Polypharmacy Med List Review

A 64 year old female presents with the following medications:  Her primary complaints are GI upset (feels like she is going to throw up) and dizziness.

  • Atorvastatin 10 mg daily
  • Aspirin 81 mg daily
  • Lisinopril 20 mg daily
  • Hydralazine 5 mg three times daily
  • Metformin 1000 mg twice daily
  • Sitagliptan 25 mg daily
  • Glipizide 10 mg BID
  • Valsartan 40 mg daily
  • Omeprazole 20 mg daily
  • Tums as needed
  • Mobic 15 mg daily
  • Ultram 100 mg three times daily
  • Acetaminophen 650 mg as needed
  • Meclizine 25 mg as needed
  • Senna-S 1 tab twice daily
  • Miralax 17 grams daily

Here’s a few questions I would begin to formulate based on trying to solve the two patient complaints:

  1. First figure out how long the dizziness and GI upset have been going on and then hopefully we can associate that with when a new medication was started or increased.
  2. The two major culprits that I would start with as far as the GI upset is concerned would be the metformin and Mobic (NSAID).  Assessing how well controlled pain and blood sugars are controlled will help guide us as to which could possibly be reduced or discontinued.
  3. The dizziness: Getting blood pressure readings would be very important here.  This patient is on low doses of BP medications.  The ACE/ARB combination should be addressed and if determined that low BP is a problem in relation to the dizziness, an easy solution would be to DC the low dose valsartan.  The hydralazine dose is very low as well.

What else would you like to know about this medication list?

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Written By Eric Christianson

December 9, 2015

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