Polypharmacy in the Elderly-When Good Drugs Lead to Bad Outcomes: A Teachable Moment.
نویسندگان
چکیده
Story From the Front Lines An83-year-oldwomanwith a history of atrial fibrillation and congestive heart failure was admitted to the hospital after presenting with lightheadedness and palpitations secondary to atrial fibrillation with rapid ventricular response. This was her third admission for atrial fibrillationwithuncontrolledheartrate inthepast6months.Pharmacy records indicated she had not refilled either of her prescribed nodal blockingagentsforseveralmonths.Shewasrestartedonherreported home dose of metoprolol succinate at 50 mg daily and diltiazem 180 mg daily with prompt normalization of heart rate. She was discharged the followingday. Twodaysafterreturninghome,thepatientpresentedtotheemergencydepartmentwithapresyncopalepisodecausedbybradycardia andhypotensionafteranunintentionalmetoprololoverdose.Shewas admittedtotheintensivecareunitandinitiatedonaglucagondrip.Her symptomsresolvedafter24hours,andshewastransferredtothefloor. Atdischarge, thepatientexpressedfrustrationwithherhomemedicationregimen,statingthatitwasconfusing,burdensome,andexpensive. Herpill regimenathomeincluded11medications:metoprolol,diltiazem, digoxin, apixaban, atorvastatin, lisinopril, furosemide, ibandronate, loratadine,ranitidine,andamultivitamin.Thepatientandherfamilydesired to simplify hermedication regimen, preferring to continue only thosethatwouldhelppreservefunctionandkeepthepatientoutofthe hospital. At dischargedigoxin andatorvastatinwerediscontinued.
منابع مشابه
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عنوان ژورنال:
- JAMA internal medicine
دوره 177 6 شماره
صفحات -
تاریخ انتشار 2017