Prescription Cascade in the Elderly
Mrs. L is a 79-year-old woman who visits her doctor due to persistent swelling in her ankles and joint pain. She has a history of hypertension and osteoporosis, for which she has been taking amlodipine for blood pressure control and alendronate for bone health.
A few months ago, she was prescribed ibuprofen for her joint pain. Soon after, she began experiencing stomach discomfort and heartburn, for which her doctor prescribed omeprazole, a proton pump inhibitor (PPI). After starting the omeprazole, Mrs. L developed persistent swelling in her ankles, leading her physician to prescribe furosemide, a diuretic, to reduce the fluid retention.
At her current visit, Mrs. L complains of increased fatigue and dizziness. Upon reviewing her medication history, it is evident that a prescription cascade occurred. The ibuprofen caused gastrointestinal issues, leading to the omeprazole prescription. The omeprazole may have worsened her amlodipine-induced swelling, prompting the furosemide, which is now contributing to her dizziness and fatigue.
Her doctor recognizes the need to simplify her medication regimen, discontinuing unnecessary prescriptions and addressing the root cause of her symptoms to prevent further complications.
A). Amlodipine
B). Alendronate
C). Ibuprofen
D). Furosemide
A). Furosemide
B). Omeprazole
C). Alendronate
D). Amlodipine
A). Heart failure
B). Omeprazole causing fluid retention
C). Amlodipine-induced side effect
D). Alendronate causing swelling
A). Increase the dose of furosemide
B). Discontinue ibuprofen and review her medication regimen
C). Add another medication to treat her dizziness
D). Prescribe a stronger diuretic
