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1) In reviewing her medication list and current symptoms and clinical signs, which medication could the nurse practitioner consider de-prescribing

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1) In reviewing her medication list and current symptoms and clinical signs, which medication could the nurse practitioner consider de-prescribing.

I would consider de-prescribing the tramadol.  It was reported that Mrs. P. has stable arthritic pain.  Acetaminophen is the first line of pharmacological therapy and since it is controlled, we may be able to discontinue tramadol.  Analgesics are prescribed when the acetaminophen or NSAIDs are no longer responsive.  These drugs are prescribed for a limited time due to the potential for dependence and withdrawal symptoms (Arcangelo et al., 2017).

In addition to her medication list; I would consider de-prescribing pantoprazole 40 mg.  Usually you’ll take pantoprazole for up to 2 weeks. If symptoms improve you can take it for another two weeks.  Pantoprazole is suggested to be taken only when there are symptoms; so she doesn’t have to take it everyday (NHS, n.d.).  Mrs. P. stated having no symptoms of GERD for the past 6 months.  

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 the patient has completed the prednisone taper, the nurse practitioner can begin to reduce the Metoprolol succinate 12.5 mg.  Metoprolol is a beta blocker; and because the lungs also have beta receptors, metoprolol causes the airways in the lungs to constrict, making it difficult to breathe; especially in those who have respiratory illnesses.  Metoprolol is used with caution in people with respiratory disease (Craig, 2020).  Side effects of beta blockers can exacerbate Mrs. P’s bronchitis.  It is also recommended not to abruptly stop metoprolol but to gradually decrease the dosage.

3) Given the absence of an exacerbation of heart failure and compliance with a reduced  sodium diet, what other medication(s) adjustments could the nurse practitioner consider at this time?  

Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet; the medication that can be adjusted would be furosemide.  This is a loop diuretic, and they are indicated in the presence of edema associated with congestive heart failure and renal disease. In addition loop diuretics are more reserved for hypertensive patients with renal dysfunction (Arcangelo et al., 2017).  In my opinion and based on the research this medication could be adjusted, there is no presence of edema.