Mei Hughes

92 · female · Heart failure, Anxiety

Prepared by Domino · Oct 1, 2026

Summary

1 likely prescribing cascade link. If Furosemide were reviewed, up to 2 downstream medicines might no longer be needed (6 → 3). Anticholinergic burden is 4.

Question 1

Could the urgency or leaking be from the diuretic? Changing the timing of the dose can help before adding a bladder medication.

Furosemide (Feb 7, 2023) → leaking urine, urgency → Trospium (May 8, 2023) · likely 0.99 · consensus
Furosemide (Feb 7, 2023) → low potassium → Spironolactone (Feb 28, 2023) · possible 0.30 · graph-inferred

If reviewed: Potassium chloride (planned companion), Trospium; medicines 6 → 3; anticholinergic burden 4 → 0; fall-risk drugs 3 → 2.

Medicines

Medicine	Started	Charted for	Domino
Furosemide as prescribed Dr. A. Patel (family doctor)	Feb 7, 2023	Heart failure	Root of a cascade ACB +1 Beers-listed
Potassium chloride as prescribed Dr. A. Patel (family doctor)	Feb 17, 2023	Hypokalaemia
Spironolactone as prescribed Dr. R. Ahmed (walk-in clinic)	Feb 28, 2023	—	Possibly treating a side effect
Empagliflozin as prescribed Dr. A. Patel (family doctor)	Apr 3, 2023	—
Trospium as prescribed Dr. M. Fischer (urology)	May 8, 2023	Urinary incontinence	Possibly treating a side effect ACB +3 Beers-listed
Lorazepam as prescribed Dr. A. Patel (family doctor)	Jun 20, 2023	Anxiety	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.
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.

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.