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Diagnosis: Polypharmacy – Case study

I can’t help but smile when providers dictate that a patient has a diagnosis of polypharmacy.  Let’s cure that condition! These case studies are kind of challenging because you could go a few different directions, but they do certainly provide some educational opportunities! Here’s the med list:

Cardizem CD 120 mg daily

Aspirin 81 mg daily

Lipitor 40 mg daily

Lisinopril 10 mg daily

Novolog 4 units TID with meals

Lantus 25 units at bedtime

Metformin XR 2000 mg daily

Celexa 20 mg daily

Ativan 0.5 mg as needed

Trazodone 100 mg at bedtime

Paxil 40 mg daily

Prilosec 20 mg daily

Zofran 4 mg three times daily as needed

Tums as needed

Macrobid 100 mg daily

Ibuprofen 400 mg four times daily as needed

Neurontin 400 mg three times daily

Mobic 15 mg daily

Pulmicort 0.5 mg nebs twice daily

Albuterol nebs four times daily as needed

 

-The big questions I would want to know first from the medication list –

1. Would like to know GI status with potential duplicate NSAIDs contributing to any symptoms – i.e. how often using Zofran, Tums etc.  Also metformin/antibiotic could certainly contribute to any GI complaints

2.  Obvious duplicate SSRI’s (Celexa, Paxil) – there better be a really good reason for that, although from my experience its almost always a mistake. This patient most likely does have some significant behavioral/psych concerns given the number of psych meds. Potentially neuropathy with gabapentin and maybe an SNRI would be something to consider. – PS students: I can remember the question, “Do we need to know brand names or generic names for an exam?” – Life will be easier for you if you know both or in some cases all names 🙂

3.  Kidney Function is going to be very important as many drugs can affect or be affected by renal function (Macrobid, Metformin, NSAIDs, Lisinopril…)

4.  Diabetes, HTN, Respiratory and Pain assessment are of course necessary based on this med list, but I’m trying to help you learn how to prioritize! – Sound off if you’ve got something to contribute!

 

Written By Eric Christianson

April 6, 2014

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