MEDICATION RECONCILIATION REAL-LIFE EXAMPLE

Medication 1: Amlodipine

Dosage: 5mg

Frequency: Once per day and is taken first thing in the morning.

Reason prescribed: Hypertension

How long have you been taking this medication? Close to 2 years.

How it works: Amlodipine is like a key that helps open narrow blood vessels in our body. When these blood vessels widen, it allows blood to flow more easily, which can help reduce high blood pressure. By making it easier for the heart to pump blood, amlodipine helps our heart work better and can also ease chest pain for some people.

Potential Side Effects:

Swelling: It may cause swelling in the ankles, feet, or hands.

Dizziness: Some people may feel dizzy, especially when standing up quickly.

Flushing: Amlodipine might cause flushing or feeling warm in the face or skin.

Fatigue: It could lead to tiredness or fatigue in some individuals.

Headache: Headaches are a potential side effect for some people.

Nausea: It might cause an upset stomach or feelings of nausea.

Is it managing your condition? Not sure according to the patient.

Is it improving your health? Not sure according to the patient because of the other medication taken.

Any side effects experienced? The patient suspects the medication is causing her to experience headaches and tiredness. But, again not sure because of all the other medication she is taking.

Any drug interactions with other drugs taken? The patient was not sure what she should be looking for when it comes to drug interactions.

Interactions with food, alcohol, or other substances? The patient was not sure because he does not take the drug with anything except a cup of milk in the morning but does not believe any interactions are happening with the milk.

Medication 2: Lisinopril

Dosage: 20mg

Frequency: Once per day and is taken after 10 am.

Reason prescribed: Hypertension

How long have you been taking this medication? For exactly 1 year.

How it works: Lisinopril helps your heart by making it easier for your blood to flow through your body’s pipes (blood vessels), and by telling your body to get rid of some extra water, which helps to lower your blood pressure.

Potential Side Effects:

Cough: Some people may develop a dry, persistent cough while taking Lisinopril. This side effect usually goes away once the medication is stopped.

Dizziness or lightheadedness: Lisinopril can sometimes cause a drop in blood pressure when standing up quickly, leading to feelings of dizziness or lightheadedness.

Fatigue: Some individuals may feel tired while taking Lisinopril.

Headache: Headaches are a common side effect, especially when starting Lisinopril or adjusting the dosage.

Nausea or vomiting: Lisinopril can cause gastrointestinal symptoms like nausea or vomiting in some people.

Kidney problems: In rare cases, Lisinopril can affect kidney function, especially in individuals with pre-existing kidney disease.

Hyperkalemia: Lisinopril can sometimes cause elevated levels of potassium in the blood, which can be dangerous.

Allergic reactions: Although rare, Lisinopril can cause allergic reactions such as swelling of the face, lips, tongue, or throat, which require immediate medical attention.

Is it managing your condition? Not sure according to the patient.

Is it improving your health? Not sure according to the patient because of the other medication taken.

Any side effects experienced? The patient suspects the medication is causing her to experience headaches, nausea, and tiredness. But, again not sure because of all the other medication she is taking.

Any drug interactions with other drugs taken? The patient was not sure what she should be looking for when it comes to drug interactions.

Interactions with food, alcohol, or other substances? The patient was not sure because he did not take the drug with anything except a small handful of nuts.

Medication 3: Metformin

Dosage: 1000mg

Frequency: Twice per day. First thing in the morning and before bedtime.

Reason prescribed: Diabetes Mellitus

How long have you been taking this medication? 1 year.

How it works: Metformin helps the body use sugar better and tells the liver to not make too much of it. This helps keep the sugar levels in the body balanced, like keeping the right amount of fuel in the car so it runs smoothly.

Potential Side Effects:

Gastrointestinal Issues: The most common side effects of Metformin affect the stomach and intestines. These can include nausea, vomiting, diarrhea, abdominal discomfort, and gas. Starting with a low dose and gradually increasing it can help reduce these symptoms.

Taste Changes: Some people may notice a metallic taste in their mouth when taking Metformin.

Decreased Appetite: Some individuals may experience a decreased appetite or loss of taste for food.

Vitamin B12 Deficiency: Long-term use of Metformin may lead to decreased absorption of vitamin B12, which could result in symptoms such as weakness, tiredness, or numbness and tingling in the hands and feet. Regular monitoring of vitamin B12 levels and supplementation, if necessary, can help prevent deficiency.

Lactic Acidosis (Rare): Although rare, lactic acidosis is a serious but potentially life-threatening side effect of Metformin. It occurs when there is a buildup of lactic acid in the bloodstream. Symptoms can include rapid breathing, muscle pain or cramping, weakness, dizziness, and abdominal discomfort. Lactic acidosis is more likely to occur in people with kidney or liver problems or those taking high doses of Metformin.

