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Medication Related to Falls

Case Base Simulation

Pharmacy Department

Falls Intervention Team

Hospital Kuala Lumpur

FIT Workshop HPJB, 14th June 2022

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Case 1

  • Mr CH is a 47 y/o gentleman, currently admitted for relapse mania with auditory hallucination. He is a moderate size gentleman of 60kg.

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  • He is diagnosed with BMD T1 previously with auditory and visual hallucination since 4 years ago. His BMD control has been fluctuating for the past 4 months after his divorced.

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  • His current active medications are T. Olanzapine 20mg ON, T. Epilim Chrono 1.5g ON, IM Fluphenazine 50mg monthly. This regiment has been continued the same since ½ year ago. Had a history of mild orodyskinesia with haloperidol 2 years ago. Had no history of falls, but occasional near falls episodes in the past. Able to ambulate independently.

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  • Due to his physical and verbal aggression, IV Diazepam 5mg STAT x 3 and IV Haloperidol 5mg STAT x 2 are administered during his 1st day of admission. His regular medications are resumed in the ward. Physical restraints are enforced in the 1st 2 days since his admission.

FIT Workshop HPJB, 14th June 2022

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Case 1

  • He was noted to have a fall in the morning at the walkway on the 3rd day after accidentally hitting the side trolley.

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FIT Workshop HPJB, 14th June 2022

Vital signs taken stat:

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BP lying : 135/67mmHg, PR: 75bpm

BP standing : 116/56mmHg, PR: 71bpm

RBG : 9.4 mmol/L

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Observation and examination:

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Has a laceration on the right palm.

Patient looks calmer, but not really expressive.

Noted to has new facial dyskinesia of the eyes and bilateral UL tone are stiff.

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Case 1

  • What are the falls risk factor?
    • Morse Falls Scale
    • Medications
    • Comorbidities
    • Vital signs assessment
  • What are the important points to be included in the Incident Report?
  • What can be done for the subsequent falls precautions?

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FIT Workshop HPJB, 14th June 2022

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Case 2

  • Mr A is a 67 y/o gentleman, currently admitted to a medical ward for his blood pressure (BP) stabilization

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  • He is diagnosed with hypertensive emergency, and has multiple comorbidities including T2 diabetes, chronic vein ulcer and history of TIA. Had no previous history of falls before but he has been walking with a cane to support himself

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  • His lying BP currently remained between 138-165/ 65-91 mmHg with T. Amlodipine 10mg OD, T. Prazosin 3mg TDS and T. Metoprolol 100mg BD

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  • His overall blood glucose level ranges between 4.1-9mmol/L with single pill T. Gliclazide MR 90 mg OD.

FIT Workshop HPJB, 14th June 2022

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Case 2

  • He was noted to have a fall in the morning by the bedside while trying to stand up and ambulate, complaining that he has dizziness

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FIT Workshop HPJB, 14th June 2022

Vital signs taken stat:

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BP lying : 141/87mmHg, PR: 65bpm

BP sitting : 128/66mmHg, PR: 71bpm

RBG : 4.4 mmol/L

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Observation and examination:

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Has a bruised elbow

Patient is alert and conscious

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Case 2

  • What are the falls risk factor?
    • Morse Falls Scale
    • Medications
    • Comorbidities
    • Vital signs assessment
  • What are the important points to be included in the Incident Report?
  • What can be done for the subsequent falls precautions?

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FIT Workshop HPJB, 14th June 2022

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Case 3

  • Madam Z is 51 years old lady with a diagnosis of early onset Parkinson Disease and is admitted for anti-Parkinsons optimization

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  • She is able to self ambulate without any walking aids, but she has been complaining of worsening in bradykinesia, resting tremors and frequent ‘freezing time’ episodes especially in the morning. Had multiple near falls episodes

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  • Her current dose of T. Amantadine is increased to 75mg BD (served at 8am &8pm), and the dose of T. Madopar was maintained at 125mg TDS (served at 8am, 4pm and 12mn)

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  • She is also diagnosed with functional incontinence during this admission, in which the urge for urination usually occur early in the morning (3-5am)

FIT Workshop HPJB, 14th June 2022

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Case 3

  • She was reported to had a fall in the walkaway, while she was rushing for the toilet

FIT Workshop HPJB, 14th June 2022

Vital signs taken stat:

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BP lying : 129/77mmHg, PR: 97bpm

BP sitting : 128/86mmHg, PR: 89bpm

RBG : 6.5 mmol/L

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Observation and examination:

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Has a bruised elbow

Patient is alert and conscious

Muscle tone of all limbs are stiff

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Case 3

  • What are the falls risk factor?
    • Morse Falls Scale
    • Medications
    • Comorbidities
    • Vital signs assessment
  • What are the important points to be included in the Incident Report?
  • What can be done for the subsequent falls precautions?

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FIT Workshop HPJB, 14th June 2022