Question

CASE STUDY with QUESTIONS…

Mr. Smith is an 84-year-old Caucasian male who lives in an apartment

that adjoins his son’s house. Mr. Smith is accompanied to this

clinic visit by his son, who assists with the history. Although

previously outgoing and social, Mr. Smith recently has been

limiting his outside activities.

History

Mr. Smith stated that for the past year he has felt dizzy when he stands up

after sitting or lying down and that he often needs to “catch himself” on

furniture or walls shortly after standing. His dizziness is intermittent but

happens several times per week.

Mr. Smith cannot identify any recent changes in his medications or other

changes to his routine that would explain his symptom. He says there is

no pattern and he experience dizziness at different times during the day

and evening. He denies experiencing syncope, dyspnea, vertigo, or pain

accompanying his dizziness.

Medications

Valsartan 80 mg daily

Citalopram 40 mg daily

Flomax 0.8 mg at bedtime

Finasteride 5 mg daily

Lipitor 40 mg at bedtime

Omeprazole 20 mg daily

Cyanocobalamin 1 mg daily

Claritin 10 mg daily

Flonase nasal spray two puffs to each nostril daily

Gabapentin 300 mg tabs 2 tabs three times daily

Tylenol 500 mg one to two four times daily prn

Brimonidine tartrate 0.15% ophth 1 drop OU twice daily

Cosopt 2%-0.5% 1 drop OU at hs

Latanoprost 0.005% 2 drops OU at hs

Lorazepam 0.25 mg at hs

Calcium carbonate 500 mg 1-2 tabs three times daily

Tylenol PM at bedtime daily prn

Cyclobenzaprine 5mg three times a day prn

Advil OTC 400mg three times a day prn

Based on the BEERs criteria https://qioprogram.org/sites/default/files/2019BeersCriteria_JAGS.pdf and other resources what medications are you concerned about Mr. Smith taking?

List the top 3 medications you would like to see Mr. Smith stop taking.

Which medications could be contributing to his feelings of dizziness?

List the medications that Mr. Smith is taking that are included on the above list: “Ten Medications Older Adults Should Avoid or Use with Caution” and list the medication class.

Answer 1

medications which are to be looked about and that should be avoided for Mr. Smith are:
Citalopram : The selective serotonin reuptake inhibitor (SSRI) citalopram should not be used at doses greater than 20 mg per day in adults older  than 60 years because of a potential risk for QT prolongation

Lipitor : Compared to younger adults, older  adults are more likely to suffer serious side effects from using statins. It can cause muscle problems, such as aches, pains, or weakness. Rarely, there can be a severe form of muscle breakdown.

Omeprazole: PPI(proton pump inhibitors) use in the elderly has been shown to lead to a number of health concerns. Recent data have shown that PPI use is associated with an increased risk of fracture (hip, spine, or wrist fracture, primarily in adults >50 years of age ; the greatest risk occurs with high doses or long-term use [>1 year]).

flonase nasal spray : elderly  patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving this spray.

lorazepam : Long half-life benzodiazepines usually are not preferred for older  patients because of cumulative toxicity. Among the short half-life drugs, high-potency compounds (e.g. lorazepam, alprazolam) may be more toxic

Cyclobenzrapine: It can be toxic in older adults and people whose  kidneys do not work well. These can cause dangerously low blood sugar.

advil : Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil ( ibuprofen) is  not as safe for seniors as acetaminophen is. NSAIDs have side effects that include upset stomach, heartburn, nausea, constipation, and dizziness.

top 3 medicine that should be avoided are : citalopram, flucanose nasal spray, cyclobenzrapine

Medicines that produce dizziness : Advil, cyclobenzrapine, lorazepam, citalopram, valsartan, flomax