Hypoglycemia (Low Blood Sugar): While Metformin itself does not usually cause hypoglycemia, it can sometimes lead to low blood sugar when combined with other diabetes medications or if not taken with food

Is it managing your condition? The patient was not sure.

Is it improving your health? Not sure.

Any side effects experienced? The patient complained of sometimes having low blood sugar.

Any drug interactions with other drugs taken? The patient was not sure what she should be looking for when it comes to drug interactions.

Interactions with food, alcohol, or other substances? The patient does not believe so.

Medication 4: Insulin Glargine

Dosage: twenty units

Frequency: Once per day at bedtime

Reason prescribed: Diabetes Mellitus

How long have you been taking this medication? 1 year

How it works: Insulin glargine helps your body control blood sugar levels by slowly releasing insulin, letting glucose into cells for energy, storing extra glucose, and stopping the liver from making too much glucose. It is like a helpful tool that keeps your body’s fuel levels in balance, just like a good mechanic keeps a car running smoothly.

Potential Side Effects:

Hypoglycemia: This is the most common side effect of insulin therapy, including insulin glargine. Hypoglycemia, or low blood sugar, can cause symptoms such as shakiness, sweating, confusion, dizziness, hunger, and in severe cases, loss of consciousness. It is important to check blood sugar levels regularly and be aware of the signs of low blood sugar.

Injection site reactions: Some people may experience redness, swelling, or itching at the site of injection. These reactions are usually mild and go away on their own. Rotating injection sites can help minimize these reactions.

Weight gain: Insulin therapy, including insulin glargine, can sometimes lead to weight gain, especially if blood sugar levels are not well controlled. Monitoring your diet and staying active can help manage weight while using insulin.

Allergic reactions: Although rare, some people may be allergic to insulin glargine or the ingredients in the medication. Signs of an allergic reaction may include rash, itching, swelling, or difficulty breathing. Seek medical attention if you experience any signs of an allergic reaction.

Hypokalemia: In some cases, insulin therapy can cause low potassium levels in the blood, known as hypokalemia. Symptoms of hypokalemia may include weakness, muscle cramps, irregular heartbeat, and fatigue. Your healthcare provider may check your potassium levels regularly if you are using insulin.

Fluid retention: Insulin therapy may cause fluid retention, leading to swelling in the hands, feet, or ankles. If you notice sudden or severe swelling, contact your healthcare provider.

Lipodystrophy: Long-term use of insulin injections at the same site can sometimes cause changes in the fat tissue under the skin, resulting in either fat loss (lipoatrophy) or fat accumulation (lipohypertrophy) at the injection site. Rotating injection sites can help prevent these changes.

Is it managing your condition? The patient believes it is due to her sugar being controlled and her sugar level being out of range twice.

Is it improving your health? Not sure if her health is improving. Since taking this drug her body has been bloated and she may have to go on some type of water retention medication to help relieve the body of the extra fluids.

Any side effects experienced? The patient is unsure about what side effects this drug may be causing and is certain it is causing some.

Any drug interactions with other drugs taken? The patient was not sure what she should be looking for when it comes to drug interactions.

Interactions with food, alcohol, or other substances? The patient could not give any details being she takes this drug during her bedtime.

Medication 5: Atorvastatin

Dosage: 40 mg

Frequency: Once per day in the afternoon

Reason prescribed: Hyperlipidemia (High levels of fats in the blood)

How long have you been taking this medication? 1 year, 3.5 months

How it works: Atorvastatin is a medicine that helps your body manage cholesterol, which is like fat in your blood. Atorvastatin works by blocking a part of your body that makes cholesterol. So, it helps lower the bad cholesterol and raises the good one, which keeps your heart healthier and lowers the chance of heart problems.

Potential Side Effects:

Muscle pain or weakness: In rare cases, atorvastatin can cause muscle pain or weakness, which may be a sign of a more serious condition called rhabdomyolysis.

Liver problems: Atorvastatin can affect liver function, leading to elevated liver enzymes. This usually resolves once you stop taking the medication, but in rare cases, it can cause more severe liver damage.

Increased blood sugar levels: Some people may experience an increase in blood sugar levels while taking atorvastatin, particularly if they have diabetes or are at risk for developing it.

Memory problems or confusion: There have been reports of cognitive issues such as memory loss, confusion, or forgetfulness in some people taking statins like atorvastatin, although the link is not fully understood.

Allergic reactions: Rarely, atorvastatin can cause allergic reactions such as rash, itching, swelling, or difficulty breathing.

