Here’s a medication list and a few thoughts to go with it.

• Amiodarone 200 mg daily
• Famotidine 20 mg daily
• Enalapril 10 mg daily
• Metoprolol 25 mg BID
• Pantoprazole 40 mg daily
• Acetaminophen 500 mg TID
• Requip 0.5 mg HS
• Aranesp (hold for hemoglobin less than 11)
• Aspirin 81 mg daily
• Buspirone 10 mg BID prn

Aranesp is used to treat anemia.  One mistake I’ve seen with Aranesp is either not assessing iron stores or not using iron.  Lack of iron is one of the most common reasons for failure of Aranesp therapy.  Monitoring hemoglobin is obviously essential. I have seen the mistake made at a LTC facility where Aranesp was given at a hemoglobin higher than goal.  In another instance, I recall Aranesp being given and clear parameters for use were not given. It’s really important to make sure everyone is on the same page when using ESA’s.

The other really important point with iron is that low iron can potentially contribute to symptoms of restless legs.  Without a diagnosis list we can’t definitively say that Requip is being used for RLS, but based upon my experience at the night time dosing schedule, it would be highly unlikely that it wouldn’t be.

Buspirone is an anti-anxiety medications and typically takes weeks to work.  PRN use of buspirone will likely be ineffective.  I would definitely want to follow up with the patient/provider about this.

What else would you want to investigate?

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