You can know everything there is to know about medication management and still do the wrong thing for your patient.  How is that possible?

Patients sometimes don’t think that medications are actually medications.  When we say ask them what medications are you currently taking, we think we are getting the correct answer including herbals, over-the-counters, and prescription medications.  In my experience, this is seldom the case and the real ugly part is, those medications can be a huge piece of the puzzle.

RS is a 79 year old female who is currently “taking”

• Aspirin 325 mg daily
• Vistaril 50 mg at night for sleep
• Torsemide 20 mg daily
• Lisinopril 10 mg daily
• Tylenol 1-2 tabs as needed, nearly nightly for pain

After we completed going through the medication list, a simple, quick review of systems was assessed.  In this brief assessment, two more medications were uncovered as well as a complaint that she forgot to mention.  Senna that she takes 2-3 tablets every day, Artificial Tears, as well as complaints of dry mouth.  Pretty important piece of the puzzle huh?  Vistaril is likely causing or contributing to these symptoms with its anticholinergic activity.

In this case, the patient did not feel that these were important enough to mention, but when used in context of the other medications, the reporting of these medications is highly valuable to identifying side effects.  Always assume a patient is taking more medications than what they report, more often than not, you’ll be right.

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