Polypharmacy

Student’s Name
Course
Instructor’s Name
Date
Polypharmacy
The medications of Mr. Z are ranked from the least inappropriate to the most inappropriate as follows: Valsartan 160mg PO daily, Atenolol 50mg PO daily, Simvastatin 20mg PO QHS, Celecoxib 200mg PO daily, Benazepril 20mg PO daily, Aspirin 81mg PO daily, Citalopram 40mg PO daily, Morphine 1mg IV q2h, Cyclobenzaprine 5mg PO Daily, Diphenylhydramine 25mg Po, Pregabalin 75mg PO, Duloxetine 20mg PO and Amitriptyline 10 mg Po QHS.
Drug-drug interactions are common in the elderly and due to the reason polypharmacy is discouraged (Waller and Maclean, 2003). Mr. Z is likely to suffer from renal failure due to a combination of Aspirin and Benazepril. Aspirin is an NSAID while Benazepril is classified as an ACE inhibitor and their synergy causes renal failure. Amitriptyline is a tricyclic antidepressant known to interact with drugs such as diphenhydramine and duloxetine causing adverse effects. A combination of the drugs leads to respiratory depression. Thus they are likely to worsen Mr. Z’s condition. A combination of drugs acting on the CNS and analgesics or antidepressants causes adverse effects such as confusion, sedation, and falls. The patient is on Amitriptyline, Morphine, and Aspirin. The above drug combinations are the probable causes of the confusion and history of falls observed in the patient.
The patient is diagnosed with right-sided CVA, and the usage of TCAs such as Amitriptyline causes adverse effects of orthostatic hypotension and dizziness.

The patient has a history of congestive cardiac failure also making the TCAs one of the drugs to avoid. The confusion and falls observed could be a result of muscle relaxants usage. Cyclobenzaprine should be avoided in the patient. Amitriptyline also causes impaired psychomotor function and accelerates additional falls observed. Diphenhydramine drug is avoided in patients with confusion because it has a high anticholinergic activity. The drug causes sedation and confusion thus should be avoided in the elderly.
Works Cited
Waller and Maclean, “Updating the Beers criteria for potentially inappropriate medication use in older adults.” Arch Intern Med, 163, 2003, pp. 2716-2724. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.579.227&rep=rep1&type=pdf