Table 1.
History of medication experience
| # | Drug | Reason for use (if known) | Knowledge, efficacy, compliance, goals and safety assessment | Duration (if known) |
|---|---|---|---|---|
| 1 | Ramipril 10 mg daily | Hypertension | BP at GDH initially ranging from 106/86-138/64 mmHg, most systolic <130 mmHg with occasional orthostatic hypotension | Unclear |
| 2 | Amlodipine 10 mg daily | Hypertension | Some left ankle swelling, recently on right as well | Unclear |
| 3 | Metoprolol 75 mg twice daily | Hypertension | FHT pharmacist states metoprolol was 25 mg twice daily prior to valve replacement, increased during hospitalization to 75 mg twice daily 2 years ago; no attempts to taper since; heart rate = 76 | Several years |
| 4 | Furosemide 40 mg daily | Unknown | Using for ankle swelling? | Unclear |
| 5 | ASA 81 mg daily | Stroke prophylaxis (following bioprosthetic aortic valve replacement) | No bruising or bleeding | 3 years |
| 6 | Rosuvastatin 10 mg daily | Hyperlipidemia | LDL = 1.2 mmol/L (last summer; info from FHT) | Many years |
| 7 | Metformin 500 mg, 2 tablets at breakfast, 1 at noon, 2 at supper | Diabetes | HbA1c = 7.9% (last summer; info from FHT) | About 9 years |
| 8 | Loperamide as needed | Diarrhea | One helps for 2 to 3 weeks, then diarrhea restarts | |
| 9 | Vitamin B12 1200 mcg daily | B12 deficiency | B12 = 879 pmol/L (last winter; info from FHT) | Unclear |
| 10 | Ferrous fumarate 300 mg daily | Ferritin deficiency | Ferritin = 65 mcg/L (last winter; info from FHT) | Unclear |
| 11 | Amitriptyline 10 mg 2 tablets at bedtime | Sleep? Depression? | Patient uncertain of reason; naps during the day, can fall asleep in the evening but has difficulty getting back to sleep if up during the night | A long time |
| 12 | Rabeprazole 20 mg daily | Heartburn | Patient stated had not had heartburn in a long time (seems to have started in hospital after valve replacement) | About 3 years ago |
Allergies/intolerances: sulfonamides, tetracyclines, quinolones, sulfamethoxazole/trimethoprim, glyburide. ASA, acetylsalicylic acid; BP, blood pressure; FHT, Family Health Team; GDH, Geriatric Day Hospital; HbA1c, glycosylated hemoglobin; LDL, low-density lipoprotein.