Looking over this medication list, there’s plenty of stuff to pick on, I’m going to limit myself to two things to further investigate and let you all help with the rest. Feel free to speculate on diagnosis, appropriate alternatives, potential causes of polypharmacy etc.
Always important to take a look at the Lovenox (enoxaparin) dose and make sure it is correct and that we have an end date in mind when using for prophylaxis. I’m also going to look at the Indocin (indomethacin) with the Lovenox as this patient will be at high risk for GI bleeding. They are on Aspirin as well. GI protection should be considered with close monitoring of hemoglobin/platelets while on the Lovenox especially.
So many to choose from, but that Seroquel just screams at me as I’ve seen antipsychotics used so many times for acute delirium type situations and then left on board long term. I’m going to try to investigate why this patient was put on this medication and see if we can’t get possibly get rid of it. With the use of thiamine, this patient could very well have a history of alcoholism, something to dig into as well in the patient history.
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