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    Furosemide
    Ramipril
    Seretide
    Bisoprolol
    Diclofenac
    Temazepam

    I was given this list at an interview for practice pharmacist. It was a repeat list for an elderly lady. No doses are given or any other information. Could anyone point out what they are possibly looking at?

    I am thinking -

    (1) patient prescribed diclofenac without gastroprotection *increased risk of bleeding with fluticasone
    (2) salbutamol inhaler - is this because patient's condition is well controlled?
    (3) temazepam - the risk of falling for elderly
    (4) renal function monitored?

    what do people think?

  • #2
    Ramipril : cough?
    Seretide : linked to above?
    Diclofenac and disoprolol : wheeze linked to above.
    Gastroprotection with diclofenac.
    Fluticasone : not really unless patient is not using inhaler correctly.

    As you mentioned : renal monitoring. (Furosemide/Ramipril/diclofenac)

    Temazepam : risk of falls.

    Overall : is the patient actually taking all these medicines?
    Reality can sometimes be different from the prescription!

    47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
    2018 AD : Modern Man : I shopped, I clicked, I collected.
    How times change.

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    • #3
      And the combination requiring renal monitoring would also, IIRC, be associated with the risk of falls. I'd query the Seretide too. If the cough is Ramipril induced, would any broncho dilators be indicated?

      Comment


      • #4
        You'd definitely need to see blood results before you could decide if it's all appropriate or not. We don't issue temazepam, especially in the elderly as it's longer acting then zopiclone. Mind you we don't issue many of them either. You'd need to know why the patient is taking it all, for example the bisoprolol is often used for AF but if that was the case there's no anticoagulation which is vital. Salbutamol inhalers aren't usually put on repeats at our surgery because people just get them routinely if we do and we can't keep an eye on how many they are using.

        I think they are just looking at what questions you'd ask about these drugs and how you'd go about investigating if they are appropriate or not. Without indications, bloods and doses there it isn't possible to say if it's all safe and appropriate or not. One obvious one is there's no PPI.
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        • #5
          Thank you everyone. It has been really helpful.

          I believe bisoprolol is also contraindicated with asthma and so is Temazepam due to risk of respiratory depression.

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          • #6
            Yes true beta blockers can effect asthma.
            Lively debate is encouraged but please respect the opinions and feelings of others.
            Please help keep the forum vibrant by spreading the work to friends and colleagues via word of mouth or social media.
            Thank you for contributing to this site.

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            • #7
              Wonder about date of last review and who/when the initial medication was started?
              This patient might just be one of those on repeat?
              47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
              2018 AD : Modern Man : I shopped, I clicked, I collected.
              How times change.

              If you find you have read something that has upset or offended you an anyway please unread it at once.

              Comment


              • #8
                Originally posted by sfshum View Post
                Thank you everyone. It has been really helpful.

                I believe bisoprolol is also contraindicated with asthma and so is Temazepam due to risk of respiratory depression.
                I think bisoprolol is cardio-selective so is one of the preferred beta blockers to be used if it is absolutely necessary that an asthmatic needs a beta blocker. Others like sotalol would be contraindicated.

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