Multiple medical problems

Ritter J et al ACTH revisited Effective treatment for acute crystal induced synovitis in patients with multiple medical problems. J Rheumatol 1994 21 696. [PMID 8035395]... 

It is commonly found that patients with multiple medical problems may be taking as many as 10 to 15 drugs concomitantly. It is also becoming increasingly obvious to physicians, and other members of the health-care delivery team, that many drug combinations, when used inappropriately and injudiciously, have the inherent potential to interact adversely, leading to side effects and even death (see Chapter 4). 

This was a complex case, because of the multiple medical problems and treatments. However, it has been reported that since the launch of venlafaxine in Australia in 1996, the Adverse Drug Reactions Advisory Committee there has received 15 reports of hyponatremia, suggesting that the association is real (20). 

The elderly patient usually has multiple medical problems, in addition to pain. A helpful article was published in 1998 by Ruoff for practicing physicians.This article discusses issue with the use of nonsteroidal antiinflammatory and opioid medications in the elderly and patients with comorbid conditions. 

Clients can be exposed to uncertainty and are expected to address many problems that include health and wellness issues, finances, recent and multiple medical problems, or the death of loved ones. Defined simply, fear is the body s response to a real threat, and anxiety is an exaggerated response to something that is unrealistic or unknown. 

A 47-year-old woman with multiple medical problems stabilised on warfarin (and also taking azathioprine, captopril, furosemide, insulin, capto-pril, prednisone, levothyroxine, valproic acid and zolpidem) had all her teeth removed under general anaesthetic. Sixteen days later she needed a dental abscess drained and was given oral clindamycin 300 mg four times daily with ibuprofen 600 mg for any discomfort. On day 17 she needed a suture to stop some bleeding and her INR was found to be 3.5. By day 20 she had developed more severe oral bleeding, which needed emergency room treatment. Her INR was found to have risen to 13 and her haemat-ocrit decreased to 18%. She was treated successfully with a blood transfusion and vitamin K. ... 

A 74-year-old man with treatment-refractory bipolar disorder and multiple medical problems, including chronic renal insufficiency (creatinine clearance 26 ml/minute) secondary to type 2 diabetes and lithium, took psychotropic... 

If patients are having difficulty swallowing tablets or capsules, ensure that they are trying to swallow them one at a time (this may be a problem with patients taking multiple medications at the same time each day). 

Magnetic resonance imaging (MRI) is a medical technique used to obtain images of body tissue. Physicians use the procedure to examine a wide range of medical problems, including diagnosing diseases (multiple... 

Persons at greatest risk for NSAID hemodynamic nephropathy generally have pre-existing renal insufficiency, medical problems associated with high plasma renin activity (hepatic disease with ascites, decompensated congestive heart failure, or intravascular volume depletion), or systemic lupus erythematosus. Additional risk factors include atherosclerotic cardiovascular disease and diuretic therapy. The elderly are also at higher risk due to interaction of prevalent medical problems, multiple drug therapies, and reduced renal hemodynamics. Advanced age, however, has not been shown to be an independent risk factor for toxicity in limited trials in otherwise healthy elderly subjects. Combined NSAID and ACEl or ARB therapy is also a concern and should be avoided. 

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