CPPE MUR section 4--someone please help

[nicholass]

here is the scenario

60+year old man agreed to have a MUR.
Current medication:
bendroflumethiaizide 2.5mg tab od
atenolol 50mg tab od
ramipril 5mg cap od
simvastatin 40mg tab od

he felt lethargic, and put in down to the back pain (lumbago) he had. he takes OTC co-codamol effervescent for it.

upon questioning, he only takes his water tablet for blood pressure, bendroflumethiazide when not going out with friends.

he takes atenolol and ramipril in the morning for his blood pressure but ocassionally forget to take them.

he takes simvastatin in the morning to protect his heart and emphasizes it is important to remember taking this one.

he takes OTC co-codamol effervescent for lumbago, four to six tablets throughout the day and two at night.



I filled in the MUR form this way and I failed unfortunately..

bendroflumethiazide- compliance issue, recommend to take every day, for consideration by patient
atenolol 50mg-over use, recommend to reduce prescribed dose (i think this may cause lethargic), for consideration by GP
ramipril-compliance issue, recommend urgent BP check (as i think he isn't taking all three properly), for consideration by Patient and GP
simvastatin-no issue, recommend to take at night, for consideration by patient
OTC co-codamol-inappropiate formulation, advise to stop and suggest an alternative, for consideration by patient

(take as prescribed?, know indication?, formulation appropiate?, side effect?, comment)
bendroflumethiazide-no (take in morning when not going out), yes(water tablet for blood pressure),yes,no side effect, omit doses
atenolol-yes(take in morning),yes(blood pressure),no(lethargic?),side effect, inappropiate formulation
ramipril- yes(take in morning),yes(blood pressure),yes,no side effect, omit doses
simvastatin-yes(take in morning),yes(protect heart?),yes,no side effect,take at night
OTC co-codamol-yes(four-six daily and two at night),yes(lumbago),no,no side effect,inapproapiate formalation-high sodium content..


i don't know what went wrong..
hope can give some opinion. might try again in six days or try to attend one of the day course. any recommendation?

[bambalec]

well I haven't made it as far as section 4 yet; managed to bugger up section 3 this morning. Really wound up about it.

Looking at your answers, you seem to have recommended BP tests and dosage reductions. I read these types of recommendations aren't to be done on MUR's because we don't have access to patients notes so don't know the full clinical condition?

[nicholass]

so will there be no issue identified for those? this isn't easy to do

[bambalec]

how does the section work; does it give you a list of options on what to do?

[shan]

Going by my experience, it is the easiest section. Don't turn the video on, just read the trascript of the cosultation. take one question at a time and refer back to the transcript every time. Kepp the online BNF on. there is more than enough time. Use logic than trying to go by the books.

It may sound odd, but the CPPE is more trickier.

Shan

[nicholass]

yea, there are few options to choose from for each.

[shivpopat]

woohoo just passed part 4

[shan]

So now that you did it share it with others

Shan

[shivpopat]

ye, you know i found part 4 easy, long, but easy, the only bit i found hard was part 2

[nicholass]

mur cert on its way..really have to think in a simple direction...