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Idiopathic fibrosis, arthritis, hyponaremia, UTI, lacunar infarcts. Medications okay ?

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Internal Medicine Specialist
Practicing since : 2007
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Please review the medications and advise course of action. She was walking/standing in a limited manner till 26 XXXXXXX 2011...after which she had to be hospitalized twice and presently is bedridden
Posted Tue, 8 May 2012 in Medicines and Side Effects
Answered by Dr. Kiran Kumar 16 hours later

The current problems are
1. Idiopathic Fibrosis with severe lung fibrosis requiring home oxygen
2. Old CVA - Lacunar Infarcts
3. Arthirits, Uveitis, Problems related to urination
4. Hyponaremia - Low Sodium levels.
5. UTI - likely chronic

Your mother is on following medications and my comments are with them.

24 x 7 Oxygen will be required for life long due to her lung condition.

Tiotropium bromide Monohydrate
Methyl Prednisolone Tablets 4 mg - restarted on 29/7/2011,
formoterol fumarate and mometasone furoate respules

All three are essential and to continue

Diltiazem Hydrochloride - Helps to control heart rate.
Entergermina - thrice daily - its a probiotic and can be continued.
N Acetylcystiene 600mg to continue
Azathioprine - Immunosuppressive medication. Does not have a clear benefit in IPF, however is prescribed by pulmonologist as there is no other option in this condition.

Lubiprostone 24 mcg- for constipation and IBS - Can be continued
Medications for Constipation can be continued.
Pantoprazole + Levosulpiride - Antacid which is essential as she is taking multiple medications.

Alfusin - Helps in bladder motility and therefore continue.
Levofloxacin 500 - once daily (3 weeks advised from 28/7/2011) ; We usually give for 1 week. Its likely that she has chronic UTI and thee fore the medications can be extended for 2 - 3 weeks.

Potassium Chloride for low potassium - can be stopped if K+ levels are normal
Clopidogrel + Aspirin - Since there is GI issues, you ca avoid using them.

I must be honest that your mothers ILD (Idiopathic Pulmonary Fibrosis) is an irreversible condition and is relentlessely progressive. There is no definitive treatment. Hyponatremia is something which can be recurrent and can lead to drowsyness and inability to walk.

Most of the medicines which she is on are essential and will be required for life long.
Consider repeating her sodium levels to see how much it has improved.

She will need a good nursing care and regular chest physiotherapy.

Hope this answers our query.
Please get back if you need any further information

Thanks and Regards

Dr Kiran
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