Question

CASE STUDY with QUESTIONS…

Mr. Smith is an 84-year-old Caucasian male who lives in an apartment

that adjoins his son’s house. Mr. Smith is accompanied to this

clinic visit by his son, who assists with the history. Although

previously outgoing and social, Mr. Smith recently has been

limiting his outside activities.

History

Mr. Smith stated that for the past year he has felt dizzy when he stands up

after sitting or lying down and that he often needs to “catch himself” on

furniture or walls shortly after standing. His dizziness is intermittent but

happens several times per week.

Mr. Smith cannot identify any recent changes in his medications or other

changes to his routine that would explain his symptom. He says there is

no pattern and he experience dizziness at different times during the day

and evening. He denies experiencing syncope, dyspnea, vertigo, or pain

accompanying his dizziness.

Medications

1. Valsartan 80 mg daily
2. Citalopram 40 mg daily
3. Flomax 0.8 mg at bedtime
4. Finasteride 5 mg daily
5. Lipitor 40 mg at bedtime
6. Omeprazole 20 mg daily
7. Cyanocobalamin 1 mg daily
8. Claritin 10 mg daily
9. Flonase nasal spray two puffs to each nostril daily
10. Gabapentin 300 mg tabs 2 tabs three times daily
11. Tylenol 500 mg one to two four times daily prn
12. Brimonidine tartrate 0.15% ophth 1 drop OU twice daily
13. Cosopt 2%-0.5% 1 drop OU at hs
14. Latanoprost 0.005% 2 drops OU at hs
15. Lorazepam 0.25 mg at hs
16. Calcium carbonate 500 mg 1-2 tabs three times daily
17. Tylenol PM at bedtime daily prn
18. Cyclobenzaprine 5mg three times a day prn
19. Advil OTC 400mg three times a day prn

1. Based on the BEERs criteria https://qioprogram.org/sites/default/files/2019BeersCriteria_JAGS.pdf (Links to an external site.) and other resources what medications are you concerned about Mr. Smith taking?

2. List the top 3 medications you would like to see Mr. Smith stop taking.

3. Which medications could be contributing to his feelings of dizziness?

4. List the medications that Mr. Smith is taking that are included on the above list: “Ten Medications Older Adults Should Avoid or Use with Caution” and list the medication class

Answer 1

1) The top three medications that are of concern to use in older individuals (Mr. Smith) and should stop taking further include the following,

• Citalopram
• Lorazepam
• Cyclobenzaprine

2) The medications that could cause dizziness in this case include cyclobenzaprine

3) The medications that are included in ten medications that older individuals should avoid but included in Mr. Smith's medications include the following,

• Citalopram
• Cyclobenzaprine
• Lorazepam
• Tylenol
• Advil