An 81 year old female is taking Lasix as needed. The reason for taking the Lasix as needed may surprise you!
Medication List:
- Advair 250/50 BID
- Simvastatin 20 mg HS
- Furosemide 40 mg once daily as needed for blood pressure
- Duonebs QID prn
- Flonase 1 spray into each nostril daily
- Toprol XL 12.5 mg once daily
- Norvasc 5 mg daily
- FeSO4 325 mg BID
- Senna-S 3 tabs BID
- The first thing I notice is the furosemide as needed for blood pressure! A pretty unique order for sure. I have seen prn orders quite a bit with loop diuretics in relation to CHF/edema, but it is pretty unusual for hypertension. I would investigate this further.
- Another question to ask here; Is the patient actually doing daily blood pressures and what blood pressure would they take the furosemide for?
- It appears there would be plenty of room to increase other blood pressure medications as well.
- I would investigate the iron supplement. Do they need it long term as well as the possibility to contribute to constipation and the pretty substantial dose of Senna-S
- Hemoglobin and ferritin would be a good assessment here to get a sense for the necessity of long term iron.
- This patient looks like a potential aspirin candidate. The hemoglobin and past history may give us some guidance here as to why this patient isn’t on aspirin.
- Assessing the use and frequency of use of Duonebs is always something I try to look into. We obviously don’t have a diagnosis here, but this will help give us a sense of the respiratory control.
What else would you like to investigate?
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