Home Medicines Review 78
| Patient Details | |||
| Name: | Keith Kirby | Age: | 72 |
| Address: | 22 Second Avenue | Weight: | 82 kg |
| Referring GP: | Dr Mingle | Height: | 176 cm |
| Patient Information from HMR Referral |
| Allergies or adverse reactions: Endep amitriptyline – hallucinations |
| Smoking: quit 16 years ago |
| Alcohol: 2-3 glasses of white wine each night – sometimes more |
| Reason for referral for HMR |
| • Generalised skin rash which is hard to explain • Polypharmacy |
| Patient History (Social/Medical) from HMR Referral |
| Medical History • Ischaemic heart disease (stent inserted 2 years ago) • Depression • Hypertension • Cerebrovascular accident (2010) • Fractured sacrum 8 months ago (due to fall) and bilateral lumbar back pain • Osteoporosis |
| Current Medications | ||
| Medication | Dose (according to Mr Kirby) | Purpose/comments (according to Mr Kirby) |
| Norvasc (amlodipine) 10 mg | 1 each morning | Blood pressure |
| Imdur (isosorbide mononitrate) 60 mg | 1 each morning | Angina |
| Thiamine 100 mg | 1 each morning | Alcohol consumption |
| Circadin (melatonin) 2 mg | 1 night | Sleep |
| Aspirin 100mg | 1 each morning | Prevent stroke |
| Atorvastatin 40 mg | 1 each night | Cholesterol |
| Targin (Oxycodone / Naloxone) 15 mg / 7.5 mg | 1 twice daily | Pain relief |
| Perindo Perindopril 8mg | 1 each morning | Blood pressure |
| Duloxetine 30mg | 1 each morning | Depression |
| Prolia (denosumab) 60mg | 1 every 6 months | Osteoporosis |
| Relevant Test Results |
| Recent laboratory test results: • Na+ 140 mmol/L (136-146) • K+ 4.5 mmol/L (3.5-5.2) • Creatinine 66 micromol/L (45-90) |
| • Glucose (fasting) 4.5 mmol/L (3.0-6.4) • Total Cholesterol 5.1 mmol/L (<5.6) (Breakdown of LDL/HDL/ Triglycerides not provided with referral) • GGT 87 U/L (5-35) • Haemoglobin 145 g/L (120-160) (all CBP parameters in normal limits) |
| Information from Patient Interview |
| Whilst at Mr Kirby’s home the following information is obtained: • Rash was on inside of thighs and arms and it is now resolving with Eumovate cream and fexofenadine 180mg (Telfast) which he purchased OTC. The rash has only occurred the once, it was itchy and bit lumpy. (It started in hot weather and Mr Kirby did not change any detergents or soaps). • Sweating is of concern and at the time of the visit the hair around temple was damp. • He is feeling optimistic and would like to travel overseas in about 8 months’ time and is keen to reduce his alcohol intake (he feels the duloxetine has been helpful). • Goes to sleep well but wakes about 4 hours later to toilet then tosses and turns (has been taking melatonin for at least a year). • Takes curcumin 600mg twice daily for pain but has not advised Dr Mingle of this. • Has been seeing physiotherapist and finding exercises are helping pain. • He has a Nitrolingual spray which he has not needed to use. It expires next month. • He has had two doses of denosumab and the last dose was about the time of the rash, but he is uncertain whether it was before or after the rash developed. • Has Endone 5mg at home but has not taken any for a long time. • He usually remembers to take morning medicines but sometimes forgets night medicines. • He tells you the doctor says his blood pressure is “good”, but he is unsure of the numbers. • He said he eats cheese and has milk on cereal for breakfast. He has never been told he is vitamin D deficient. |
| QUESTIONS |
| Consider the patient needs or concerns, medication-related problems and medication management issues. 1. What further information would assist in making your assessment of this patient? Explain reasons for obtaining this information. Who/where would you obtain this information? 2. Based on the information provided, identify potential and actual medication related and disease-related problems, and patient concerns. Suggest how these could be addressed and/or monitored. 3. Write a letter or report to the referring GP, outlining your key findings for this patient and your suggestions or recommendations. |