Prescription Analysis

The Prescription

The Prescription

Prescription Errors?
Generic names are specified on Rx Brand name is in parenthesis AFTER generic All ethical drugs no regulated/ prohibited drugs Legible NO PTR NUMBER Prescription is in NOT accordance with RA 6675 of 1988 and AO No. 62 s. 1989

Drugs Prescribed
Aspirin 80 mg tab OD #1 Atorvastatin 40 mg tab OD HS #1 Citicholine (Cholinerv) 500 mg tab 2 tabs BID # 4 Amlodipine 5 mg tab OD # 1

Aspirin 80 mg OD
Aspirin 80 mg once a day Brands Bayer Aspirin, Aspilets/ EC Category: Analgesic, anti-inflammatory, antiplatelet, antigout Indication to reduce platelet aggregation; cardioprotective MOA irreversible COX1 inhibition, lasting for life of platelet

Aspirin 80 mg OD
Adverse effects GI (nausea, vomiting, epigastric pain) LOW dose ASA increases plasma uric acid levels Bleeding

Pregnancy Category C

Aspirin 80 mg OD
Clinical Pharmacists Role Check the patients chart to ensure Ms. Lydia is not pregnant Check if patient chart for any ulcer problems Recommend to be taken with food to reduce GI irritation If GI irritation is a problem suggest enteric coated aspirin

Atorvastatin 40 mg tab OD HS
Atorvastatin 40 mg tab once a day at bedtime Brand Lipitor Category antihyperlipidemic Indication - for dyslipidemia, atherosclerotic vascular disease (primary and secondary prevention); acute coronary syndromes MOA HMG CoA reductase inhibitor

Atorvastatin 40 mg tab OD HS
Adverse Effects Rhabdomyolysis Hepatotoxicity GI disturbances (diarrhea, constipation, nausea, vomiting)

Pregnancy Category X

Atorvastatin 40 mg tab OD HS
Clinical Pharmacists Role Check the patients chart to ensure Ms. Lydia is not pregnant Monitor for any muscle pain, may be indicative of toxicity
CK MM Liver enzymes (AST, ALT)

Citicholine (Cholinerv) 500 mg 2 tabs bid

Citicholine (Cholinerv) 500 mg 2 tablets twice a day Brand Cholinerv Category Other CNS Drugs (MIMS) Indications
For ongoing disease of the blood vessels that serve the brain (chronic cerebrovascular disease): 600 mg of citicoline per day. For immediate treatment of stroke due to a clot (ischemic stroke): 500-2000 mg of citicoline per day starting within 24 hours of stroke.

Citicholine (Cholinerv) 500 mg 2 tabs bid

MOA - three mechanisms (1) repair of the neuronal membrane via increased synthesis of phosphatidylcholine (2) repair of damaged cholinergic neurons via potentiation of acetylcholine production (3) reduction of free fatty acid build-up at the site of stroke-induced nerve damage.

Citicholine (Cholinerv) 500 mg 2 tabs bid

Adverse Effects Hypotension, bradycardia Diarrhea, stomach pain

Pregnancy Category There is not enough evidence on Cholinerv's safety in pregnant and breastfeeding women. Cholinerv should be used in pregnancy and lactation only when benefits justify the potential risks.

Citicholine (Cholinerv) 500 mg 2 tabs bid

Clinical Pharmacists Role Advise patient to take with or w/o food Monitor patients response and vital signs

Amlodipine 5 mg tab OD
Amlodipine 5 mg tablet once a day Brand Amvasc, Norvasc Category Calcium Channel Blocker Indication For hypertension, angina

MOA inhibition of L-type Ca channel in smooth muscle and cardiac myocytes -> relaxation of muscles

Amlodipine 5 mg tab OD
Adverse Effects Hypotension, bradycardia Drug interactions grapefruit juice Pregnancy Category C

Amlodipine 5 mg tab OD
Clinical Pharmacists Role Monitor patients cardiac output

Medication Assessment
No

significant drug interactions Ensure patient does not drink GFJ Monitor patient response/ cardiac signs Monitor for muscle/ liver toxicities Patient probably is admitted for heart attack/ stroke based on medications prescribed

Suggested Medication Regimen

7

am (after breakfast)

Take aspirin 80 mg tablet Take 2 Cholinerv 500 mg tablets Take 1 amlodipine 5 mg tablet
7

pm (after dinner)

Take 2 Cholinerv 500 mg tablet Take 1 atorvastatin 40 mg tablet before bedtime

Thank You!