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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

     

     

    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?