remeron at night, both of which can be sedating – so we are using a combination meds that can ramp you up and potentially slow you down. Also looks like plenty of cardiac issues by the meds which Ritalin needs to be monitored closely for.
Always important when you get someone on this many meds not to lose sight of the fact that they are on Coumadin (warfarin) which as I’ve mentioned before can have a ton of drug interactions – so we need to be extra careful about medication changes – I’ve posted a few cases on Coumadin before if you’d like to check them out, search Coumadin on the site!
There are plenty of labs we need to monitor…Synthroid, Lisinopril, Digoxin, Coumadin, Glyburide, Lasix etc.
I can’t resist…one more thing – I’d like to know why they are on Duonebs TID without any controller type medication – suspect maybe a recent acute respiratory issue in which maybe long term scheduled nebs would not be necessary, but certainly needs to be investigated further.
Please feel free to comment!