A sample medication review – Miss B.Y 90 years-old female

In this medication review, we will analyse Miss B.Y drug profile.

She is 90 years old female, a monthly blister pack patient, currently taking 14 chronic medications.  She is using a walker. Looks mildly cognitively impaired and is a bit confused about her meds. She was discharged from the hospital less than a month ago, but she can’t recollect why she was admitted in the first place. When she first came to our pharmacy she was concerned about the amount of drugs she takes and their cost.

In terms of compliance with her drug therapy, she is residing in an assisted living community and it looks like she is taking all her medications as prescribed by her doctor. She receives her daily meds from her assisted living nurse (“I just swallow a bunch of pills every day. And I don’t know what I am even taking. Or if I even need them ”, she notes).

Looking at her medications, she was taking: Allopurinol; Atorvastatin; Calcium Carbonate; Ferric Gluconate; Fludrocortisone; Glyburide; Latanoprost;
Metoprolol; Paroxetine; Potassium Chloride; Rabeprazole; Saxagliptin; Vitamin D3  and Zopiclone.

We revised her frug profile, reviewed the current guidelines and came up with the following recommendations:

  1. Allopurinol –elimination should be considered, as the patient was free of goat-attack for the past the 10 years and on the other hand, her kidney functions probably deteriorated.
  2. Fludrocortisone – the indication for its use should be revised. Elimination should be considered.
  3. Paroxetine and Metoprolol have a class D interaction when combined. A possible switch from Paroxetine to Mirtazapine should be considered instead.
  4. Potassium – possible dose reduction, if considering the elimination of Fludrocortisone.
  5. Glyburide- possible change to a safer alternative as the patient is 90 years old and the risk for hypoglycemia outweighs the benefit of its use.
  6. Atorvastatin – dose reduction or total elimination should be considered due to the patient advanced age.
  7. Vitamin B12 – consider adding it as a daily supplement.

Of the seven recommendations, four were accepted by her doctor. And we were able to reduce the number of prescription drugs she was chronically taking. which means not only improving her health by reducing unnecessary drugs, but also saving her money every month.

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