Is it managing your condition? She believes the medication is managing it but sure it is not curing it.

Is it improving your health? She does not think her health is improving because the medication does not cure it.

Any side effects experienced? Her liver levels have been a little high since she has been taking this medication.

Any drug interactions with other drugs taken? The patient was not sure what she should be looking for when it comes to drug interactions.

Interactions with food, alcohol, or other substances? The patient was not sure.

Medication 6: Ibuprofen

Dosage: 400 mg

Frequency: Twice per day in the afternoon and around 6 pm.

Reason prescribed: Osteoarthritis (arthritis)

How long have you been taking this medication? 2 years

How it works: Ibuprofen works by blocking enzymes that make chemicals in your body responsible for pain, inflammation, and fever. By doing this, it helps reduce these symptoms when you are sick or in pain.

Potential Side Effects:

Stomach irritation: It may lead to stomach pain, heartburn, or nausea.

Gastrointestinal bleeding and ulcers: Prolonged or high-dose use can increase the risk of stomach ulcers and bleeding.

Kidney problems: Ibuprofen can affect kidney function, especially in people with existing kidney issues.

Cardiovascular risks: Long-term or high-dose use may increase the risk of heart attacks and strokes, particularly in individuals with cardiovascular disease or those at risk.

Allergic reactions: Some people may experience allergic reactions such as rash, itching, or swelling.

Is it managing your condition? The medication is not helping her condition. She said the problem is getting worse.

Is it improving your health? She does not think her health is improving.

Any side effects experienced? She complained of no side effects

Any drug interactions with other drugs taken? The patient was not sure what she should be looking for when it comes to drug interactions.

Interactions with food, alcohol, or other substances? The patient was not sure. She does not watch what she eats when taking this medication.

Assessment of Patient Medication Regimen:

     I.         We first noted that Mrs. Stones is taking two medications for her hypertension and her diabetes. For her hypertension, she is taking Amlodipine 5mg and Lisinopril 20 mg both once per day. Her blood pressure normally runs at 129/80 but has reached 130/80 which is considered stage 1 hypertension. So, I asked if the doctor recommended that she try a lifestyle before prescribing her medication for this condition (change in eating habits, exercise, reduce alcohol/tobacco intake, and try to manage stress) and she said “No.”

So, I must ask myself, why would he recommend medication before trying another alternative such as a lifestyle change that usually works with the work of the patient? I know that sometimes blood pressure can be a problem when other illnesses come into play such as diabetes, but this is not the case.

Let us dive into the two medications. She is taking two medications for her hypertension that are doing a similar job and that is to lower her blood pressure. Now, there are reasons for both drugs to be prescribed to a patient with high blood pressure and that reason would be if an individual blood pressure consistently read as 140//90 mmHg. But as we know Mrs. Stone’s blood pressures run between 129/80 and 130/80 and do not need both medications. This is called overprescribing, and the patient is the one who suffers from this.

Patients taking these drugs together run the risk of renal function issues, an increase of potassium levels in the blood, weakness, and dizziness.

    II.         Mrs. Stones is taking Insulin Glargine and Metformin for her diabetes condition. The two drugs are used together to make the treatment more effective for the patient. Insulin glargine helps sugar get out of the blood into the body’s cells which helps keep the sugar level stable when eating. Metformin makes Insulin glargine work better by helping the absorb insulin properly into the body’s correct cells.

The only time both medications should be prescribed is when the Insulin Glargine is not working correctly in the body. Signs that the insulin glargine is not working are the patient experiencing spiked blood sugar levels, frequent urination, unquenchable thirst, blurred vision, and unexplained weight loss. This patient did not or has not had any of these symptoms with her metformin and is not sure why her doctor prescribed the drug. But now that she is taking this medication, she is having problems with fluid retention. This is another case of overprescribing a medication to a patient that is not needed.

Mrs. Stones is given a 1000 mg prescription for metformin taken twice per day. This is the highest mg to be given to a person and for people who become tolerant of a lower dosage, blood sugar stays high and shows signs of insulin sensitivity. This patient’s blood sugar stays in a good range between 80 to 130 mg/dL pre-eating and 180 post-eating, sugar is consistent throughout the day, and has experienced dizziness only a few times since taking insulin glargine and that has been a year ago.

  III.         Atorvastatin is the fifth drug Mrs. Stone is taking. She has been taking this medication for over 15 months to help control her cholesterol. That is the fat that gets stuck in the blood and needs help moving the fat through the blood properly. Her LDL runs between 157 mg/dL and 161 mg/dL and can put her at risk for cardiovascular disease and since high cholesterol runs in her family, I can see why she was given this drug.

