Tuesday, November 22, 2011

How many medications can a patient take?

Here is a list of medications that a 75-year-old patient is taking at home. All are orally taken except where noted.

Acidophilus 2 twice a day
Colace 100 mg twice a day
Coumadin 5 mg once a day
Detrol 4 mg once a day
Diflucan 50 mg once a day
Duragesic 12 ug transdermal patch every 3 days
Klor-Con 10 meq once a day
Lactulose 30 mL twice a day
Lantus 15 units subcutaneously once a day
Lasix 40 mg alternating with 20 mg every other day
Lisinopril 2.5 mg once a day
Metoprolol 25 mg twice a day
Multivitamin 1 tab once a day
Novolog Sliding Scale subcutaneously with meals [dose varies according to blood sugar]
Oxycontin 20 mg every 12 hours
Prilosec 20 mg once a day
Reglan 5 mg before each meal
Vitamin A 25,000 units once a day
Zoloft 50 mg once a day
Docusate 100 mg twice a day as needed
Hyoscyamine 0.25 mg sublingual every 4 hours as needed
Oxycodone 5 mg every 8 hours as needed

That’s 22 different drugs with a minimum of 24 pills per day and a maximum of 35.

With the Lasix and the sliding scale Novolog, do you think she ever misses a dose or takes a wrong dose?

The above patient is on three narcotics Duragesic, Oxycontin and as needed oxycodone. Add to those meds Zoloft and Reglan. I wonder if she’s drowsy or confused? I bet it will be a big mystery when she falls and breaks her hip.

What effect do you suppose 10 meq of oral potassium per day is having on her total body potassium [total body contains some 3000 meq of potassium] or even serum potassium?

This is not close to the record. I once was consulted on a patient who was on 31 different medications at home. I’m sure that someone has seen a patient taking more than 31 medications. Have you?

12 comments:

Anonymous said...

Often.

(You forgot the 2L 02)

-SCRN

Solitary Diner said...

My personal record was 38. The patient got a cup of pills with every meal. I was quite pleased to be able to knock 10 of the meds off the list while she was admitted. As for the potassium supplement, the dose has no relationship to the total body potassium - it is simply whatever dose is required to maintain the patient's potassium at a normal level. It's quite common for patients on a low dose of diuretic to also require a low dose of potassium - often in the 10 mEq per day range.

Lastone2join said...

I've seen around 40 once. I asked his internist if they were all necessary, and he said yes. I didn't think so

It seems very common these days for patients to be on around 20 meds in my experience. Could this be attributed to patients wanting a pill for everything?

Another thought, too many cooks (physicians) in the kitchen? Each not appropriately reviewing patients meds to avoid duplicates? Physicians not really know how to prescribe certain meds doing so? Perfect example above. Oxycontin and Fentanyl?!?! The fentanyl dose is so small. There is still room for titration of the oxycontin.

Skeptical Scalpel said...

Solitary

Not sure lasix 40 & 20 is a low dose of a diuretic. Also, I still feel that 10 mew of K is a mighty small dose.

Last

I also wonder if their all necessary. Agree the narcotic situation is a mess. I believe OxyContin is not supposed to be given with other narcotics.

Anonymous said...

That none of the patient's caregivers caught on to colace and docusate are the same exact drug is kind of sad. Hyoscyamine and acidophillus are usually used for the runs and the multiple stool softeners can cause the runs, so someone isn't paying attention. Who needs daily diflucan? Even immunocompromised dont take daily diflucan. The insanity of this drug list is terrible. Just hope my tax dollars aren't paying for this cluster.

Skeptical Scalpel said...

Both Anons

Good comments. Thanks.

hotflash said...

Just saw a patient with "perianal wounds" (ie diaper rash from C. diff). Pt was on 5 different topical ointments, but without any direction as to where to put them. Obviously this was just a cumulative effect of various folks ordering meds and nobody discontinuing them. She was on triamcinolone, Santyl, miconazole powder, nystatin ointment, and metronidazole gel (don't ask me what for).

Skeptical Scalpel said...

Hot flash,

I appreciate the comments. I'm surprised the wound care nurse didn't put seaweed on her bum. Maybe the metronidazole gel was for C diff of the skin. :-)

Anonymous said...

What! No vitamin D, Calcium,? There should be a potion to prevent macular degeneration? This is why the clinical pharmacists send out multiple forms,which require an antidepressant on the part of the doc.

Skeptical Scalpel said...

Must be vitamin D in the multivits.

Jeffrey Gold MD said...

Surprised no atypical antipsychotic for dementia behaviors :)

Skeptical Scalpel said...

Yes, a glaring omission.

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