78 year old female is receiving the following medications:
- Aspirin 81 mg daily
- Tramadol 50 mg twice daily
- Lisinopril 10 mg once daily
- Amlodipine 5 mg daily
- Losartan 25 mg daily
- Omeprazole 20 mg daily
- Ropinerol 0.25 mg daily
- Sinemet 25/100 three times daily
- Mineral Oil 15 mls po as needed
Two major considerations that I’m going to pick out here:
1. Mineral Oil is sometimes used orally for constipation. Mineral oil is used as a lubricant laxative. It is far from a first line laxative as it can increase risk of aspiration pneumonia. This is especially problematic in individuals who might have swallowing issues/difficulties. We don’t have a diagnosis list provided, but I would likely suspect a Parkinson’s diagnosis, and the patient is 78 years old as well and at risk of having swallowing complications. Another alternative here would certainly be appropriate. A stimulant and/or stool softener for prevention would be strong considerations depending upon frequency and severity of constipation.
2. The other potential concern that I would be looking to address is the use of losartan and lisinopril. Losartan and lisinopril don’t exactly work via the same mechanism of action, but work on the same pathway. Of course we’d like to dig into the history further, but they should likely not be used together in this case. Following blood pressure readings, we could possibly discontinue the losartan and increase the ACE Inhibitor or calcium channel blocker (amlodipine).
If you would like to add other possible considerations about the medication list, please feel to do so! If you are looking for more free clinical pharmacy content, check out the 30 medication mistakes! It is a FREE 6 page PDF I put together based upon my experiences as a clinical pharmacist.