Polypharmacy is a big topic in geriatrics. In the case below, I provide an example of diabetes medications and how we can try to minimize medications. Specifically, I look at the use of sulfonylureas with long acting insulin. An 88 year old female with a past medical history of CHF, edema, hypertension, type 2 diabetes, hyperlipidemia, anxiety, urinary retention and frequency, COPD, and anemia.
- Aspirin 81 daily
- Metoprolol XL 100 mg daily
- Lasix 20 mg daily
- Lipitor 20 mg daily
- Amaryl 2 mg daily
- Lantus 25 units daily
- Xanax 0.25 mg at bedtime as needed
- Vesicare 5 mg daily
- Duonebs QID
With an A1C value reported at 6.1 and an already substantial dose of Lantus, this is a classic example where you could look at discontinuing the low dose sulfonylurea (remember that sulfonylureas stimulate insulin release) and monitor the A1C and accuchecks going forward.
Another possible source of reducing medications would be to look at the Duonebs. Assessing respiratory status and identifying if this patient has ever been on or would be a candidate for a long acting anticholinergic or possibly a long acting beta agonist would be an appropriate thing to look at.
The bladder anticholinergic (Vesicare) is always an important medication I like to look at and make sure that this patient is actually benefiting. If you’d like to add any questions or concerns, please feel free to do so!
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