Country : Australia
Assignment Task:

Task:

Mrs. Elaine is taking Aspirin 100 mg daily and she has no history of cardiovascular disease e.g. stroke, ischaemic heart disease, MI. Aspirin and other antiplatelet drugs are not routinely recommended for the primary prevention of cardiovascular disease (CVD), including in older people, people with diabetes or people at high absolute CVD risk. Meta-analysis reports no benefit of aspirin for primary stroke prevention. 1. Indication of Aspirin
2. Ask patient and GP any history of CVD/s
3. Any symptoms of abnormal bleeding, bruising or stomach ache that may be due to aspirin-induced ulcer bleeding Cease Aspirin if for primary prevention of CVD as Mrs. Elaine doesn’t has cardio? or cerebrovascular disease, the risk of major bleeding from aspirin generally outweighs any slight reduction in vascular events.
https://tgldcdp.tg.org.au/viewTopic?topicfile=cardiovascular-disease-risk-modification#toc_d1e378
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003154/https://amhonline.amh.net.au/chapters/blood-electrolytes/antiplatelet-drugs/other-antiplatelet-drugs/aspirin-antiplatelet?menu=hintsMrs. Elaine is taking Esomprazole 40 mg daily and she has no history of upper GI diseases. 1. Indication of Esomeprazole
2. Ask patient and GP any history of upper GI disease e.g. peptic ulcer disease (H.pylori), GORD, dyspepsia, Barrett's esophagus.
3. Any symptoms of upper GI diseases – well controlled or uncontrolled Cease Esomeprazole 40 mg if Mrs. Elaine doesn’t have history of upper GI diseases.
If she does have those conditions but the symptoms are well controlled. Consider reducing Esomeprazole 40 mg to 20 mg and take when required for trial.
Although PPIs are generally considered safe, there have been reports of serious adverse effects with both short-term use (e.g. interstitial nephritis) and long-term use (e.g. hypomagnesaemia, increased risk of pneumonia, Clostridium difficile and other gastrointestinal infections, impaired nutrient absorption, risk of fracture)
https://tgldcdp.tg.org.au/viewTopic?topicfile=disorders-oesophagus&guidelineName=Gastrointestinal#toc_d1e47https://amhonline.amh.net.au/chapters/gastrointestinal-drugs/drugs-dyspepsia-reflux-peptic-ulcers/proton-pump-inhibitors?menu=verticalMrs. Elaine is taking Donepezil 10 mg at night that may be indicated for her Alzheimer dementia. Her recent MMSE assessed last month was 10/30, it seems her cognitive impairment hasn’t been improved and her dementia is still severe.
Donepezil is an acetylcholinesterase inhibitor, it modestly improve or stabilise cognition, alertness and function in short term only. 
However, its significant adverse effects, which include prominent GI adverse effects (particularly nausea, vomiting), weight loss, vivid dreams, urinary incontinence, tremor, cramps, dizziness and drowsiness may lead to discontinuation when intolerant. 1. Ask if Mrs. Elaine has experienced any adverse effects of Donepezil e.g. GI adverse effects, weight loss, vivid dreams, urinary incontinence, tremor, dizziness and drowsiness since she started 2 yrs ago.
2. Did she have adverse effects with a low initiating dose of Donepezil.
3. Any improvement or stabilisation in her cognitive function.
4. Ask if evening dose of Donepezil causes insomnia or vivid dreams Consider stop treatment if Mrs. Elaine experiences significant adverse effects of Donepezil and doesn’t obtain stabilisation or improvement of her symptoms of Alzheimer dementia.
Donepezil is not recommended as Mrs. Elaine’s fall risk is high.
If Mrs. Elaine’s urinary incontinence is caused by Donepezil, treating it with Oxybutynin may likely lead to her confusion. As elderly people may be more sensitive to anticholinergic adverse effects such as blurred vision and confusion that results in high fall risk.

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