In this med list reveiw, a 75 year old male is on the following medications:
- Furosemide 80 mg twice daily
- Metolazone 2.5 mg daily
- Aldactone 100 mg daily
- Lisinopril 10 mg daily
- Metoprolol 25 mg twice daily
- Ibuprofen 400 mg four times daily as needed
- Zantac 150 mg daily
- Aspirin 81 mg daily
- Famotidine 20 mg at bedtime
- Capsaicin topical to knees as needed
If you remember from previous med list reviews, I simply highlight a few things that I would be interested in following given the medication list. It is basically an educational exercise, a way to learn how to formulate questions, and identify potential concerns to monitor. Here’s a few that I’m going to be looking at!
This patient is on multiple diuretics. Monitoring electrolytes with diuretic therapy will be of utmost importance given the number and doses of diuretics this patient is on. Kidney function will also be very important.
NSAID use will be important to monitor. Given the medication list and the diuretics being used, I would speculate that this is a CHF patient. NSAIDs can exacerbate edema/CHF.
Avoiding two H2 blockers would be important to address.
Capsaicin is typically ineffective as needed, so that would be an important medication to assess and either possible discontinue or schedule.
What else would you like to investigate/follow?
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If this is a CHF patient, would we need to make sure that the patient is on metoprolol succinate and not tartrate (which is typically dosed twice daily) for the mortality benefit? And if they are already on succinate, that could possibly be changed to once daily dosing to condense the med list. Unless they were experiencing beta blocker side effects and BID dosing helped?
The patient may benefit from switching to torsemide vs. furosemide for a more potent diuretic effect. It may eliminate the need for twice daily dosing of a loop diuretic and reducing the daily need for metolazone.
I think the ibuprofen 400mg qds is too much for ds patient, considering d age, and the risk of Side effects as bleeding in d elderly. Also worsening of CVD, as hypertension and renal functions with high-dose NSAID use. Duplicate therapy with H2R blockers should be reviewed.