Table 1.

History of medication experience: The patient’s allergies and intolerances included penicillin (rash, fever, short of breath), levofloxacin (myalgias), venlafaxine (agitation), and citalopram, nefazodone, bupropion, and trazodone (headaches, light-headedness, dizziness, falls).

MEDICATION	REASON FOR USE (IF KNOWN)	KNOWLEDGE, EFFICACY, COMPLIANCE, GOALS, SAFETY ASSESSMENT	DURATION (IF KNOWN)
2.5 mg of ramipril daily	Hypertension	Patients’ BP measurements at GDH ranged from 116/64 to 156/70 mm Hg in first 3 weeks of admission (4 of 8 above target) Target BP < 140/90 mm Hg	Years
75 mg of clopidogrel once daily	Secondary prevention	3 CVAs in the past (March and May 2002 and June 2003)	Months
30 mg of domperidone 4 times daily	For IBS when symptoms are primarily constipation	Dose recently reduced from 40 mg 4 times daily	Years
250 mg of erythromycin 3 times daily as needed		Patient’s husband states erythromycin has made no difference in symptoms	Months
3 tbsp of lactulose 3–4 times daily as needed		Uses after 6–7 days of constipation for 2 days until diarrhea appears	Years
30 mL of psyllium laxative twice daily as needed		Uses after 6–7 days of constipation for 2 days until diarrhea appears	Years
50 mg of pinaverium 3 times daily	For IBS when symptoms are primarily diarrhea	Patient unsure if helping	Years
2 mg of loperamide every 6 hours as needed		Uses 5, 2-mg capsules over several hours when diarrhea appears until diarrhea stops	Years
5 mg of chlordiazepoxide with 2.5 mg of clidinium 2–3 times daily	IBS	Unsure if helping	Years
200 mg of amitriptyline every night at bedtime	Depression	History of severe depression; controlled now	Since 1994
Half-capsule of acetylsalicylic acid, butalbital, codeine, and caffeine as needed	Esophageal spasm	Patient states she gets no relief from it; patient states using once weekly, but refill records suggest 4 times weekly	Unknown
30 mg of lansoprazole daily	Heartburn	Still having nightly heartburn; uses 3 calcium carbonate antacid tablets each evening	2 years
Calcium carbonate antacid tablets as needed			Unknown
0.088 μg of levothyroxine each morning	Hypothyroidism	Thyroid-stimulating hormone level is 0.67 mU/L	Years
Codeine with acetaminophen as needed (average 2 per day)	Headaches	Relieves “tight band” headaches within 20–30 minutes but not “noise-light” headaches	Years
Acetaminophen with phenylephrine hydrochloride as needed	NA	NA	Years
10 mg of loratadine once daily	Environmental allergies	NA	Years
2 puffs of budesonide-formoterol inhaler twice daily	Asthma	Uses terbutaline every morning (husband states was prescribed because could not use salbutamol inhaler but now using both); hates taste	Years
2 puffs of terbutaline inhaler daily as needed			Years
2 puffs of 200-μg–dose salbutamol inhaler every 4 hours as needed		Uses salbutamol 4–5 times daily; has difficulty pressing canister down owing to thumb weakness	Years

BP—blood pressure, CVA—cerebrovascular accident, GDH—Bruyère Continuing Care Geriatric Day Hospital, IBS—irritable bowel syndrome, NA—not available.