In this polypharmacy case study, I pick out some medications that we may be able to discontinue.
An 88-year-old male is looking to reduce his medication burden.
Current medications include:
- Aspirin 81 mg daily
- Furosemide 10 mg daily
- KCL 10 meq daily
- Omeprazole 20 mg daily
- Famotidine 20 mg BID
- Oxycodone 5 mg every four hours as needed
- Tramadol 50 mg every 6 hours as needed
- Acetaminophen 500 mg TID
- Glucosamine 1500 mg daily
- Lisinopril 10 mg daily
- Metoprolol 25 mg BID
- Ropinirole 0.25 mg at bedtime
- Atorvastatin 80 mg daily
- Cyclobenzaprine 10 mg at bedtime
- Zolpidem 10 mg at bedtime
- Alprazolam 0.25 mg BID PRN anxiety
- Loratidine 10 mg daily
One of the first things I do in a situation like this is to look at the medications that are treating symptoms. Any indication where it likely wouldn’t be serious (or life-threatening) to take away a medication would be a good place to begin your investigation into whether medication can be discontinued. Examples of medications in this case that may be able to be reassessed for reduction or discontinuation include allergy meds, pain meds, heartburn meds, insomnia meds, and RLS meds.
In this case, I would be looking in the records and reviewing with the patient as to how beneficial/necessary these medications would be; omeprazole, famotidine, acetaminophen, cyclobenzaprine, glucosamine (particularly if using a lot of opioids), ropinirole, zolpidem, and loratadine.
I would also review the indication for the furosemide and assess if the patient was having symptoms that necessitated its long term use. If we could get rid of the furosemide, we could also likely get rid of the potassium (nothing better than 2 for 1’s).
Blood pressure meds and cardiovascular medications tend to be a little more challenging to get rid of. In a hospice end of life type of situation, we are more likely to get rid of some of these medications (particularly the statin). Given the high dose atorvastatin, I would guess (but certainly look into this further) that the patient does have a significant cardiovascular history and that it may be being used for secondary prevention.
The duplicate PRN opioids should not be overlooked and would be a place where we could likely trim down the medication list.
Hope you enjoyed me breaking down this med list in this polypharmacy case study! What did I miss?
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