-
Instruction – Please review this patient's drug chart and identify any errors, contraindicated therapies or obvious omissions.
Show Answer
Model answer:
Bendroflumethiazide 5mg is a large dose, which may cause increased side effects, but will not improve blood pressure control more than a 2.5mg dose.
Naproxen is an NSAID, which should be withheld following stroke due to an increased risk of bleeding and tendency to increase blood pressure.
Aspirin is a useful antiplatelet drug in preventing myocardial infarction and stroke. However, it may not be sufficient as a stroke has occurred despite treatment – consideration should be given to the best antiplatelet regime (or anticoagulation) for this patient.
The indication for proton pump inhibitors should be considered. These drugs are often overused for dyspeptic symptoms, and may not be needed long term. Stopping the NSAID, and changing the antiplatelet regime may change the risk of gastrointestinal haemorrhage, so careful consideration is needed.
Consider whether a laxative is needed as a long-term treatment option
Statins are useful in secondary prevention of stroke, and the addition of one should be considered in this patient.
Further drugs for blood pressure control may be required as secondary stroke prevention
