Toni is a 46-year-old African American female patient diagnosed with diabetes approximately one year ago. She began taking glipizide XL 10 mg daily. Concerned about her diagnosis, she lost 5 lbs, adhered to her medication regimen, and educated herself about diabetes. Six months ago, her physician noted improvements but increased her glipizide XL to 10 mg twice daily as she was still outside her therapeutic range.

Pharmacy Record of Toni’s Medications:

1. HCTZ 25 mg / Triamterene 37.5 mg
2. Felodipine 5 mg
3. Simvastatin 40 mg
4. Glipizide XL 10 mg
5. Ibuprofen 400 mg
6. St. John’s Wort
7. Chromium
8. Magnesium
9. Multivitamin
10. Ranitidine 75 mg

Social History (SH):

- Very sedentary at work.
- Watches TV several hours each night.
- Snacks throughout the day and evening while working and watching TV.
- Smokes approximately 10 cigarettes per day.
- Knee replacement 2 years ago limits physical activity.

Review of Systems (ROS):

- Complains of fatigue and frequent urination.
- Wakes up two to three times per night to urinate.
- Reports no episodes of hypoglycemia.

Physical Exam (PE):

- Blood Pressure: 152/92
- Heart Rate: 78
- Respiratory Rate: 18
- Weight: 250 lbs (gained 10 lbs over the past year)
- Monofilament test: Good sensation in both feet.

Laboratory Results:

- Point-of-care testing conducted last month (results not provided).

Question:

What medication-related problems does Toni have? Provide a prioritization list with details of each problem and its priority level (high, medium, or low).

Toni's medication-related problems can be identified through a thorough review of her medication list and the information provided. Here are the specific issues:

Drug Interactions: St. John's wort, a herbal supplement, can interact with several medications, including glipizide, potentially reducing its effectiveness. This poses a high priority problem as it may impact Toni's diabetes control.

Inappropriate Medication Use: Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), may increase the risk of kidney problems and interfere with blood pressure control. Given Toni's hypertension and frequent urination, its use may not be appropriate. This is a medium priority problem.

Potential Medication Side Effects: Glipizide, a diabetes medication, can cause hypoglycemia (low blood sugar). Although Toni reports no episodes of hypoglycemia, this side effect should be monitored closely. This is a medium priority problem.

Prioritization list:

High priority:

Drug interaction with St. John's wort and glipizide.

Medium priority:

Inappropriate use of ibuprofen.

Potential side effects of glipizide.

Low priority:

No specific low priority medication-related problem mentioned in the given information.

Addressing these medication-related problems will require healthcare provider intervention to adjust medications, discontinue inappropriate use, and educate Toni about potential side effects and interactions to ensure optimal medication therapy management and improve her overall health outcomes.

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