The Case Study For Polypharmacy Assignment Paper

The Case Study For Polypharmacy Assignment Paper

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Polypharmacy: The Case of 80-Year-Old Mrs. Peshlakai

Multimorbidity in the elderly is the key factor contributing to polypharmacy in that particular demography, according to Nguyen et al. (2020). They have a higher chance of being prescribed a lot of medicines as a result. Polypharmacy is the practice of simultaneously treating one or more illnesses with a number of different medications for the same patient. People who are 65 years of age or older are considered to be elderly. Many comorbid disorders exist in this population demography as a result of age-related physiological functional decline as well as everyday tissue wear and tear. Because of this, polypharmacy’s side effects on the elderly are always a possibility. The purpose of this paper is to analyze the case of Mrs Peshlakai, who is 80-years-old and on 11 different types of medications at discharge The Case Study For Polypharmacy Assignment Paper

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The Patient

Apart from the diagnosis of acute bronchitis, Mrs Peshlakai has the following comorbidities: heart failure, hypertension, osteoarthritis, GERD, and hyperlipidemia. For these, she is on a total of 11 different medications viz: doxycycline, prednisone, tiotropium inhaler, metoprolol succinate, pantoprazole, atorvastatin, lisinopril, furosemide, potassium chloride, acetaminophen, and tramadol.

Medications for Deprescribing

After reviewing her current signs and symptoms, the medications the nurse practitioner may consider deprescribing to reduce the current polypharmacy are: doxycycline, tiotropium, tramadol, pantoprazole, and potassium chloride. The bronchitis is resolved and so she does not need the antibiotic and the inhaler. She has not had symptoms of GERD for six months and so she does not need the proton pump inhibitor (pantoprazole)The Case Study For Polypharmacy Assignment Paper. Her arthritic pain is much less and so acetaminophen is sufficient; there is no need for tramadol. There is clearly also no current indication for the potassium chloride. Deprescribing the above medications will leave the patient with just four medications. These are the medications she needs at the moment to maintain her health. The problem of polypharmacy is thus resolved.

After the Prednisone Taper

After the prednisone taper, the medication that the nurse practitioner may start to reduce given the reported symptoms is the potassium chloride. There does not seem to be a problem of hypokalemia and continuing to give the potassium chloride may in fact lead to deadly arrhythmias (Hammer & McPhee, 2018; Rosenthal & Burchum, 2018)The Case Study For Polypharmacy Assignment Paper. This is a patient with heart disease already. The potassium chloride dose will thus need to be reduced and eventually stopped altogether.

Other Medication Adjustments

The absence of exacerbation of the heart failure and the compliance with the sodium diet allows the nurse practitioner to modify the pharmacotherapy even further. This is why metoprolol can be stopped to leave lisinopril as well as furosemide to take care of the heart disease and hypertension (Syifa et al., 2023). These changes will however be subject to close monitoring of the patient and prompt reporting of any changes by the daughter.

Conclusion

Polypharmacy is a risk to the elderly in terms of potential drug interactions and serious side effects. The reason for this is that multiple comorbidities due to old age, the elderly usually require medications to manage each of those preexisting conditions. The patient in this case study has heart failure, GERD, arthritis, hypertension, and hyperlipidemia. Additionally, she was on a record 11 different medications for each of those problems. The cause of her admission was acute bronchitis, which resolved quickly The Case Study For Polypharmacy Assignment Paper.

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Nguyen, T., Wong, E., & Ciummo, F. (2020). Polypharmacy in older adults: Practical applications alongside a patient case. The Journal for Nurse Practitioners, 16(3), 205-209. https://doi.org/10.1016/j.nurpra.2019.11.017

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

Syifa, N., Rahmayanti, N., Yusetyani, L., & Hasmono, D. (2023). Study of lisinopril in heart failure patients. KnE Medicine / 2nd International Conference on Medical Health Science (2nd ICMEDH), 259–269. https://doi.org/10.18502/kme.v3i2.13058

Week 5 Assignment 1: Polypharmacy Case Study

Read the case of Mrs. Peshlakai.

