Table 4 Details of patients with discrepancies in medication continuity
Patient No | Diagnosis for hospitalization | Categories | Medicinal efficacy classification | Definitiona | Details | Extra Information |
|---|---|---|---|---|---|---|
1 | Cerebral infarction | Addition of drugs | Other agents relating to blood and body fluids (antiplatelet drugs) | 1 | Aspirin was added to cilostazol | ・Be prescribed single antiplatelet drug for having cerebral microbleeds |
Dosage (same drugs) | Vasodilators | 4 | The dose of amlodipine was increased from 2.5 mg to 5 mg | |||
Dosage (same drugs) | Agents for peptic ulcer | 4 | The dose of lansoprazole was increased from 15 to 30 mg | ・Prescribing PPI to prevent aspirin-induced peptic ulcers | ||
2 | Cerebral infarction | Drug discontinuation | Antihypertensives | 4 | Doxazosin 1 mg, which was added during hospitalization, was discontinued | |
3 | Cerebral infarction | Dosage (same drugs) | Agents for hyperlipidemia (HMG-CoA reductase inhibitors (statins)) | 1 | The dose of pitavastatin was reduced from 2 to 1 mg pitavastatin | |
4 | Cerebral infarction | Drug discontinuation | Other agents relating to blood and body fluids (antiplatelet drugs) | 1 | Clopidogrel was not prescribed. The community pharmacist made prescription inquiry to the physicians the cases but non approved by the physicians | |
Drug discontinuation | Agents for hyperlipidemia (HMG-CoA reductase inhibitors (statins)) | 1 | Rosuvastatin was not prescribed | |||
Dosage (same drugs) | Agents for peptic ulcer | 4 | The dose of rabeprazole has been reduced from 20 to 10 mg | ・Considering the symptoms that suggest a recurrence of peptic ulcer, the PPI dose was increased | ||
5 | Transient ischemic attack | Addition of drugs | Other agents affecting digestive organs (antiemetic agent that acts on the central nervous system) | 3 | Discontinued metoclopramide has been resumed | |
6 | Cerebral infarction | Dosage (same drugs) | Other agents relating to blood and body fluids (antiplatelet drugs) | 1 | The dose of clopidogrel has been reduced from 75 to 50 mg (the remaining drug was taken as prescribed before admission) | |
Addition of drugs | Vasodilators | 4 | 2.5 mg of amlodipine was added | ・She Visited her home doctor on the day of discharge | ||
7 | Cerebral infarction | Drug discontinuation | Other agents relating to blood and body fluids (antiplatelet drugs) | 1 | Aspirin was not prescribed. The community pharmacist made prescription inquiry to the physicians the cases but non approved by the physicians | ・Taking 14 medications before admission and this number increased owing to recurrent stroke ・The interrupted Aspirin was resumed at the second follow-up visit |
Dosage (same drugs) | Agents for hyperlipidemia (HMG-CoA reductase inhibitors (statins)) | 1 | Pravastatin has been reduced from 15 to 5 mg. The community pharmacist made prescription inquiry to the physicians the cases but non approved by the physicians |