A significant clinical medication review for everyone today, where I pick out a couple areas of concern to me and you can help do the rest by adding any comments/thoughts/questions below! There’s plenty to pick on in this one, so I may need a little help to cover everything! – Also reminder that new subscribers can get free unlimited access to my 20 minute webinar on the 10 Commandments of Polypharmacy – just look on the right side of the page to subscribe. As always with these med list reviews, your priorities are going to depend upon what is going on with your patient, so this is really more of an educational exercise to help get your mind right in trying to identify medication related problems!
The first concern that jumped out at me that I’d look to investigate is the Ritalin indication. Also, the fact that Ritalin is being used in combination with Klonopin and potentially the Remeron at night, both of which can be sedating – so we are using a combination meds that can ramp you up and potentially slow you down. Also looks like plenty of cardiac issues by the meds which Ritalin needs to be monitored closely for.
Always important when you get someone on this many meds not to lose sight of the fact that they are on Coumadin (warfarin) which as I’ve mentioned before can have a ton of drug interactions – so we need to be extra careful about medication changes – I’ve posted a few cases on Coumadin before if you’d like to check them out, search Coumadin on the site!
There are plenty of labs we need to monitor…Synthroid, Lisinopril, Digoxin, Coumadin, Glyburide, Lasix etc.
I can’t resist…one more thing – I’d like to know why they are on Duonebs TID without any controller type medication – suspect maybe a recent acute respiratory issue in which maybe long term scheduled nebs would not be necessary, but certainly needs to be investigated further.
Please feel free to comment!
If you enjoyed this post, please check out the 10 Commandments of Polypharmacy and the Worst Case of Polypharmacy I’ve ever seen!
Also potential of Tylenol overdose as patient is taking OTC Tylenol q6h as well as HC/APAP. Also too much Tylenol may interfere with INR level. I also wonder if both Docusate and Senna is necessary to help with Opioid-induced constipation.
So many thoughts. Here’s a few:
How about metoprolol potentially causing daily fatigue (Ritalin use?) and possibly depression (indication for Venlafaxine?).
How old is patient: Glyburide may not be not the best choice renally.
Indication for mirtazapine- for sleep? Could Ritalin be causing sleeping problems?
Venlafaxine with cardiac problems?
Venlafaxine and mirtrazapine prescribed together?
Yes and it gives a synergistic effect
I’m talking about the venalfaxine and remeron part
What about interaction between nitro and imdur
Nitro I would suspect is likely as needed sublingual for chest pain? But certainly something to double check on…
It concerns me as to why you would give a patient Ritalin while they are also on two blood pressure medications (that I can recognize anyway). Wonder about which one came first and if both blood pressure meds are needed due to Ritalin. It’s a small dose but the patient can be sensitive to a stimulant- would love to know their age.
If I had to guess, I would think perhaps this patient has narcolepsy. The clonazepam in low-dose is to control room sleep behavior disorder which can be seen in patients with narcolepsy. The Ritalin is to help with the time alertness. The antidepressant is to control cataplexy. Finally, The Mirapex is to control restless leg syndrome. Ironically, venlafaxine aggravate symptoms of restless leg syndrome, but if they’ve had problems with depression or if they need the medication for some other reason, sometimes when does need to control the restless leg syndrome sufficiently to get them to sleep. People with narcolepsy can have other medical illnesses. Nonetheless, putting this medication list is an admirable and important goal.