Home Medicines Review 78

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.

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