In this case, the question for the doctor would be since her numbers are not high why would you have not recommended a lifestyle change first or given her 10 mg with a lifestyle change combined or 20 mg with a lifestyle change combined? Now that her liver levels have been a bit high and this started with the use of this drug, take her off the medication and try a lifestyle change or lower the dose.

 IV.         Mrs. Stones suffers from Osteoarthritis and takes Ibuprofen to help with the condition. Ibuprofen is used to help alleviate the pain and inflammation caused to the joints, but ibuprofen should be used for short periods and periodically. Prolonged or excessive use of ibuprofen can increase the risk of adverse effects such as gastrointestinal bleeding, kidney damage, and cardiovascular problems. And remember, the patient has a history of high cholesterol which affects the cardiovascular system.

Final Assessment:

I would recommend that Mrs. Stone schedule a consultation appointment with her doctor to get a clear understanding of her medication regimen. What she is taking, and why she is taking it.

1.    As for her hypertension medication, she needs to know why she is taking two different medications when her blood pressure does not run in an alarming range. She needs to ask for her blood pressure reading from the past 6 months to evaluate her pressure range and if her number is just borderline hypertension, I would recommend she ask her doctor to remove her from this medication and suggest a plan for a lifestyle change to control her blood level. If she is removed from the medication, I would recommend that she check her blood pressure twice per day, once in the morning and once at night, and most importantly, make a note of it for the next month. Follow up with her doctor after her evaluation and talked about the results.

Exercise 3 to 4 times per week, reduce her alcohol intake to once per week, eat low-sodium foods, fruits, and veggies, and drink garlic tea every day.

2.    With the two diabetic medications being used she can cut the metformin. Metformin is prescribed when the insulin medication does not dissolve in the system properly and does not keep the blood sugar regulated at a safe level. The patient said she had gone 30 days without taking the metformin and was solely using the insulin glargine and her blood sugar remained within a safe range and did not spike. Since she has had minimum side effects a few times this shows the insulin glargine is all she needs to control her diabetes.

It is recommended she speak to her doctor to remove the metformin for a while and continue to check her sugar, take notes, and revisit with your doctor after 30 days. It is important to understand that your blood level will spike with certain foods so if this happens, make sure you make note of what you ate during the spike and do not just suggest the medication may be needed.

3.    Atorvastatin is being taken for her cholesterol which is not that bad and considered a borderline condition and can be cured with a changed diet and exercise. If she insists on being on the medication, I will ask for the dosage to be dropped to the lowest dose and for the medication to be taken in the shortest amount of time. But, from her medical history, she does not need to be taking medication for her cholesterol. What these numbers show is that if she does not make the changes now, her cholesterol could become a real issue in the future that will require medication.

4.    Mrs. Stone uses Ibuprofen to help with the pain and inflammation due to her osteoporosis. This medication is not for use for an extended period and can cause serious stomach issues overall. Because she does not check how she feels when taking medications, for her everything is lumped together. It is strongly recommended she stop the consumption of this drug being she has been on it for 2 years and find a better solution to her problem. Ask the doctor about a diet high in calcium, a vitamin D regimen, or an omega-3 supplement.

Summary:

A person’s daily activities and life quality are affected by the adverse effects caused by the mixture of medication. Mrs. Stones’s symptoms of fatigue, confusion, and difficulty concentrating concern potential adverse drug reactions or drug interactions due to polypharmacy. The combination of multiple medications, especially those with central nervous system effects (e.g., lisinopril, atorvastatin), may be contributing to her symptoms. The two drugs that are being taken for her hypertension can increase the risk of low blood pressure when combined.

Additionally, there is a risk of drug-drug interactions between her antihypertensive medications (amlodipine and lisinopril) and his diabetes medications (metformin and insulin) causing the medication not to be as effective as it is supposed to be and leaving the condition untreated.

Furthermore, the regular use of ibuprofen for osteoarthritis pain management can worsen her hypertension and increase the risk of gastrointestinal bleeding.

Mrs. Stone needs to schedule an appointment with her healthcare provider to discuss her concerns and produce a solution that will allow her to reduce the effects she is having or may have in the future from taking those medications. A thorough medication needs to be conducted between Mrs. Stone and her healthcare providers to get her medication regimen perfected.

As the patient it is first your responsibility to become completely aware of your medical history and the medications you are consuming. You must do the research when it comes to your health and not leave 100% responsibility up to the doctor. Doing research gives you the power to say what should and should not happen to your body but if you do not know what is going on, it leaves your health in the hands of someone else. It is your health, your life, and your choice!

Disclaimer: Medication Report

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