Medication review brief · for the pharmacist
Irene Andersen
83 · female · Hypertension, Osteoarthritis pain, Osteoporosis
Prepared by Domino · Oct 1, 2026
Summary
2 likely prescribing cascade links. If Naproxen were reviewed, up to 2 downstream medicines might no longer be needed (5 → 2).
Question 1
Could the raised blood pressure be from the NSAID? NSAIDs raise blood pressure and blunt most antihypertensives.
- Naproxen (Feb 21, 2025) → high blood pressure → Lisinopril (Apr 23, 2025) · likely 0.99 · consensus
If reviewed: Omeprazole (planned companion), Lisinopril; medicines 5 → 2; anticholinergic burden 0 → 0; fall-risk drugs 1 → 0.
Do not stop abruptly
- Omeprazole: Consider a step-down: stopping suddenly can cause rebound acid symptoms.
Question 2
Could the indigestion be from the bisphosphonate (and how it is taken)?
- Alendronate (Apr 9, 2025) → heartburn or indigestion → Pantoprazole (Apr 26, 2025) · likely 0.70 · label
If reviewed: no downstream change; medicines 5 → 4; anticholinergic burden 0 → 0; fall-risk drugs 1 → 1.
Medicines
| Medicine | Started | Charted for | Domino |
|---|---|---|---|
| Naproxen as prescribed Dr. A. Patel (family doctor) | Feb 21, 2025 | Osteoarthritis pain | Root of a cascade Beers-listed |
| Omeprazole as prescribed Dr. A. Patel (family doctor) | Feb 23, 2025 | GI bleeding risk | Beers-listed |
| Alendronate as prescribed Dr. A. Patel (family doctor) | Apr 9, 2025 | Osteoporosis | Root of a cascade |
| Lisinopril as prescribed Dr. A. Patel (family doctor) | Apr 23, 2025 | Hypertension | Possibly treating a side effect |
| Pantoprazole as prescribed Dr. A. Patel (family doctor) | Apr 26, 2025 | — | Possibly treating a side effect Beers-listed |
Evidence
- McCarthy LM, et al. ThinkCascades: A Tool for Identifying Clinically Important Prescribing Cascades Affecting Older People. Drugs Aging. 2022;39(10):829-840.
- Gurwitz JH, et al. Initiation of antihypertensive treatment during nonsteroidal anti-inflammatory drug therapy. JAMA. 1994;272(10):781-786.
- 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.
- Product monographs and prescribing information (adverse reaction sections), curated by hand for this prototype. Frequencies are approximate bands, not exact rates.
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.