Question

The client’s medication list includes: 1) donepezil (Aricept) 5 mg PO daily 2) Sinemet 10/100 PO TID 3) aspirin 325 mg PO daily 4) warfarin (Coumadin) 5 mg PO qHS 5) tolterodine (Detrol) 2 mg PO BID 6) atorvastatin (Lipitor) 40 mg PO qHS 7) insulin (long-acting and sliding scale) 8) gabapentin (Neurontin) 300 mg PO TID 9) iron sulfate 325 mg PO TID 10) trazodone 50 mg PO qHS 11) levothyroxine 50 mcg PO daily 12) furosemide (Lasix) 60 mg PO BID 13) potassium chloride 20 mEq PO daily 14) metoprolol 100 mg PO BID 15) lisinopril 20 mg PO daily 16) amlodipine 10 mg PO daily 17) acetaminophen 1,000 mg PO TID 18) docusate sodium 100 mg PO BID 19) polyethylene glycol powder (Miralax) 17 g PO daily 20) tiotropium (Spiriva) 18 mcg inhaled daily 21) montelukast (Singulair) 10 mg PO daily 22) fluticasone/salmeterol (Advair) 100/50 inhaled BID 23) Albuterol/Atrovent nebulizers PRN for wheezing 24) multivitamin one PO daily 25) vitamin E 400 IU PO daily 26) calcium carbonate 500 mg PO TID 27) vitamin D 800 units PO daily 28) kava root 100 mg PO QID 29) nitrofurantoin (Macrobid) 100 mg PO qHS

1)Explain which of these medications you would have concerns in administering to an elderly client and why. 2) Discuss what alternatives you might recommend to either the client or provider. 3) Describe the teaching you would provide and/or information you would need to ensure that the client understands related to the medication regimen prior to discharge.

Answer 1

Ans1:Donepezil using with Aspirin may increase the risk of stomach ulcers specially in older clients.

Warfarin and NSAIDS[Aspirin and Acetaminophen]together will increase the risk of Gastro intestinal bleeding

Ans2:Highly recommend to avoid Acetaminophen as two medications prescribed from same category[NSAIDs],also recomend to omit Aspirin too,if its not highly indicated.

Ans3:If the client experiences any kind of symptoms like coffee ground vomiting or tarry stools,immediately report to the health care provider.,should not take Sinemet with iron and miultivitamins it decreases the absorption,.so seperate the timings.Also the client may experience dark coloured urine ,sweat and saliva,but its harmless.Patient should be aware of this.Patient may feel lightheadedness with Sinemet,so try to get up slowly from a sitting or lying position.

As patient is on warfarin avoid tooth picking,heavy nose blowing and vigerous brushing of theeth,also avoid foods like Brocholi,Spinach,Cauliflower,Green tea ,as it contains more Vitamin K which reduces the effectiveness of Warfarin.

Gabapentin causes blurred vision or double vision ,so the client should be educated regarding this.Client is not allowded to quit the medications without the physician's order.Avoid alcohol and quit smoking as it has serious interactions with many of the medications.

Take Metoprolol at same time everyday for better absorption.