Recurrent Falls in an 86-Year-Old Woman Taking Multiple Antihypertensives
Write a prescription for recurrent falls with orthostatic hypotension and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
hard5 scoring rulesrenal impairment
- Patient
- 86 years, female, 60 kg
- Diagnosis
- Recurrent falls with orthostatic hypotension
- Renal function
- eGFR 45 mL/min/1.73m²
- Allergies
- None known
- Current medicines
- doxazosin 4 mg once daily (modified release); amlodipine 5 mg once daily; bendroflumethiazide 2.5 mg once daily; zopiclone 3.75 mg at night
The scenario
An 86-year-old woman (weight 60 kg) is admitted to the care of the elderly ward following a fall at home. She reports feeling light-headed when rising from a chair. She has had three similar episodes in the past month, but has never lost consciousness. She is usually independent and mobilises with a stick.
On examination: cognition is normal. Blood pressure is 158/84 mmHg lying, and 108/62 mmHg after standing for three minutes, with a pulse of 88 bpm. Heart sounds are normal, chest is clear, no peripheral oedema. Neurological examination is unremarkable. She is noted to be frail but not acutely unwell.
Investigations: serum creatinine 1.2 mg/dL, eGFR 45 mL/min/1.73m². Urea 8.4 mmol/L, sodium 128 mmol/L, potassium 3.2 mmol/L. ECG shows sinus rhythm, no ischaemic changes.
Her GP-recorded medications are: doxazosin 4 mg once daily (modified release), amlodipine 5 mg once daily, bendroflumethiazide 2.5 mg once daily, and zopiclone 3.75 mg at night. She has no documented drug allergies.
Task: Review the medication chart and write up appropriate changes to her repeat prescription. Consider which drugs might be contributing to her falls and postural hypotension, and make a safe prescribing decision.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
5 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
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A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.