After reading the case, answer the following questions:

1. In reviewing her medication list and current symptoms and clinical signs, which medication could the nurse practitioner consider deprescribing?
2. Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to reduce given the patient’s reported symptoms?
3. Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet, what other medications adjustments could the nurse practitioner consider at this time? The Case Study For Polypharmacy Assignment Paper

Be complete in your responses and include scholarly citations. Include references per APA 7^th edition. Use full sentences and paragraphs in your responses.

Readings

Required

Read the following articles and web resources:

• Andy, U. U., Vaughan, C. P, Burgio, K. L, Alli, F. M., Goode, P. S., & Markland, A. D. (2016). Shared risk factors for constipation, fecal incontinence, and combined symptoms in older U.S. adults. Journal of the American Geriatrics Society, 64(11), e183-e.
• Consult Geri. TryThis:® Series:
  • Dowling-Castronovo, A., & Spiro, E. (n.d.). Urinary incontinence assessment in older adults: Part I—transient urinary incontinence.
  • Dowling-Castronovo, A., & Spiro, E. (n.d.). Urinary incontinence assessment in older adults: Part II—established urinary incontinence.
• Davis, N. J., Wyman, J. F., Gubitosa, S., & Pretty, L. (2020). Urinary incontinence assessment in older adults: Part I—transient urinary incontinence (PDF). The American Journal of Nursing, 120(1), 57–62.
• Kim, J., & Parish, A. L. (2017, September). Polypharmacy and medication management in older adults. Nursing Clinics of North America, 52(3), 457–468.
• National Institute on Aging. (2019). Urinary incontinence in older adults.
• (2012). Beers revised: Drugs not to use in older adults. American Pharmacist Association.
• Cojuc-Konigsberg, G., Schoo, C. (2022). Inappropriate Medication In The Geriatric Population. National Library of Medicine.
• Sergi, G., De Rui, M., Sarti, S., Manzato, E. (2011). Polypharmacy in the elderly: Can CGA reduce inappropriate medication use? Drugs & Aging, 28(7), 509–518.
• Shaw, Tansey, R., Jackson, C., Hyde, C., & Allan, R. (2001). Barriers to help seeking in people with urinary symptoms. Family Practice, 18(1), 48–52.
• Stinson, M. J., Guervitz, S., & Carrigan, A. (2019). Deprescribing at the end of life in older patients. Journal of the American Academy of Physician Assistants, 32(7), 20–24. The Case Study For Polypharmacy Assignment Paper
  

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The Case of Mrs. Peshlakai

Mrs. Peshlakai is an 80-year-old woman living with her daughter. She was recently discharged from a 24-hour observation stay at the hospital after being diagnosed with acute bronchitis. She has a history of heart failure, hypertension, osteoarthritis, GERD, and hyperlipidemia. She has no history of smoking. While in the hospital she was prescribed doxycycline, prednisone 15 mg to taper, and a tiotropium inhaler. Her current list of daily medications prior to hospitalization includes metoprolol succinate 12.5 mg, pantoprazole 40 mg, atorvastatin 10 mg, lisinopril 10 mg, furosemide 40 mg, potassium chloride 20 mEq bid, acetaminophen 650 mg bid for pain, and tramadol 25 mg as needed. Her discharge report indicated resolving bronchitis, no exacerbation of heart failure, and stable arthritic pain. Today she reports one week after discharge with her daughter for a primary care appointment, and they both are concerned about the number of medications she has been prescribed and want her medications reviewed. In further review, she is found to have lost 5 lbs over the past six months and her current BMI is 25. She states that the weight loss may be due to a change to a healthier diet and reducing sodium as instructed. She also reports no symptoms of GERD for the past six months and minimal arthritic pain because of regular use of acetaminophen and daily walking around her garden and home. Upon examination, her lungs are clear to auscultation and no evidence of lower extremity edema.

The Case Study For Polypharmacy Assignment Paper