Severe Asthma Medication Review
You can’t tell everything from a medication list, but you can certainly begin to formulate questions and identify possible areas of concern. What do you notice that seems a little wacky? Here’s a patient with severe asthma, on multiple medications:
- Advair 100/50 BID
- Albuterol inhaler 2 puffs four times daily and as needed
- Singulair 10 mg daily
- Pulmicort nebulizer 0.5 mg twice daily
- Claritin 10 mg daily
- Lactulose 30 mls twice daily
- Propranolol 20 mg BID
- Diovan 80 mg daily
- Coreg 6.25 mg BID
- Aspirin 81 mg daily
If we address the known “severe asthma” first, the duplication of two inhaled corticosteroids is a little bizarre. The patient has orders for both Pulmicort nebulizer (and why are they doing a nebulizer?) and Advair (which contains a long acting beta agonist as well as the corticosteroid). The other unique thing about the Advair is that we are using the lowest dose in a patient with “severe” asthma. Digging into this would be a top concern for sure.
The scheduled use of albuterol and assessment of how much prn albuterol is being used would also be an important aspect in this case.
Next I would look at the duplicate beta-blockers. This patient is on both Coreg (carvedilol) and Propranolol. Also remember that propranolol is non-selective and has a higher risk of exacerbating this patient’s asthma than other beta-blockers. With that stated, and noticing the lactulose order, I would assess if this patient has a history of liver issues. Remember that propranolol can be used for esophageal varices prophylaxis.
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