Case Studies

• 80 year old male presented to the hospital after a fall
• Hypotensive (SBP <80)
• AKI with SCr 2x baseline and metabolic acidosis
• Patient had been admitted to the hospital 1 month prior
• Medications were adjusted during admission for hypotension and ramipril was discontinued
• After discharge, ramipril was unintendedly restarted due to lack of communication with the community pharmacist

OUTCOME:

• Ramipril was discontinued
• Renal function improved with rehydration
• Ramipril ADR documented in ActionADE to prevent a re-exposure

• 86 year old female presented to the hospital with confusion
• Bradycardic (HR 46) and hypotensive
• ED physician documented plan to stop metoprolol
• 2 days later, patient returned to hospital with UTI symptoms
• Patient was bradycardic
• Patient was still taking metoprolol from her blister pack

OUTCOME:

• Metoprolol was stopped and HR remained within target range after 1 week
• Metoprolol ADR reported in ActionADE to avoid another re-exposure

• 45 year old male presented to the hospital for treatment of pneumonia
• Received ceftriaxone and doxycycline for 5 days
• Course of antibiotics were completed but presented with new onset odynophagia
• Esophagogastroduodenoscopy performed
• Severe reflux esophagitis with ulceration

OUTCOME:

• ED physician suspected doxycycline-associated chemical injury
• Other potential cause included significant alcohol use prior to admission
• Doxycycline ADR documented in ActionADE to inform future perscribers

• 67 year old female presented to hospital with left arm pain and cellulitis
• Significant erythema and swelling and skin blisters of unknown etiology
• No clear precipitating injury
• Patient had been taking over 2x recommended maximum daily dose of pregablin for at least 2 years for chronic back pain
• Possible associated between excessive pregablin and dermopathies

OUTCOME:

• Pregablin decreased by 40%
• Other pain medications added
• Patient started on IV antibiotics
• Pregablin ADR documented in ActionADE to avoid re-exposure to the prior dose

• Presented with SAH
• Patient was not a candidate for neurosurgery due to fraility and age
• Clinical team decided on conservative management

OUTCOME:

• Patient required PCC to reverse anticoagulation
• Reported in ActionADE

• Patient presented with AKI and hyperkalemia
• Patient has history of CAD, CHF, AF (more prone to arrhythmias given their cardiac history)
• – Resulting ECG changes (peaked T waves)

OUTCOME:

• requiring emergency K shifting (insulin IV + dextrose), cardioprotection ( IV calcium), and dialysis (enhanced elimination)