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hospital pharmacy

    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





    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?