The student identifies appropriate, reasonable plans for all significant problems affecting this client. The student is able to reduce the medication burden for the client/polypharmacy. You will discuss using the heading Problem List and how 17 medications were reviewed on drugs.com for interactions and one major interaction showed between the two drugs spirlactalone and potassium chloride. The interaction was listed as high due to the possibility of causing hyperkalemia which can cause multiple serious problems such as cardiac arrhythmia, cardiac arrest, kidney failure, ou may be more likely to develop hyperkalemia while using these medications if you are elderly, dehydrated, or have kidney disease, diabetes, or advanced heart failure. (you need to reference all these issues as they were copied and pasted from drugs.com). You will then talk about how the patients recent lab work showed hypokalemia with a K of 3.0 and she was placed on sprilacalone once a day at a low dose of 25mg to help correct her hypokalemia and since this is a short term/temporary change that is being monitored it would of been probably a wiser choice to decrease the patient torsemide from 40mg twice daily to 20mg twice daily and add extra dose of potassium chloride to correct the hypokalemia since her hypokalemia is most likely related to her increased diuretics dosing where she was on 20mg twice a day and it was recently increased a week ago to 40mg twice a day due to increase fluid in her legs and weight gain. Reference how diuretics can cause hypokalemia and Reference why diuretics should be decreased after fluid correction and if they are not the effects this can do on the body and kidney labs. You will then mention how famotidine interacts with tramadol showing a moderate risk for irregular heart rhythm and Tramadol will be discontinued not only due to this but also because the patient reports not feeling any positive effects from the medication and better effect with acetaminophen for back pain. also discuss why tramadol should be avoided in elderly and the effects it can cause on body. Also discuss how it effects the kidneys as well and reference. You will also talk about how the drug interaction checker used on drugs.com showed a interaction between Milk of magnessium and ferrous sulfate may decrease the absorption of ferrous sulfate which may contribute to her slightly lowered hemoglobin and hematocrit levels from ferrous sulfate not being absorbed fully and correctly. (Drugs.com, 2020). Since patient has not needed magnesium hydroxide containing medications recently will discontinue milk of magnesia. The next medication to be discussed in paper is a moderate interaction between mirlax and torsemide along with a moderate interaction between mirlax and tramadol Combining these medications, especially over a prolonged period, may increase the risk of dehydration and electrolyte abnormalities.-reference. and then discuss how plan already is to discontinue tramadol and you reviewed the patients medication administration and she has not needed mirlax in a long time and since there is a moderate risk with these medications it seems like a wise approach to discontinue mirlax. There is a moderate risk between aspirin and insulin glargine that may increase the risk of hypogycemia. You can talk about how you reviewed the patients blood sugar level trends and she has not had any reaccurent or recent hypoglycemia trends and issues and since patient has severe mobility restrictions from her comorbidities and is a diabetic and needs insulin and aspirin also helps prevent blood clots due to her immobility that this combination moderate risk the benefits of keeping her on the medication outweigh the risks so will keep her on this. Also reference in this part from source on why aspirin is important in preventing blood clots in patients that are immobile and their positive effects. Also discuss how there is a moderate risk between torsemide and insulin glargine and insulin lispro that may reduce the sensitivity of insulin glargine. You can discuss how her blood sugar level trends have been reviewed and she has not shown any irregularity in her levels from baseline and the benefits or torsemide outweigh the risks since she has active swelling in her legs and don’t want to cause a CHF exacerbation and fluid overload. Also discuss how guidelines recommend giving a short term adjustment in insulin glargine if blood sugar levels due become irregular and how this is a better approach to patient care instead of discontinuing diuretic medication. -reference this from source. Insulin lispro and aspirin show a moderate risk for hypoglycemia and patient has not had any issues with this and been on both medications for years so will continue on these medications as benefits outweigh risks. There is a moderate risk between omeprazole and ferrous sulfate. This may decrease absorption of ferrous sulfate that may be contributing to patients abnormal hemoglobin and hematocrit levels. Will talk about how patient takes 20mg omeprazole twice a day and will try decreasing the dose to 20mg once a day and see how she does since she is also on Famotidine that does not show a interaction. Also talk about how literature shows its not good to be on PPI for long periods and high dosing and reference this. the last one is a moderate interaction between aspirin and milk of magnesium that may cause decreased effectiveness of aspirin. Since patient has not needed milk of magnesium for awhile will disctontinue and reevaluate other medication choice if she develops acute constipation that won’t interact with other medications she is on. The plans are clear, and are supported by practice guidelines and/or current literature. Scholarly articles can’t be more than 5 years old. the plans provided are organized with rationales provided for why they are appropriate in reducing the risk of polypharmacy and potential complications for the client. All key components of patient management are considered and included. The student demonstrates an exceptional understanding of polypharmacy, geriatric assessment/functional status and overall management of the patient conditions. must be APA format.