Case Study

Patient X, a 75-year-old female, was admitted to the hospital with the chief complaints of tremors, inability to move both lower limbs for the past 3 days, and slurred speech, fever and loss of appetite. Her past medical history includes hypertension, Coronary artery disease, and Parkinsonism. The patient was ambulant until 3 days before admission. She reported being allergic to sulfa drugs 8 years ago, but no other known allergies.

Her past medication history includes T. amlodipine 5mg (1-0-0), T. Aspirin 75mg(0-1-0), and T. Syndopa (Levodopa and carbidopa) 110mg (1/2-1/2-1/2). Upon admission, the patient was conscious and oriented. Physical examination revealed an afebrile temperature, blood pressure of 130/80 mmHg, pulse of 100/min, and oxygen saturation of 99%. CVS and CNS were normal, except for B/L lower limb rigidity.

Lab investigations revealed a hemoglobin level of 13g/dl, platelet count of 2.06 lakhs/cumm,, bilirubin (T) of 0.3 mg/dl, bilirubin (DIR) of 0.1 mg/dl, SGPT of 7 U/L, SGOT of 12 U/L, alkaline phosphate of 68 U/L, albumin of 3.8 g/dl, and cholesterol of 234mg/dl. Urine analysis was normal. Electrolyte levels were within normal limits. Imaging studies were also normal.

The patient was diagnosed with hypertension, Coronary artery disease, and Parkinsonism with paraphasia. Treatment included IV fluids, Inj. Ceftriaxone 1g (BD) antibiotic, antiemetic agent Inj. Ondansetron 4mg (BD), and various medications for hypertension, Parkinsonism, and other symptoms. These medications included T. amlodipine 5mg (1-0-0), T. levodopa/carbidopa 110mg (1/2-1/2-1/2), T. trihexiphenyldyl 5mg (1/2-1/2-0), vitamin C 1tab, Syrup lactulose 2tsp (TDS), T. selegiline 5mg (0-0-1), T. enalapril 2.5mg (1-0-1), T. alprazolam 0.5mg (HS),  T. quetiapine 25mg (HS), T. aspirin 150mg (0-1-0), and T. atorvastatin 20mg (0-0-2).

Discussion

Upon review of the patient’s medication regimen using the 2019 American Geriatric Society Beers Criteria[4], several potentially inappropriate medications were identified. These include the use of amlodipine, a first-generation calcium channel blocker, which is not recommended in older adults due to an increased risk of falls. Additionally, the use of trihexiphenyldyl, a medication with anticholinergic properties, is not recommended in older adults due to the risk of cognitive impairment and confusion.

The patient was also prescribed multiple medications for hypertension management (amlodipine, enalapril, and atorvastatin), which may increase the risk of adverse effects and drug interactions. The use of alprazolam, a benzodiazepine, also carries a risk of fall and cognitive impairment in older adults. Furthermore, the patient was on polypharmacy, with 15 different medications prescribed during her 8-day hospital stay. This increases the risk of adverse effects and drug interactions.

Conclusion

In conclusion, this case report highlights the potential for inappr