Session 14 - Group Work Flashcards
1
x
2
x
3
x
4
x
5
x
6
Hayfever meds
Case 1
Mr Taylor is a 91 year old retired sheep farmer from Derbyshire. He has recently moved with his wife of 68 years from the farm house into the adjacent single story farm cottage. He uses a stick to mobilise due to osteoarthritic hip pain and reluctantly wears bifocals when he can find them. His wife suffers from vascular dementia. He is her primary carer and continues to drive her to a day centre twice a week. He fiercely guards his independence and collects and manages both his and his wife’s medications himself.
Past medical history:
Hypertension, benign prostatic hyperplasia, osteoarthritis, type II diabetes mellitus, hay fever and newly reported nocturia.
Whilst discussing his medications Mr Taylor reports that he has fallen or nearly fallen on a number of occasions in the last three months.
Mr Taylor reports that the falls have occurred upon standing to attend to his wife. He confirms that although he feels pain in his hip, he doesn’t feel that this is making him fall. He reports feeling dizzy and then remembering mobilising himself from the floor with the help of his armchair and or walking stick.
His ECG shows sinus rhythm and observations demonstrated a lying BP of 128/84. Upon standing his BP drops to 96/75 within 1 minute and he reports symptoms of dizziness.
- What could you recommend to help with the nocturia? If you haven’t already, you may want to consider doses in your answer.
- Avoid caffeine PM
- Drink less before bed
- Keep a fluid chart to ascertain what makes the nocturia worse
- Decrease thiazide diuretic
Case 1
Mr Taylor is a 91 year old retired sheep farmer from Derbyshire. He has recently moved with his wife of 68 years from the farm house into the adjacent single story farm cottage. He uses a stick to mobilise due to osteoarthritic hip pain and reluctantly wears bifocals when he can find them. His wife suffers from vascular dementia. He is her primary carer and continues to drive her to a day centre twice a week. He fiercely guards his independence and collects and manages both his and his wife’s medications himself.
Past medical history:
Hypertension, benign prostatic hyperplasia, osteoarthritis, type II diabetes mellitus, hay fever and newly reported nocturia.
Whilst discussing his medications Mr Taylor reports that he has fallen or nearly fallen on a number of occasions in the last three months.
Mr Taylor reports that the falls have occurred upon standing to attend to his wife. He confirms that although he feels pain in his hip, he doesn’t feel that this is making him fall. He reports feeling dizzy and then remembering mobilising himself from the floor with the help of his armchair and or walking stick.
His ECG shows sinus rhythm and observations demonstrated a lying BP of 128/84. Upon standing his BP drops to 96/75 within 1 minute and he reports symptoms of dizziness.
Mr Taylor reports that he self prescribes ibuprofen to manage osteoarthritic hip pain.
What advice would you give him?
- What other drugs may you consider?
Ibuprofen has causes kidney problems, so this gentleman because elderly already has a low eGFR.
- Paracetamol
- Co-codamol
Case 1
Mr Taylor is a 91 year old retired sheep farmer from Derbyshire. He has recently moved with his wife of 68 years from the farm house into the adjacent single story farm cottage. He uses a stick to mobilise due to osteoarthritic hip pain and reluctantly wears bifocals when he can find them. His wife suffers from vascular dementia. He is her primary carer and continues to drive her to a day centre twice a week. He fiercely guards his independence and collects and manages both his and his wife’s medications himself.
Past medical history:
Hypertension, benign prostatic hyperplasia, osteoarthritis, type II diabetes mellitus, hay fever and newly reported nocturia.
Whilst discussing his medications Mr Taylor reports that he has fallen or nearly fallen on a number of occasions in the last three months.
Mr Taylor reports that the falls have occurred upon standing to attend to his wife. He confirms that although he feels pain in his hip, he doesn’t feel that this is making him fall. He reports feeling dizzy and then remembering mobilising himself from the floor with the help of his armchair and or walking stick.
His ECG shows sinus rhythm and observations demonstrated a lying BP of 128/84. Upon standing his BP drops to 96/75 within 1 minute and he reports symptoms of dizziness.
Mr Taylor reports that he self prescribes ibuprofen to manage osteoarthritic hip pain.
What advice would you give him?
- In accordance with the STOPP START guidelines would you recommend initiating any other medications?
START - Statins e.g. atorvastatin
bc he is diabetic with >1 co-existing major CV risk factor (in this case, HT)
Remember: Statins interact with grapefruit juice (CYP 3A4!)
Case 1
Mr Taylor is a 91 year old retired sheep farmer from Derbyshire. He has recently moved with his wife of 68 years from the farm house into the adjacent single story farm cottage. He uses a stick to mobilise due to osteoarthritic hip pain and reluctantly wears bifocals when he can find them. His wife suffers from vascular dementia. He is her primary carer and continues to drive her to a day centre twice a week. He fiercely guards his independence and collects and manages both his and his wife’s medications himself.
Past medical history:
Hypertension, benign prostatic hyperplasia, osteoarthritis, type II diabetes mellitus, hay fever and newly reported nocturia.
Whilst discussing his medications Mr Taylor reports that he has fallen or nearly fallen on a number of occasions in the last three months.
Mr Taylor reports that the falls have occurred upon standing to attend to his wife. He confirms that although he feels pain in his hip, he doesn’t feel that this is making him fall. He reports feeling dizzy and then remembering mobilising himself from the floor with the help of his armchair and or walking stick.
His ECG shows sinus rhythm and observations demonstrated a lying BP of 128/84. Upon standing his BP drops to 96/75 within 1 minute and he reports symptoms of dizziness.
Mr Taylor reports that he self prescribes ibuprofen to manage osteoarthritic hip pain.
What advice would you give him?
- Beyond reviewing Mr Taylor’s medications what else may improve his adherence and that of his wife?
- Pill box
- ## Home assessment by Occupational Therapy/Physiotherapist
What is the drug class of aspirin 75 mg o.d.?
Antiplatelet drugs
NSAIDs
What is the indication for aspirin 75mg o.d.?
CV disease (secondary prevention); TIA; following coronary bypass surgery;
What is the drug class of clopidogrel 75 mg o.d.?
Antiplatelets
What is the indication for clopidogrel 75mg o.d.?
TIA; prevention of atherothrombotic events in peripheral arterial disease, acute myocardial infarction with ST-elevation or AF
What is the drug class of amlodipine 10mg o.d.?
Dihydropyridine CCB
