Medication review brief · for the pharmacist
Omar Tremblay
87 · male · Atrial fibrillation, High cholesterol, Enlarged prostate (BPH), Anxiety
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Lorazepam were reviewed, up to 1 downstream medicine might no longer be needed (7 → 5). Dangerous combination: bleeding stack.
Question 1
Could the memory problems be from the benzodiazepine? Benzodiazepines impair memory and attention in older adults.
- Lorazepam (Feb 12, 2024) → confusion or memory problems → Galantamine (May 20, 2024) · likely 0.99 · consensus
If reviewed: Galantamine; medicines 7 → 5; anticholinergic burden 1 → 1; fall-risk drugs 4 → 2.
Do not stop abruptly
- Lorazepam: Taper slowly if changed: stopping suddenly can cause withdrawal, including seizures.
Question 2
Could muscle aches be from Simvastatin?
- Simvastatin (Jan 9, 2025) → muscle aches → Ibuprofen (May 6, 2025) · likely 0.74 · graph-inferred
If reviewed: Ibuprofen; medicines 7 → 5; anticholinergic burden 1 → 1; fall-risk drugs 4 → 4.
Combinations
- Bleeding stack (Warfarin + Ibuprofen): An anticoagulant or antiplatelet combined with an NSAID or SSRI/SNRI raises bleeding risk.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Warfarin as prescribed Dr. K. Osei (cardiology) | Nov 13, 2022 | Atrial fibrillation | ACB +1 Beers-listed |
| Diltiazem as prescribed Dr. K. Osei (cardiology) | Dec 13, 2022 | Atrial fibrillation | |
| Lorazepam as prescribed Dr. J. Martin (family doctor) | Feb 12, 2024 | Anxiety | Root of a cascade Beers-listed |
| Galantamine as prescribed Dr. L. Romero (geriatrics) | May 20, 2024 | Cognitive impairment | Possibly treating a side effect |
| Simvastatin as prescribed Dr. J. Martin (family doctor) | Jan 9, 2025 | High cholesterol | Root of a cascade |
| Ibuprofen as prescribed Dr. T. Nguyen (walk-in clinic) |
Evidence
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- Doherty AS, Lund LC, Moriarty F, et al. Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland. Ann Fam Med. 2025;23(4):315-324.
- American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081.
Decision support only. Domino flags patterns in a synthetic record for a clinician to review; it does not diagnose, and it never recommends stopping or changing a medicine. Synthetic data; no real patient.