Case Report of an Interprofessional Intervention to Improve Quality of Life for a Fluid-Limited Patient
Abstract
:1. Introduction
2. Case Presentation
- Chronic lower back pain,
- Restless legs syndrome (RLS),
- Phantom limb pain,
- Irritable bowel syndrome,
- Diverticulitis,
- High blood pressure,
- Depression,
- Glaucoma in both eyes,
- Gastro-oesophageal reflux disease (GORD),
- Osteoporosis,
- Benign paroxysmal positional vertigo (BPPV), and
- Insomnia.
Pharmacist Intervention
- Refer to pelvic floor physiotherapist for assessment of incontinence and possible pelvic floor exercises
- Seek incontinence support (Continence Foundation of Australia) to institute CAPS (Continence Aids Payment Scheme) and provide incontinence garments
3. Outcome
4. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Symptom | Medication at Time of Hospitalisation |
---|---|
Constipation | Coloxyl 120 (stool softener); Macrogol (osmotic laxative); Bisacodyl (stimulant laxative) |
Targin (oxycodone/naloxone) (morning); Endone (oxycodone) (evening) | |
Insomnia | Clonazepam (benzodiazepine) |
Neuropathic pain | Lyrica (pregabalin) |
Hypertension | Irbesartan—angiotensin II receptor blocker |
Dry skin (prone to cracking) | Two different steroids (one cream, one ointment); 10% urea cream |
Chronic cough | Bromhexine—Mucolytic; Pholcodine-Opium alkaloids and derivatives |
Overactive bladder/Urinary incontinence | Oxybutynin (urinary antispasmodic); Mirabegron (urinary antispasmodic) |
RLS | Pramipexole (dopaminergic anti-Parkinson’s disease agent) |
Depression | Venlafaxine—selective serotonin and norepinephrine reuptake inhibitor |
Potassium oral supplement | |
GORD | Pantoprazole (proton pump inhibitor) at highest dose, twice a day |
Action/Suggestion | Rationale |
---|---|
Changed irbesartan to amlodipine | To deal with chronic cough |
Stopped two cough mixtures | Different modes of action which act at cross purposes |
Start a long-term clonazepam decreasing dose regimen to cessation | |
Cease potassium supplement | Pathology tests showed normal potassium levels |
Cease all medicines for constipation | |
Start regular Coloxyl and senna | Stool softener plus stimulant laxative |
Suggested oxybutynin be reviewed | Patient stated that it made her feel dizzy; recognised adverse effects of dry mouth, dry eyes quite challenging for a fluid-restricted patient |
Recommended cessation mirabegron | Most common adverse effects include hypertension, urinary tract infection, dry mouth and constipation |
Action/Suggestion | Rationale |
---|---|
Review and assess glaucoma (optometrist or ophthalmologist referral needed) | Rural location of patient means ophthalmologist referrals can take many months, so optometrist referral prioritised |
Use Systane Ultra for dry eyes | Management of dry eyes until ophthalmologist review |
Propose change from venlafaxine (depression) to duloxetine (depression and pain) | Manage two conditions with 1 medication, reduce number of medicines/doses |
Reduce pantoprazole to 20 mg at night and consider Gaviscon liquid for breakthrough heartburn | Use of PPI may contribute to increased risk of any fractures and she has osteoporosis. |
Consider small hot milk drink with dinner for sleep | |
Cease pramipexole and replace with levodopa/benserazide nocte only | Severity of RLS was lower during the time of falling asleep and during the night and satisfaction and disease burden was also higher |
Phantom limb pain—move pregabalin to bedtime | To lower falls risk |
Severe dry skin—Shower chair, use soap-free wash and also moisture shield after patting dry. Review two steroids that were being used regularly. Consider moving from moderate (triamcinolone) and potent (mometasone) to hydrocortisone and keeping stronger for flare-ups | |
BPPV—cease prochlorperazine, review with vestibular physiotherapist for procedure and exercises | Reduce severity or resolve condition |
Change pain management to oxycodone-with-naloxone-controlled-release (CR) tablets (Targin) lower strength in the morning and higher strength at bedtime |
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Cox, J.L.; Simpson, M.D. Case Report of an Interprofessional Intervention to Improve Quality of Life for a Fluid-Limited Patient. Pharmacy 2022, 10, 18. https://doi.org/10.3390/pharmacy10010018
Cox JL, Simpson MD. Case Report of an Interprofessional Intervention to Improve Quality of Life for a Fluid-Limited Patient. Pharmacy. 2022; 10(1):18. https://doi.org/10.3390/pharmacy10010018
Chicago/Turabian StyleCox, Jennifer L., and Maree Donna Simpson. 2022. "Case Report of an Interprofessional Intervention to Improve Quality of Life for a Fluid-Limited Patient" Pharmacy 10, no. 1: 18. https://doi.org/10.3390/pharmacy10010018