Case Study 1
A 78-year-old woman presents to the emergency room after a fall in her home. She is in considerable pain, and on examination she has a left hip fracture. She is alert and oriented, and says that as she was getting out of bed she became dizzy, tripped on a rug, and fell to the floor. Her past medical history is positive for myocardial infarction 5 years ago, osteoarthritis, type 2 diabetes mellitus, and depression. Her husband of 52 years died 4 years ago and she has lived alone in their home since that time. She has no medication allergies, does not drink alcohol and has never smoked. She says that she walks most days, usually for a half hour, and prior to the fall was feeling well. Current medications are low dose aspirin (75 mg/day), metoprolol, naproxen, pantoprazole, metformin, and citalopram.
On physical examination she is a thin (5’4”, 102 lbs, BMI 18) woman in moderate distress. Blood pressure is 164/75 mm Hg, heart rate 84/minute and regular, temperature 97 ˚F, and respirations 18/minute. She has pain with movement of the left leg, otherwise the examination is unremarkable. She is taken to the operating room for surgical repair of the hip, and returns from the operating room receiving low molecular weight heparin.
1. Discuss the age-related differences in response to this patient’s medications prior to the hip fracture.
2. Discuss the approach for reinstitution of the patient’s medications following the surgery.
3. Discuss polypharmacy as it relates to the patient.
4. Discuss medications that should be avoided in the patient during her post-operative and convalescent period.
Case Study 2
An 84-year-old man with congestive heart failure, chronic obstructive pulmonary disease, osteoarthritis, and benign prostatic hypertrophy has increasing shortness of breath. His physical examination is consistent with congestive heart failure that has recently worsened. He lives in an assisted living facility and has limited mobility, though is able to walk to the bathroom and dining room. Current medications are lisinopril, carvedilol, furosemide, low dose aspirin, albuterol, ibuprofen, terazosin and oxybutynin.
1. Discuss the age-related differences in response to medications that this patient is receiving.
2. Discuss the mechanism of orthostatic hypotension that the patient may experience associated with the terazosin therapy.
3. Discuss the effects of oxybutynin in the patient and why it may not be an optimal therapy.
Presented by the PhRMA Foundation Safe and Effective Prescribing Project
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