N503.46 Beer’s Criteria Activity: Review of Patient’s Medication Jayda Medication Indication/Diagnosis Classification Recommendations/ Considerations Prednisone 20 mg daily Decrease inflammation of lungs- bronchitis SAFE- steroid SAFE Metoprolol ER 50 mg daily Decrease BP, hypertension SAFE- Beta blocker SAFE Aspirin 325 mg daily 325 mg too high for prophylactic use. Pain NOT SAFE- NSAID GI bleeding/peptic ulcer in high risk patients Omeprazole 20 mg daily GERD SAFE- PPI SAFE Lisinopril 10 mg daily Hypertension SAFE- ACE inhibitor SAFE Furosemide 40 mg daily Hypertension SAFE- Loop diuretic SAFE KCL 20 mEq daily Electrolyte management SAFE- Electrolyte SAFE Safer Alternative/ Proposed Option Codeine, acetaminophen, short term NSAIDS Atorvastatin 20 mg daily Lower cholesterol SAFE- HMG-COA inhibitor SAFE Acetaminophen 650 mg twice daily Pain SAFE- Analgesic SAFE Tramadol 50 mg PRN Pain NOT SAFE- Opiate analgesic Lowers seizure threshold. Multivitamin Vitamin supplement SAFE- Vitamin SAFE Levoflaxacin 500mg daily Bronchitis SAFE- Antibiotic SAFE Duloxetine, venlafaxine, pregabalin, gabapentin N503.46 Beer’s Criteria Activity: Review of Patient’s Medication Medication Indication/Diagnosis Classification Recommendations/ Considerations MEGAN HTN bendroflumethiazide Diuretic Safe Safer Alternative/ Proposed Option lisinopril HTN ACE inhibitor Safe Simvastatin Lower cholesterol HMG-CoA reductase inhibitors Safe Rheumatoid arthritis Antimetabolites Safe Folate deficiency caused by methotrexate Supplement Safe Rheumatoid arthritis Non-opioid analgesic Safe Supplement Supplement Safe Rheumatoid arthritis NSAID Risk for bleeding Acetaminophen Sleep aid Sedative Safe but consider same parameters as eszopiclone Consider same parameters as eszopiclone UTI Antibiotic Safe methotrexate Folic acid paracetamol multivitamin ASA 81 mg Zopiclone trimethoprim N503.46 Beer’s Criteria Activity: Review of Patient’s Medication Medication Indication/Diagnosis Classification Recommendations/ Considerations Safer Alternative/ Proposed Option Brittany furosemide HTN, HF diuretic safe potassium Replacement due for wasting effects of furosemide electrolyte safe metoprolol Pulse control Beta blocker safe aspirin HTN, HF antiplatelet/ NSAID Use with caution, not enough evidence to support use in patients 80+/ Risk for Bleed Glaucoma, help with pressures in the eye Ophthalmic eye drops safe Timolol maleate No proposed alternative OTC pain reliever/ knee pain Non opioid analgesic safe supplement/maybe help with dietary deficiencies vitamin safe Calcium/vit D supplement/ bone health vitamin safe lisinopril HTN/ HF ACE inhibitor safe tramadol For orthopedic pain Opioid analgesic Concerns/ caution with patients with seizure disorders NSAIDS or non opioid analgesic Diclofenac topical Pain relief Topical NSAID Caution with use/ Risk for Bleed Already on Aspirin Tylenol PRN Multi Vit N503.46 Beer’s Criteria Activity: Review of Patient’s Medication Medication Josh F Indication/Diagnosis Drug Classifications Recommendations/ Considerations Safer Alternative/ Proposed Option Digoxin 0.25 mg daily Heart failure, a fib, paroxysmal atrial tachycardia Antiarrhythmics, inotropics Dose reduction, with monitoring15 Dose reduction with monitoring Triamterene 37.5 mg/HCTZ 25 mg, 2 capsules daily Edema associated with HF Diuretics (potassium sparing) Use potassium-sparing diuretics (e.g., amiloride, spironolactone) with caution (i.e., frequent potassium monitoring, low dose, slow titration) if CrCl <30 mL/min Frequent caution with potassium or use lasix instead Quinidine gluconate 324 mg three times daily A fib or flutter antiarrhythmics Rate control preferred for atrial fibrillation. Use this or digoxin to see if both needed Lisinopril 20 mg daily