Case Summary

Polypharmacy guidance: realistic prescribing
Scottish Government Effective Prescribing & Therapeutics Division
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Patient Details

58 year old woman

Current medical history

  • Diabetes Type 2 (diagnosed 5 years ago)
  • Coronary Heart Disease (non-STEMI 1 year ago)
  • Hypertension
  • Atrial Fibrillation
  • COPD
  • Chronic Back Pain
  • Depression (2 episodes)
  • Hypothyroidism

Results

  • HbA1C 86 mmol/mol (10%)
  • BP 150/85 mmHg
  • BMI 35 kg/m2
  • Spirometry shows mild obstruction
  • No urinary protein detected
  • eGFR 55 ml/min

Lifestyle

  • Smoking: 10 – 15 cigarettes a day
  • Alcohol: 20 units/week

Current Medication

  • Aspirin 75 mg once daily
  • Metformin 1 g three times daily
  • Gliclazide 80 mg twice daily
  • Pioglitazone 30 mg once daily
  • Salbutamol inhaler as required
  • Becotide inhaler 100 twice daily
  • Levothyroxine liquid once daily
    • 50 micrograms/5 ml
    • 25 micrograms/5 ml
  • Citalopram 20 mg once daily
  • Lisinopril 30 mg once daily
  • Amlodipine 10 mg once daily
  • Atenolol 50 mg once daily
  • Furosemide 40 mg once daily
  • Gabapentin 400 mg three times daily
  • Co-codamol 8/500 mg 2 tablets up to four times daily
  • Diclofenac 50 mg up to three times daily
  • Omeprazole 40 mg once daily
  • Bendroflumethiazide 2.5 mg once daily

 

Current Function

Receptionist in local garage. Works 6 half days per week. Provides support for elderly mother who lives alone and has early dementia. Lives with husband who is out of work long term. Two previous acute admissions to hospital. Flu-like illness leading to exacerbation of COPD two years ago. Chest pain 12 months ago - found to be in atrial fibrillation on admission and troponin positive. Angiogram showed widespread coronary artery disease but not severe enough to warrant revascularisation. Echocardiography showed normal left ventricular systolic function. On dual aspirin and clopidogrel for 1 year. Recently moved to aspirin monotherapy.

 

Most Recent Consultations

Ongoing ankle swelling. Back pain difficult to manage and resistant to several strategies. Occasional palpitations, and persistent indigestion with heartburn. Long-term financial worries. Increasing carer strain. Concerns dominated by the heart attack last year and fear of recurrence,  “I don’t know what my mother and husband would do if I got too ill to work or look after her.”