A sample medication review – Miss B.M 88 years-old female

In this section, we will try to give you a feeling on how a medication review look like?

In a medication review, we look at your overall current medication usage and history. We would access your Pharmanet profile to see exactly what medications you are using. In addition to this, we would ask you what current over the counter medications, herbal or natural products you may be on. Some of the questions we would ask you specifically:

  • Did you experience any allergic reaction or intolerance to drugs?
  • Did you develop any side effects?
  • Have you changed or stopped taking any medications lately?
  • Are there any concerns with your current medications?

Once we have this information, we would look at the following:

  • What is the reason or indication for each drug you are on?
  • Is the dose correct?
  • Is the manner you take the drug correct (with or without food, morning or evening, etc.)?
  • Is the length of treatment correct according to recent medical guidelines?
  • Are there any potential interactions between your medications or certain foods?
  • Are there any special warnings (for instance: stay off the sun or any expected common drug reactions)?
  • Are there are any matters you wish us to inform or discuss with your doctor?

Now let’s see how is this used in real life?

Miss B.M is a typical 88-year-old patient. She uses a walker to keep her from falling, looks relatively underweight and lives by herself. She experienced a stroke over 20 years ago.
Currently, she is on 12 different medications which are arranged in her “bubble pack” and are dispensed to her weekly.
She is taking four different high blood pressure medications (amlodipine, hydrochlorothiazide, ramipril and metoprolol).
Gabapentin to treat her chronic back pain.
Oxazepam to treat her insomnia. Synthroid to treat her hypothyroidism. Atorvastatin to treat her high cholesterol level. Calcium, baby aspirin, potassium and a multivitamin.

Looking at her medications:

The following issues were identified by performing her total medication review.

  1. Gabapentin is taken 2 in the morning, 2 at lunch and 3 at bedtime. The lunchtime dose is taken in conjugation with calcium which would make it poorly absorbed. As the patient is a female, potentially underweight and is 88 years old, her dose appears to be on the higher end. This could potentially lead to enhanced neurological side effects (especially combined with her oxazepam). The patient is also using a walker which may indicate potential neurological impairment.
  2. The patient is on four different hypertension drugs. Without knowing her actual systolic/diastolic readings, this may lead to taking too many and possibly too high a dose. Her age, weight and walker use may lead to potentially harmful side-effects.
  3. Atorvastatin is taken as 40 mg once per day. Considering the patient’s age and weight this may lead to myopathies which may outweigh the potential cardiovascular benefit from using it, if any.
  4. Synthroid is taken daily along with the rest of the morning pills at breakfast. The patient was explained about the proper way to take it ( which is better on empty stomach – absorption wise).

Recommendations made:

1. Gabapentin: a dose reduction should be considered. Take calcium at supper.
2. Hypertension drugs should be revised depending on systolic/diastolic readings.
3. Atorvastatin: dose reduction or possible elimination should be considered.
4. Synthroid: as the patient has been stable on the same dose – no need to change the dose.

To conclude:

One might think that the patient in the example above, who is using weekly blister packs, would be carefully monitored in terms of the appropriateness of the medications she is on. However, the example has shown that this patient needs to have her medications reviewed and possibly even changed or stopped. This example shows the importance of a medication review done by a pharmacist on a regular basis.

Call us today or just drop by, for your medication review. We do house calls for medication reviews and provide FREE delivery on prescription drugs.