Pretty extensive med list, and I’m going to pick out three points that need to be investigated – It’s really hard to limit it to three, but that gives you all an opportunity to identify other potential problems!
1. They have orders for management of hypoglycemia here, and they are on a very steep dose of glipizide – it’s pretty obvious to me that we need to monitor blood sugars very closely! On Actos (pioglitazone) as well which is split up into two doses. Usually given once daily, but would need to investigate that further as well.
2. Oxybutynin patch is usually dosed twice weekly – certainly need to address this and make sure that is correct, beneficial, and tolerable for the patient.
3. Appears to be a probable rehab patient with the Aspirin dosed twice daily for one month. One thing I’ve come across several times is to make sure that anticoagulation/antiplatelet therapy get addressed long term versus short term. In this case, there is no noted order to continue Aspirin for CV prophylaxis, and they are likely a candidate long term being on the statin with diabetes meds. GI and bleeding risk history certainly needs to be assessed as well before continuing long term antiplatelet therapy.
As always – comments/suggestions are encouraged!
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