Posted: March 24th, 2015

hospital pharmacy

hospital pharmacy

Order Description

As part of your role with the hospital you have been asked to undertake a medication review for a recently admitted patient Mr JD within the Hospital.

Upon checking his records you find out the following information

Age 85 years

Weight 73kg

Height 160cm.

His Medical History indicates that he suffers from Hypertension, Type 2 Diabetes, Gout, Osteoarthritis, GORD and COPD

His charted medications are listed below

Medication
Dose
Allopurinol 300mg
1 at 0800

Amlodipine 10mg
1 at 0800

Digoxin 250mcg
1 at 0800

Glicazide SR 30mg
1 at 0800

Esomeprazole 20mg
1 at 0800

Paracetamol 665mg
2 tablets 0800, 1400 and 2100

Salbuatamol 100mcg MDI
1-2 prn

Allergies were noted be for Metformin and Mr JD was noted to have suffered from developed itchy skin rashes upon prescribing of this medication

He is a non smoker

His Pathology results indicated that his serum creatinine was 114 micromol/L

His liver function tests and serum creatinine levels were indicated to be within the normal range

His last record BP that morning was 150/85

As part of of your role to speak to Mr JD’s wife to check and confirm the charted medications and you are told the following information inregards to his medication

Current medication

Allopurinol 300mg 1 mane for Pain in feet

Amlodipine 10mg 1 mane for blood pressure

Digoxin 250mcg 1 mane for the heart

Enalapril 10mg 1 mane for blood pressure

Gliclazide SR 30mg 1 mane for diabetes

Omeprazole 20mg 1 mane for indigestion

Paracetamol 500mg 1-2 prn for pain

Arthri-Relief 1500mg 1 daily prn for pain

Salbutamol 100mcg/dose MDI prn for breathing

Based on the information that you have discovered identify potential and actual medication related issues and suggest how these could be addressed or monitored?

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