77 year old female has a past medical history including but not limited to: GERD, PMR, Hypertension, Iron Deficiency Anemia, Osteoporosis. Her current medication list includes:
- Ferrous Sulfate 325 daily
- Aspirin 81 mg daily
- Ranitidine 150 mg twice daily
- Prednisone 10 mg daily
- Alendronate 70 mg weekly
- Ferrous Gluconate 324 mg daily
- Enalapril 10mg daily
- Acetaminophen 500 mg as needed
There is an obvious question to ask here. This patient is using two different iron supplements for anemia. Our patient is on both Ferrous Gluconate and Ferrous Sulfate. I would suspect this is an oversight, or the patient did this on their own. It would be appropriate to get rid of one of the supplements. With that stated, it will also be important to assess anemia and iron stores in the future to make sure that long term iron supplementation doesn’t get continued indefinitely without follow up.
This patient has a history of PMR and is likely taking the prednisone for that reason. I would likely suspect the prednisone is long term, but the length of prednisone therapy always needs to be assessed for appropriateness. Because of the prednisone, this patient is at higher GI risk (on Aspirin as well). The prednisone increases the risk of osteoporosis and this patient is likely on alendronate for treatment of that. I’m usually not an advocate for adding medications in the elderly if we can help it, but assessing if calcium and vitamin D supplementation is necessary would be appropriate here.
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A very good example of prescription error
This example of polypharmacy brings home the idea of regular review of medications for older adults (or anyone really) to reduce duplications & errors and to reassess duration/follow-up of medications that may/many not be needed on a regular basis.
Pt has a history of GERD. Why does she need ASA. I don’t see a mention of cardiac issues. why is she not on a PPI rather than Rantidine? Iron is a duplication for sure. stop one and reassess in 6 months
Prednisone dose needs to be reassessed. Perhaps it can be lower? How long has she been in alendronate? How much prn acetaminophen is she taking ( advise re max of 3000mg per day, not more)
One thing that I see a lot is the misuse of iron in Anemia of Chronic Diseases. RBC, H and H are all significantly low, and resident is being managed on iron supplement 2-3X day. It’s my understanding that not only is that not good, it can also exacerbate the ACD. So, with this patient, I’d also like to see CBC w/diff.