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.
What else would you want to know more about?
Enjoy the blog? Check out my 30 medication mistakes! A free 6 page PDF for subscribers only!