Discussion Case

Mrs. P. is an 80-year-old woman recently discharged from a 24-hour observation stay at the hospital after being
diagnosed with acute bronchitis. She has a history of heart failure, hypertension, osteoarthritis, GERD, and
hyperlipidemia. She has no history of smoking. While in the hospital she was prescribed doxycycline,
prednisone 15 mg to taper, and a tiotropium inhaler. Her current list of daily medications prior to hospitalization
includes metoprolol succinate 12.5 mg, pantoprazole 40 mg, atorvastatin 10 mg, lisinopril 10 mg, furosemide
40 mg, potassium chloride 20 meq bid, acetaminophen 650 mg bid for pain and tramadol 25 mg as needed.
She lives alone but will reside temporarily with her daughter while she recovers. Her discharge report indicated
resolving bronchitis, no exacerbation of heart failure, and stable arthritic pain. Today she reports 1 week after
discharge with her daughter for a primary care appointment, and they both were concerned about the number
of medications she was prescribed and wanted her medications reviewed. In further review, she was found to
have lost weight over the past 6 months of 5 lbs and her current BMI is 25. She states that the weight loss may
be due to a change to a healthier diet and reducing sodium as instructed. She also reports no symptoms of
GERD for the past 6 months and minimal arthritic pain because of regular use of acetaminophen and daily
walking in the halls of her independent living facility. Upon examination her lungs are clear to auscultation and
no evidence of lower extremity edema.
Discuss the following:
1) In reviewing her medication list and current symptoms and clinical signs, which medication could the nurse
practitioner consider de-prescribing.
2) Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to
reduce given the patient’s reported symptoms.
3) Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet, what
other medication(s) adjustments could the nurse practitioner consider at this time.