Questions 7 to 9: Care Homes Mrs VH is a resident in a care…
Questions 7 to 9: Care Homes Mrs VH is a resident in a care home. Her current medications and their indications are: Amlodipine 10mg one daily (Hypertension) Amitriptyline 25mg one at night (Neuropathic pain following shingles 18 months ago) Aspirin 75mg one daily (Previous MI) Atorvastatin 80mg one daily (Previous MI) Bisoprolol 5mg one daily (Previous MI) Lisinopril 10mg one daily (Previous MI, hypertension, CKD) Oxybutynin 5mg one twice daily (Urinary incontinence) Metformin 500mg one twice daily (Type 2 diabetes) The local CCG has requested that care home staff are educated by local pharmacists about the ‘sick day rules’ to reduce the risk of acute kidney injury (AKI). Below is an excerpt from the CCG’s guidance: As health professionals one of our key aims is to reduce the risk of avoidable harm to our patients. Some people are at increased risk of Acute Kidney Injury (AKI), for example those with Chronic Kidney Disease (CKD), heart failure, or those taking particular medications. Health care professionals should provide advice to such patients that certain drugs should be temporarily discontinued during acute intercurrent illnesses, particularly where there is disturbed fluid balance. This advice is commonly described as ‘sick day rules’ or to take a ‘drug holiday’. The definition of ‘acute illness’ in this context has to be simple enough to be understood by patients at risk. For example: ‘when you are unwell with any of the following; vomiting or diarrhoea (unless minor) fevers, sweats and shaking’ Is Mrs VH at risk of an AKI? How should the ‘sick day rules’ be applied to her? (4 marks)
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