Mrs AB, a 89 year old from a nursing home, has been admitted to hospital with suspected urinary tract infection (UTI)

Past medical history:

• Alzheimer’s dementia (Mini mental state examination score 12)
• Hypertension
• Urinary retention secondary to atonic bladder (supra pubic catheter in-situ since three months ago)
• Recurrent UTIs (already had three UTIs this year)
• Frequent falls

Drug allergy:

• Trimethoprim (rash)

Medications on admission:

• Irbesartan 300 mg po daily
• Hydrochlorothiazide 12.5 mg po daily
• Pantoprazole 40 mg po daily
• Donepezil 5 mg po daily
• Oxybutinin 5 mg po BD

a) What are the factors that must be taken into consideration before deciding on the appropriate treatment for Mrs AB? (4 marks)

b) Discuss how uncomplicated and complicated UTIs are different in terms of the pathogens involved and treatment plans. (5 marks)

c) Upon reviewing Mrs AB’s regular medications, identify THREE additional drug related problems from her regimen and make appropriate recommendations accordingly (6 marks)