Hypertension, HF ACE inhibitor Renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy Lower dose with use of diuretic possibly Simvastatin 20 mg daily Lipid lowering agents HMG-COA reductase inhibitors Do not use with CYP3A4 inhibitors, hx of liver disease, alcoholism safe Triamcinolone inhaler 2 puffs three to four times daily Antiinflammatories for asthma or prophylactic therapy corticosteroids Diabetes, underlying immunosuppression, active untreated infections See if needed with bronchodilator or if one is only needed Formoterol inhaler one inhalation every 12 hours Asthma, COPD, bronchitis, emphysema Bronchodilators, adrenergics Hyperthyroidism, diabetes, cardiovascular disease See if needed with corticosteroid or if one is only needed Ticlopidine 250 mg twice daily Prevention of formation of clots Platelet aggregation inhibiotrs Safer alternatives available clopidogrel (Plavix), prasugrel (Effient)(post-ACS) (C), ticagrelor (Brilinta)(post-ACS)3 Chlordiazepoxide 10 mg three to four times daily Anxiety disorder benzodiazepine Change due to increase likely to falls Change to other coping mechanisms or use lower does possibly A multivitamin supplement vitamins Safe if not eaten enough safe Drugguide.com reference N503.46 Beer’s Criteria Activity: Review of Patient’s Medication HEATHER Medication Indication/Diagnosis Classification Recommendations/ Considerations Safer Alternative/ Proposed Option WARFARIN 5MG DAILY Prophylaxis and treatment of atrial fibrillation anticoagulants Safe None METOPROLOL 150MG BID Hypertension Beta Blocker - anti hypertensive Safe None Hypertension Anti hypertensive Calcium channel blocker Safe None Hypertension Anti hypertensive adrenergic Orthostatic hypotension, bradycardia, CNS adverse effects Med review by physician and pharmacy perhaps other HTN medications provide enough control. If a fourth is needed try: an ACE inhibitor, or ARB Hypertension Excess fluid lower leg edema. Anti-hypertensive, diuretic, thiazide Safe None Management of DM Type 2 Antidiabetic Biguanides Safe None SIMVASTATIN 40MG DAILY High LDL and Triglycerides Lipid lowering agent Medication may not be necessarily based on lab results. Review, possible discontinue GLYBURIDE 5MG DAILY Management of DM Type 2 Anti diabetic sulfonylureas Can cause prolonged hypoglycemia ​Glimepiride (Amaryl), 15 gliclazide (Canada)32 As needed for mild pain Non-opinion Analgesic Safe None ACETAMINOPHEN AMLODIPINE 0.1MG TID CLONIDINE 0.1 MG TID CHLORTHALIDONE 2MG DAILY METFORMIN 500 MG BID Laxative - stimulant. Stool softner Safe None SENNA As needed for mild constipation CELEXA 20MG DAILY depression Antidepressant - SSRI Safe None Reference: https://www.drugguide.com N503.46 Beer’s Criteria Activity: Review of Patient’s Medication Medication Indication/Diagnosis Classification Recommendations/ Considerations Safer Alternative/ Proposed Option Metformin 1000 2x daily Type 2 diabetes SAFE - Biguanides none none Metoprolol 50mg 2x dailiy Heart failure SAFE beta blocker none none Lisinopril 40 mg daily HTN, HF SAFE ace inhibitor none none Furosemide 20mg 2x daily Edam associated with congestive heart failure SAFE diuretic none none High cholesterol SAFEHMG-Co A reductase inhibitor none none Simvastatin 40 mg 2x daily Insomnia Anticholinergic Alternative tricyclics: nortriptyline (Aventyl, etc), desipramine, low-dose doxepin, trazodone She is also already on sominex None Duloxetine 20mg daily Depression Safe none none Clonazepam 0.5 mg 2x daily Neuropathy in feet safe noen none Gabapentin 600 mg 3x daily Neuropathy in feet safe none none Ranitidine 150 mg 2x daily Gerd safe none none Timolol 0.5% 1 drop Glaucoma safe None Marijuana none OTC diphenydramine 25 mg Insomnia Safe None None Amitriptyline 25 mg at bedtime