JS is a 67 year old female.  Past medical history includes:

• COPD
• Constipation
• Parkinson’s Disease
• GERD
• Osteoporosis
• Hypertension
• Chronic UTI’s

Her current medication list includes:

• Budesonide nebs 0.5 mg twice daily
• Senna 1 tablet twice daily
• Colace 100 mg daily
• Ranitidine 150 mg daily
• Metoclopramide 10 mg four times daily
• Alendronate once weekly
• Losartan 100 mg daily
• Metoprolol 25 mg BID
• Cranberry tabs once daily

Here’s a few thoughts that come to mind on questions I would be ask looking to ask this patient or at least dig into further within this patient’s medical records.  I’m going to pick out my top three and you can see what else that you would like to investigate.

1. I would certainly look at respiratory status. It is somewhat unusual for a patient to be on an inhaled corticosteroid alone for COPD without a long acting bronchodilator (i.e. an anticholinergic or long acting beta agonist).
2. The next thing that really jumped out to me was the lower dose of ranitidine with metoclopramide. Metoclopramide is probably not an ideal choice given the history of Parkinson’s.  Assessment of GI status with possibly goal of minimizing the use of metoclopramide would be an important thing to look at.
3. It is unusual to be on a bisphosphonate for osteoporosis without vitamin D supplementation and possibly calcium. I always at least consider the risk/benefit of calcium in regards to constipation.

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