As part of your role with the hospital you have been asked to undertake a medication review for a recently admitted patient Mr JD within the Hospital.



Upon checking his records you find out the following information



Age 85 years



Weight 73kg



Height 160cm.



His Medical History indicates that he suffers from Hypertension, Type 2 Diabetes, Gout, Osteoarthritis, GORD and COPD



His charted medications are listed below





Allopurinol 300mg

1 at 0800


Amlodipine 10mg

1 at 0800


Digoxin 250mcg

1 at 0800


Glicazide SR 30mg

1 at 0800


Esomeprazole 20mg

1 at 0800


Paracetamol 665mg

2 tablets 0800, 1400 and 2100


Salbuatamol 100mcg MDI

1-2 prn





Allergies were noted be for Metformin and Mr JD was noted to have suffered from developed itchy skin rashes upon prescribing of this medication



He is a non smoker



His Pathology results indicated that his serum creatinine was 114 micromol/L



His liver function tests and serum creatinine levels were indicated to be within the normal range



His last record BP that morning was 150/85


As part of of your role to speak to Mr JD’s wife to check and confirm the charted medications and you are told the following information inregards to his medication



Current medication



Allopurinol 300mg 1 mane for Pain in feet



Amlodipine 10mg 1 mane for blood pressure



Digoxin 250mcg 1 mane for the heart



Enalapril 10mg 1 mane for blood pressure



Gliclazide SR 30mg 1 mane for diabetes



Omeprazole 20mg 1 mane for indigestion



Paracetamol 500mg 1-2 prn for pain



Arthri-Relief 1500mg 1 daily prn for pain



Salbutamol 100mcg/dose MDI prn for breathing


Based on the information that you have discovered identify potential and actual medication related issues and suggest how these could be aIDressed or monitored?