The Art of Safe and Judicious Deprescribing in an Elderly Patient: A Case Report
Abstract
:1. Introduction
2. Case Presentation
- Could the difficulty in planning and attention, as well as concentration deficits be explained by this kind of treatment?
- Could the dramatic improvement recorded in our patient be due to changes in the therapeutic regimen?
3. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Treatment | Name and Dosage | Indication |
---|---|---|
Apixaban | Eliquis 5 mg bid | Atrial fibrillation |
Bisoprolol | Cardicor1.25 mg twice a day | Atrial fibrillation |
Repaglinide | Novonorm 0.5 mg bid | Diabetes |
Atorvastatin | Torvast 20 mg once a day | Hypercholesterolemia |
Tiotropium bromide | Spiriva 18 μgrams 1 puff once a day | Chronic obstructive pulmonary disease |
Ramipril/hydrochlorothiazide | Triatec HCT 5/25 mg once a day | Blood Hypertension |
Chlorpromazine | Largactil 25 mg bedtime | Psychosis |
Risperidone | Risperdal 1 mg bedtime | Psychosis |
Levodopa/Carbidopa | Sinemet 100/25 mg once a day | Parkinsonism |
N-demethyl-diazepam | En ten drops at bedtime | Anxiety |
Pantoprazole | Pantopan 20 mg | Gastric protection |
Admission | 3 Months | 6 Months | Normal Values | |
---|---|---|---|---|
Blood Glucose | 124 | 122 | 123 | 74–106 mg/dL |
Glycated hemoglobin HbA1c | 6.5 | 6.5 | 6.4 | 5.7–6.4% |
Blood cholesterol | 220 | 210 | 210 | 70–200 mg/dL |
Cholesterol-HDL | 45 | 44 | 44 | 35–39 mg/dL |
Cholesterol-LDL | 145 | 128 | 125 | <130 mg/dL |
Triglycerides | 125 | 124 | - | 50–150 mg/dL |
Aspartate amino transferase | 32 | - | - | 5–50 IU/L |
Alanine amino transferase | 31 | - | - | 5–50 IU/L |
Creatinine | 92 | - | - | 0.7–1.2 mg/dL |
White blood cells | 7,850 | - | - | 4500–11,000 cells per µL |
Red Cells | 3.4 | - | - | 4.2–5.9 × 106 cells/mcL |
Folate | 9 | - | - | 2.5–20 ng/mL |
Vitamin B12 | 420 | - | - | 200–800 pg/mL |
Homocysteine | 11 | - | - | <20 ng/mL |
TSH | 2.6 | - | - | 0.15–3.5 mU/L |
FT3 | 4.5 | - | - | 3.0–8.0 pmol/L |
FT4 | 1.2 | - | - | 0.9–2.4 ng/dL |
C-reactive protein | 8 | - | - | 0.5–10 mg/L |
Vitamin D | 12 | 25 | 30 | 30–60 ng/mL |
Sodium | 140 | - | - | 135–145 mM/L |
Potassium | 4.2 | - | - | 3.6–5.1 mM/L |
Mini-Mental State Examination (MMSE) | Admission | 3 Months | 6 Months | Comments |
---|---|---|---|---|
Orientation to time | 2/5 | 4/5 | 4/5 | Improved at follow-up vs. admission |
Orientation to place | 4/5 | 4/5 | 4/5 | |
Registration | 3/3 | 3/3 | 3/3 | |
Attention and calculation | 1/5 | 2/5 | 2/5 | Improved at follow-up vs. admission |
Recall | 2/3 | 2/3 | 2/3 | |
Language | 3/3 | 3/3 | 3/3 | |
Praxis | 5/6 | 6/6 | 6/6 | Improved at follow-up vs. admission |
MMSE total score | 20.4/30 | 24.4/30 | 24.4/30 | Normal value 26/30 |
MoCA (Montreal Cognitive Assessment) | ||||
Visuospatial abilities | 3/5 | |||
Naming | 3/3 | |||
Short-term memory recall | 3/5 | |||
Attention | 3/6 | |||
Language | 2/3 | |||
Abstract thinking | 2/2 | |||
Delayed recall | 0/5 | |||
Orientation to time and place | 3/6 | |||
MoCA total score | 19/30 | Normal value 26/30 | ||
Clock Drawing Test (CDT) | 6/10 | |||
Rey words | 21 | cut-off 28.53 | ||
Stroop Test | ||||
Time | 43 | cut-off < 36.9 s | ||
Mistakes | 2 | cut-off < 4.2 | ||
TMT-A (Trail Making Test) | normal range | |||
TMT-B | Unable | |||
NPI scale (Neuropsychiatric Inventory Scale) | 27/144 episodes of anxiety; occasional visual hallucinations | |||
GDS-15 items (Geriatric Depression Scale) | 8/15 points | cut-off ≥ 5 depressed mood | ||
Cumulative Insight Rating Scale (CIRS) | 0/8 | |||
Activities of Daily Living (ADL) | 2/6 | 3/6 | Improved at follow-up vs. admission | |
Instrumental Activities of Daily Living (IADL) | 1/5 | 2/5 | Improved at follow-up vs. admission |
• Digitalis (dosage/day > 0.125 mg/day) |
• Plasma long half-life BDZ (diazepam, N-demethyl-diazepam, chlordiazepoxide) |
• Tricyclic Antidepressants (amitriptyline, imipramine, chlorimipramine) |
• Phenotiazines with piperidine structure (thioridazine, chlorpromazine) |
• Butyrophenones (haloperidol) |
• Atypical AP (clozapine, risperidone, olanzapine, quetiapine, aripiprazole) |
• Semisynthetic belladonna alkaloids, quaternary ammonium compounds (butylscopolamine) |
• Systemic antihistamine drugs (promethazine, diphenydramine) |
• MethylDopa, Nifedipine, Disopyramide |
• Adrenergic alpha1-blockers (doxazosin, terazosin) |
• Presynaptic alpha2-agonists (clonidine) |
• Laxatives (sodium picosulfate, bisacodyl) |
• Antidiarrhea (loperamide) |
• Prokinetics (metoclopramide) |
• Class III antiarrythmics (amiodarone) |
• NSAIDs (aspirin, indomethacin, naproxen, oxicams) |
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Gareri, P.; Gallelli, L.; Cotroneo, A.M.; Manfredi, V.G.L.; De Sarro, G. The Art of Safe and Judicious Deprescribing in an Elderly Patient: A Case Report. Geriatrics 2020, 5, 57. https://doi.org/10.3390/geriatrics5030057
Gareri P, Gallelli L, Cotroneo AM, Manfredi VGL, De Sarro G. The Art of Safe and Judicious Deprescribing in an Elderly Patient: A Case Report. Geriatrics. 2020; 5(3):57. https://doi.org/10.3390/geriatrics5030057
Chicago/Turabian StyleGareri, Pietro, Luca Gallelli, Antonino Maria Cotroneo, Valeria Graziella Laura Manfredi, and Giovambattista De Sarro. 2020. "The Art of Safe and Judicious Deprescribing in an Elderly Patient: A Case Report" Geriatrics 5, no. 3: 57. https://doi.org/10.3390/geriatrics5030057
APA StyleGareri, P., Gallelli, L., Cotroneo, A. M., Manfredi, V. G. L., & De Sarro, G. (2020). The Art of Safe and Judicious Deprescribing in an Elderly Patient: A Case Report. Geriatrics, 5(3), 57. https://doi.org/10.3390/geriatrics5030057