Summary: Key Concepts in this Case

Polypharmacy guidance: realistic prescribing
Scottish Government Effective Prescribing & Therapeutics Division
Polypharmacy icon of two pills
  1. Low number of conditions and medications but still high potential for drug related illness and need to reduce dose of some medicines
  2. Identify the main condition causing the main symptom (shortness of breath)
  3. Significant number of probable actual adverse drug reactions
  4. Number of drug to drug interactions
  5. Review of medicines needed for those for symptomatic relief for heart failure will need regular follow up for side effects and monitoring (respiratory rate, BP, pulse, U+E), especially with dose (up) titration
  6. Additional medication (ACEI) will increase risk of acute kidney injury with dehydrating illness
  7. Over sedation at night is a major risk to quality of life, morbidity (falls) and mortality