hospital pharmacy

As part of your role with the hospital you have been asked to undertake a medication review for a recently admitted patient Mr JD within the Hospital.
Upon checking his records you find out the following information
Age 85 years
Weight 73kg
Height 160cm.
His Medical History indicates that he suffers from Hypertension, Type 2 Diabetes, Gout, Osteoarthritis, GORD and COPD
His charted medications are listed below
Medication
Dose
Allopurinol 300mg
1 at 0800

Amlodipine 10mg
1 at 0800

Digoxin 250mcg
1 at 0800

Glicazide SR 30mg
1 at 0800

Esomeprazole 20mg
1 at 0800

Paracetamol 665mg
2 tablets 0800, 1400 and 2100

Salbuatamol 100mcg MDI
1-2 prn
Allergies were noted be for Metformin and Mr JD was noted to have suffered from developed itchy skin rashes upon prescribing of this medication
He is a non smoker
His Pathology results indicated that his serum creatinine was 114 micromol/L
His liver function tests and serum creatinine levels were indicated to be within the normal range
His last record BP that morning was 150/85

As part of of your role to speak to Mr JD’s wife to check and confirm the charted medications and you are told the following information inregards to his medication
Current medication
Allopurinol 300mg 1 mane for Pain in feet
Amlodipine 10mg 1 mane for blood pressure
Digoxin 250mcg 1 mane for the heart
Enalapril 10mg 1 mane for blood pressure
Gliclazide SR 30mg 1 mane for diabetes
Omeprazole 20mg 1 mane for indigestion
Paracetamol 500mg 1-2 prn for pain
Arthri-Relief 1500mg 1 daily prn for pain
Salbutamol 100mcg/dose MDI prn for breathing