C3.2 R5: Reconcile a patient’s medications on ADMISSION #2

ID: WA is a 65 yo male admitted with anascara and stage 5 CKD

Confirmed: NKDA

Adverse drug reactions:

  • Sample medication (unable to verify) for volume overload from his physician.
    • ADR: “water blisters” and shingle-like reactions on both of his feet

According to Pharmanet, his most recent refills were in Jan, 2016. When going through the medications, gathered information as to his understanding, efficacy and safety of his medications

  • Hydralazine 25mg – 1 tablet PO TID
    Started around October 2015 at twice daily. Had light-headedness and dizziness, especially when moving around
  • Furosemide 40mg – 1 tablet PO once daily
    Stopped temporarily by self as he did not notice any swelling. Restarted it about a month PTA as he noticed increased swelling.
  • Digoxin 62.5 mcg – 1 tablet once daily
    Ran out of refills but not stopped by doctor.
  • Metoprolol 25mg – 1 tablet twice daily
    SEs: dreams and nightmares at night infrequently. They are disruptive to his sleep, but tolerable. Stopped temporarily by self as felt asymptomatic but also restarted it about a month PTA.

Additional medications:

  • Vitamin D 1000 IU once daily – recommended by dietician PTA
  • Acetaminophen as needed for pain
  • Ibuprofen as needed for pain, when pain is not received with acetaminophen
    • Advised and explained to patient about avoiding NSAIDs due to his CHF and CKD

Barriers to medication adherence:

  • Finds it difficult to get appointment from doctor to get refills
  • ?Understanding of his medications and indications

 

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One thought on “C3.2 R5: Reconcile a patient’s medications on ADMISSION #2

  1. Pingback: C3.2 R5: Reconcile a patient’s medications on DISCHARGE – Shermaine Ngo

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