Table 1.

History of medication experience: Patient is allergic to valdecoxib and morphine.

MEDICATION	REASON FOR USE (IF KNOWN)	KNOWLEDGE, EFFECTIVENESS, COMPLIANCE, GOALS, SAFETY ASSESSMENT	DURATION (IF KNOWN)
4 mg/d of candesartan every morning	Hypertension	Staff at retirement home checks BP BP at GDH ranging from 77/50 mm Hg to 130/74 mm Hg in first few wk Heart rate of 52 to 62 beats/min in first few wk	NA
1.25 mg/d bisoprolol every morning	No history of AF, MI, angina		NA
20 mg of rosuvastatin at bedtime	Possible hemorrhagic stroke	1 y ago LDL was 1.48 mmol/L and HDL-C ratio was 2.0 mmol/L	1.5 y
2 tablets of 100/25 mg of levodopa-carbidopa 3 times daily	Parkinson disease	Since diagnosis of Parkinson disease, walking is worse; now using a 4-wheeled walker	1 y
8 mg of betahistine dihydrochloride 3 times daily	Vertigo	Dizziness began about 1 y ago; currently somewhat improved	1 y
150 mg of risedronate monthly	Osteoporosis	High risk of fall	NA
1000 units of vitamin D daily	Osteoporosis	High risk of fall	NA
50 mg of trazodone at bedtime	Insomnia	Reports going to bed between 8–9 pm; “worries” before falling asleep; light sleeper; often up; sleep is interrupted by husband’s needs or to go to the bathroom; naps for up to 4 h daily	NA
0.05 mg/d of levothyroxine	Hypothyroidism	• TSH level of 3.46 mIU/L	NA
40 mg/d of pantoprazole	Possible nausea	• Stomach has been worse: feeling of not being able to eat and digest food properly	NA
10 mg of metoclopramide 3 times daily	Possible diverticulitis		NA
1 drop of 0.5% timolol in both eyes twice daily	Glaucoma	Concerned about watery and itchy eyes, which have become worse in past 4 mo and are preventing daily activities	10 y
20 mg/d of cetirizine	Watery, itchy eyes	• No improvement in watery and itchy eyes	6 mo
50 mg of dimenhydrinate	Nausea	• Uses when needed (unclear how often)	NA

AF—atrial fibrillation, BP—blood pressure, GDH—Bruyère Continuing Care Geriatric Day Hospital, HDL-C—high-density lipoprotein cholesterol, LDL—low-density lipoprotein, MI—myocardial infarction, NA—not available, TSH—thyroid-stimulating hormone.