68-year-old admitted dehydrated after gastroenteritis. Creatinine 180 (baseline 95).
Home medications below; which one must stop TODAY?
Medication Management
What Would You Stop?
One patient, one list, one decision. Sometimes a drug must go today; sometimes the whole list is earning its keep and the skill is saying so.
79-year-old with new urinary incontinence, started on oxybutynin last month.
Timeline: donepezil started 6 weeks ago → incontinence began → oxybutynin added.
74-year-old with HFrEF, stable, feels well. Family asks you to 'cut down the pills'.
All four. Which deserves stopping?
59-year-old, medication renewal. PPI started during an ICU stay three years ago for stress-ulcer prophylaxis; never reassessed.
No GI symptoms, no NSAIDs, no antiplatelets.
83-year-old, two 'funny turns' with sweating relieved by juice. HbA1c 6.4%.
Frail, lives alone, still driving short distances.
62-year-old post-discharge medication reconciliation. Feels 'foggy and slow' since coming home.
Compare the list for the classic reconciliation error.
An 82-year-old woman is admitted with fever, rigors and left loin pain.
Urine dip is positive; she was started three days ago on an oral antibiotic for 'a water infection'.
Her eGFR is 26 mL/min and has been for over a year.
A 22-year-old presents to the emergency department with a stiff, painfully arched neck and eyes deviated upward.
She was given an antiemetic four hours ago for migraine-associated vomiting.
She is fully alert, frightened, and has no fever or neck stiffness on passive flexion beyond the spasm.
A 71-year-old man with heart failure and an ejection fraction of 30 percent has gained 4 kg in ten days.
He is more breathless, has new ankle oedema, and his furosemide 'has stopped working'.
He started taking something for his back three weeks ago, bought at the pharmacy.
A 34-year-old with type 1 diabetes is admitted with vomiting from gastroenteritis and cannot keep food down.
She has taken no insulin since yesterday evening because she is not eating.
Capillary glucose is 16 mmol/L and ketones are elevated.
A 66-year-old is prescribed a seven-day antibiotic course for a chest infection.
Four days later he presents with severe diffuse muscle pain and dark urine.
Creatine kinase is markedly elevated and creatinine has risen from 90 to 180.
A 58-year-old with rheumatoid arthritis is admitted with mouth ulcers, a sore throat and a fever.
White cell count is 1.1, platelets 44, hemoglobin 88.
She was discharged from another hospital two weeks ago with a new prescription and has been taking it every morning since.
A 54-year-old man on long-term allopurinol presents with an acutely hot, swollen, exquisitely painful first metatarsophalangeal joint.
He has had gout for years and started allopurinol eight months ago with good urate control.
He asks whether he should stop the allopurinol until the attack settles.
A 79-year-old woman on treatment for heart failure is seen four days into an antibiotic course for a urinary infection.
She feels weak and her ECG shows peaked T waves.
Potassium is 6.4 and creatinine has risen from 110 to 148.