Medication Self Assessment Test
If you are older than 65 and answer "Yes" to most of these questions, then you should consider making an appointment with a senior care pharmacist to determine what steps can be taken to decrease your risks of health-related problems. While these risks factors are not a definitive list, they have been found to correlate with the risk of medication-related problems.
1. Do you currently take 5 or more medications? |
YES or NO |
2. Do you take 12 or more medication doses each day? |
YES or NO |
3. Do you take any of the following medications?
- Carbamazepine (e.g.Tegretol®)
- lithium (e.g. Eskalith®)
- phenytoin (e.g. Dilantin®, Phenytek®)
- quinidine (e.g. Quinidex®)
- warfarin (e.g. Coumadin®)
- digoxin (e.g. Lanoxin®, Lanoxicaps®)
- phenobarbital
- procainamide (e.g. Procanabid®, Pronestyl®)
- theopylline (e.g. Theo-dur®, Theo-24®, Slo-bid™, Theospan®, Uniphyl®)
- alpha blockers (e.g. Cardura, Catapres, Hytrin, Flomax, etc.)
- levothyroid (e.g. Synthoid, etc.)
- Darvocet N 100
- Statin Drugs (e.g. Zocor, Pravacol, Lipitor, Crestor , Lopid, etc.
- Metformin (e.g. Glucophage, Avandamet,)
- Glucotrol, Amaryl, Diabeta
- Hydrochlorthiazide
- Nitrofurantoin (e.g. Macrodantin)
- NSAIDS (e.g. Motrin, Aleve, etc.)
- Antihistamines (e.g. Benadryl, Antivert, Tylenol PM, Sleep-Ezz, Dramamine, etc.)
- Cimetidine (e.g. Tagamet)
- Ketoconazole (all oral antifungal drugs)
- Clopidogrel (Plavix), dipyridamole (Persantine)
- Sleep medications ( Sonata, Ambien, Halcion, Restoril etc…
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YES or NO |
4. Are you currently taking medications for three or more medical problems? |
YES or NO |
5. Have your medications or the instructions on how to take them been changed more than four times this past year? |
YES or NO |
6. Does more than one physician prescribe medications for you on a regular basis? |
YES or NO |
7. Do you get prescriptions filled at more than one pharmacy? |
YES or NO |
8. Does someone else, such as a delivery person from the pharmacy, a spouse, friend, or neighbor) bring any of your medications to your home for you? |
YES or NO |
9. Is it difficult for you to follow your medication regimen? If so, do you sometimes choose not to? |
YES or NO |
10. Of all of your medications, is there any particular medication for which you do not know the reason for which you are taking it? |
YES or NO |
If you answered "Yes" to most of these questions, contact a Senior Care Consultant for a complete evaluation. Call for an appointment today:
Charles S. Feucht, PD,FASCP, Senior Care Consultant at (337) 457-4604 or contact via e-mail through our Contact Us form. |
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