Case Study

[cfsmon]

Female : 31-40
non-smoker
alcohol : 10unites per week
exercise: working everyday
weight: 12stone
height:5’6”

MH
levothyroxine 150mg 2years for underactive thyroid
sertraline 150mg 7years for depressive illness/anxiety
mebeverine 5years for IBS
SOLPADOL 5years prn for Pain
Lansoprazole 30mg om 6months for stomach ulcer
zopiclone 7.5mg once a week 8 years for sleeping

If doing a care plan on this patient, what we have to consider?
thanks for giving opinions

[Nik]

A number of things need to be considered here:
1) When does patient take levothyroxine ? Pref before breakfast, on an empty stomach.
2) Does the patient still need to be on SSRI's (sertraline) ? i,e assess mental status
3) Codeine can cause constipation, and she has been taking it for the same amount of time as mebeverine. So assess the need for opioid painkillers - will non-opioids eg paracetamol work just as well ?
4) Lansoprazole dose maybe a bit high - typical maintenance dose for stomach ulcers is 15mg daily. Patient has been taking 30mg for 6 months !
5) Assess need for zopiclone if only taking once a week - does patient still really need it ?

These are just basic points that i've seen but there's a lot more to consider, i.e lifestyle factors (alcohol), drug compliance, etc.

[kemzero]

SSRIs -with or after meals as recently been shown to cause GIT bleeding

lansoprazole, need to rule out barretts; oesophagus etc ( before suggesting a step down see NICE guidelines.
for improved outcomes, could suggest taking it an hour before breakfast with levothy

Shame about the solpadol

Zopiclone- need to discuss with prescriber and perhaps suggest the BNF recommendation.Altho' drug is also licensed for 2 or so weeks , prescribers don't seem to care!

[cfsmon]

Thanks for the opinions.
Patient also mentioned she took ibuprofen and heat pad occasstionaly for pain. But then suffered stomache after ibuprofen.
She should stop using ibuprofen.
Then what kind of pain it might be? Period pain ?

one more thing to bother all u you.. where can i find guidlines for mental access ? i have searched the NICE ..but cant see a proper guidline for that or i just missed.. thanks if anyone can point it out for me.

[Jeff]

Female : 31-40
non-smoker
alcohol : 10unites per week
exercise: working everyday
weight: 12stone
height:5’6”

MH
levothyroxine 150mg 2years for underactive thyroid
sertraline 150mg 7years for depressive illness/anxiety
mebeverine 5years for IBS
SOLPADOL 5years prn for Pain
Lansoprazole 30mg om 6months for stomach ulcer
zopiclone 7.5mg once a week 8 years for sleeping

If doing a care plan on this patient, what we have to consider?
thanks for giving opinions

Our thoughts are (mis)guided by our experience - as I help out on CodeineFree - Codeine free is a support group primarily for people with problems with codeine based OTC medicines. my first thought is to wonder how much Solpadol does she appear to be actually taking? (should be guessable from prescribing records).

Jeff

[AntPharm]

Thanks for the opinions.
Patient also mentioned she took ibuprofen and heat pad occasstionaly for pain. But then suffered stomache after ibuprofen.
She should stop using ibuprofen.
Then what kind of pain it might be? Period pain ?

one more thing to bother all u you.. where can i find guidlines for mental access ? i have searched the NICE ..but cant see a proper guidline for that or i just missed.. thanks if anyone can point it out for me.

NICE mental health guidance: CLICK HERE

Also worth looking at mental health guidance from local mental health trusts.

Regards