Assessment of medication and goals of therapy need to be continually monitored. In this scenario, I pick out a few medications that should be looked in consideration of age and goals of reducing medication burden. A 98 year old female is on the following medications.
- Lipitor 10 mg daily
- Amlodipine 10 mg daily
- Diovan/HCTZ 160/12.5 mg daily
- Remeron 15 mg at bedtime
- Metformin 500 mg once daily
- Pantoprazole 40 mg daily
- Ranitidine 150 mg twice daily
- Tramadol 50 mg TID
- Vitamin C 500 mg daily
- Colace 100 mg daily
I know in school, I was taught that age should not be a consideration in discontinuing a medication. While I tend to agree that age should not be the ONLY consideration in determining if a medication is appropriate, I do believe that it is a consideration. Here’s a few of the medications that I would look at as potentially unnecessary depending upon life expectancy and patient/family goals.
- I would look at A1C. If less than 7, possibly even less than 8, I would look to possibly discontinue the metformin. It is a low dose, and this patient looks to have some significant GI problems as she is on a PPI and an H2 blocker already.
- Vitamins should always be looked at and the question asked as to why we are using a supplement. Vitamin C and reviewing its indication in this case would fall under this category.
- Past cardiac/stroke history should be looked at as well as patient goals of therapy in regards to the statin. If well tolerated and there is significant quality of life as well as life expectancy remaining, I would probably lean towards leaving it alone. Another trick is to imagine this patient has an event following discontinuation. If you would likely restart it, then you most likely wouldn’t want to discontinue it.
- Hypertension medications I typically leave alone in the absence of falls or other adverse effects, but a look at where blood pressure readings are would certainly be important.
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