There are a few medications on Mrs. P.’s list that could be considered for de-prescribing.

• Pantoprazole: Mrs. P. reports no symptoms of GERD for the past 6 months, so the pantoprazole could be discontinued. If she does start to experience symptoms again, it can be restarted.
• Furosemide: Mrs. P.’s weight has been stable and she has no evidence of lower extremity edema, so the furosemide could be reduced or discontinued.
• Acetaminophen: Mrs. P. is using acetaminophen for pain, but she is also taking tramadol as needed. If she is able to manage her pain with acetaminophen alone, then the tramadol could be discontinued.

It is important to note that these are just a few suggestions, and the final decision of which medications to de-prescribe should be made by the nurse practitioner after a careful review of Mrs. P.’s medical history and current condition.

2. Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to reduce given the patient’s reported symptoms.

Once Mrs. P. has completed the prednisone taper, the nurse practitioner could begin to reduce the lisinopril. Mrs. P.’s blood pressure is currently well-controlled, and she has no history of heart failure. Reducing the lisinopril could help to minimize the risk of side effects, such as dry cough and dizziness.

It is important to monitor Mrs. P.’s blood pressure closely after reducing the lisinopril. If her blood pressure starts to rise, the lisinopril dose can be increased or another medication can be added.

In addition to the medications mentioned above, the nurse practitioner should also consider de-prescribing any medications that are no longer necessary or that are causing side effects. The goal is to find a medication regimen that is effective and safe, and that minimizes the risk of side effects.

Discussion

The decision of which medications to de-prescribe is a complex one, and it should be made on a case-by-case basis. However, the principles outlined above can be used to guide the decision-making process.

It is important to consider the patient’s individual medical history, current symptoms, and clinical signs when making the decision to de-prescribe a medication. It is also important to monitor the patient closely after de-prescribing a medication to ensure that their condition does not deteriorate.

De-prescribing medications can be a safe and effective way to improve a patient’s quality of life. By carefully considering the patient’s individual circumstances, the nurse practitioner can help to ensure that the patient receives the best possible care.