Case scenario - Medication Review
Case study 1 (Cardio-metabolic) – Conduct a medication review in this patient
Mrs Y is a 55 year old, Asian lady who lives in East London with her extended family. She attends the surgery for a medication review with her daughter-in-law, as her English is poor.
She has a past medical history of Type 2 Diabetes, Hypertension, Hyperlipidaemia, Transient Ischaemic Attack, Thyroidectomy, Osteoarthritis and Depression.
She has a strong family history of Coronary Heart Disease. Her mother had a heart attack in her 50s and her father had a stroke in his 60s. She is a non-smoker and does not drink alcohol.
She recently attended a family wedding in Bangladesh and admits to overindulging in sweetmeats. Her daughter-in-law mentions she has been getting some “funny episodes” after taking her Gliclazide and has been reluctant to take it in the last few weeks.
Obs: BP 144/83, Pulse 77, height 5ft 2”, weight 52Kg, BMI 21 Kg/m2
Repeat Medication list:
· Citalopram 20mg od
· Levothyroxine 75mcg 1 od
· Metformin 500mg 2 bd
· Gliclazide 80mg bd
· Co-dydramol 10/500 2 qds prn
· Atorvastatin 40mg on
· Ramipril 2.5mg od
· Amlodipine 5mg od
· Aspirin 75mg od
· Arthrotec 1 tds
· Lansoprazole 30mg od
· Laxido 1 sachet prn
Allergies: NKDA
Blood results (data interpretation) - see below
WEBINAR RECORDING DISCUSSING CASE WITH CLINICAL PHARMACIST (PLEASE WATCH AFTER WORKING ON THE CASE)
Step 1: (Aim) What matters to the patient
(Consider what is the patient’s agenda and is it the same as the doctor’s?)
Step 2: (Need) Identify essential drug therapy
Step 3: (Need) Does the patient take unnecessary drug therapy?
(Consider if diet and lifestyle changes can play a part in reducing drug therapy)
Step 4: (Effectiveness) Are therapeutic objectives being achieved?
(Consider HbA1c, Cholesterol, TFTs) (What changes would you make?)
Step 5: (Safety) Is the patient at risk of ADRs (Adverse Drug Reactions) or suffers actual ADRs?
(Consider possible cause of “funny episodes”)
Step 6: (Efficiency) Is drug therapy cost-effective?
Step 7: (Patient-Centred) Is the patient willing and able to take drug therapy as intended?
(What could be the barriers that would affect patient compliance)