Duplications hidden in combination products and agents left without a reason drive the NU553 Unit 3 reconciliation, which matches one composite woman's fills across three pharmacies to a single list. Searches like "nu 553 unit 3 assignment example", "nu553 unit 3 sample" and "nu553 unit 3 example" land here.
Three Pharmacies, Four Prescribers, Fifteen Records: A Medication Reconciliation for a 59-Year-Old With Rheumatoid Arthritis and Hypertension
[Student Name]
Purdue University Global
NU553: Advanced Pharmacology and Pharmacotherapeutics
Unit 3 Medication Reconciliation
[Instructor Name]
[Date]
The patient, prescribers and fill records are composites; drug names in brackets stand for the class described, and no real patient is described.
Sources
Ms. [L.], 59, brought a bag of her medicines to the visit. Fill records were obtained from Pharmacy A, a retail chain near her home; Pharmacy B, a grocery store pharmacy near her office; and Pharmacy C, a mail-order service through her insurer. Her prescribers are primary care, cardiology, rheumatology and, once, an urgent care clinic. Reconciliation compares every source against the others and against what the patient actually takes; systematic reviews of reconciliation practice find that structured comparison of sources, done by trained clinicians, reduces medication discrepancies (Mueller et al., 2012).
The Reconciliation Table
Rows are sorted by finding, duplications first, so a prescriber meets the most urgent problems at the top.
1. [Valsartan-hydrochlorothiazide]. Pharmacy A. Primary care. Last fill [Aug 28]. Indication: hypertension. Finding: DUPLICATION, thiazide-type diuretic inside a combination name.
2. [Chlorthalidone]. Pharmacy B. Cardiology. Last fill [Sep 2]. Indication: hypertension. Finding: DUPLICATION with row 1.
3. [Metoprolol tartrate], immediate release, twice daily. Pharmacy A. Primary care. Last fill [Aug 15]. Indication: hypertension. Finding: DUPLICATION, the older form.
4. [Metoprolol succinate], extended release, once daily. Pharmacy B. Cardiology. Last fill [Sep 2]. Indication: palpitations. Finding: DUPLICATION with row 3; a switch started and never closed.
5. [Meloxicam]. Pharmacy A. Rheumatology. Last fill [Aug 20]. Indication: joint pain. Finding: DUPLICATION with row 6.
6. [Naproxen], store brand, over the counter. From her bag. No prescriber. Finding: DUPLICATION with row 5; frequency and amount unknown.
7. [Folic acid]. Pharmacy C, auto-refill. Rheumatology. Last fill [Sep 10]. Indication on record: with methotrexate. Finding: OUTLIVED ITS REASON.
8. [Cyclobenzaprine]. Pharmacy C, auto-refill. Urgent care. Last fill [Sep 12]. Indication on record: back strain, last winter. Finding: OUTLIVED ITS REASON.
9. [Methotrexate]. Pharmacy A. Rheumatology. Last fill [January]. Finding: STOPPED eight months ago; confirms row 7's orphan status.
10. [Potassium chloride]. Pharmacy B. Cardiology. Last fill [Sep 2]. Indication: low potassium. Finding: CLUE, likely a consequence of rows 1 and 2.
11. [Hydroxychloroquine]. Pharmacy A. Rheumatology. Current. Indication: rheumatoid arthritis. Finding: appropriate.
12. [Sulfasalazine]. Pharmacy A. Rheumatology. Current. Indication: rheumatoid arthritis. Finding: appropriate.
13. [Prednisone], low dose. Pharmacy A. Rheumatology. Current. Indication: rheumatoid arthritis. Finding: appropriate; review with rheumatology.
14. [Omeprazole]. Pharmacy B. Primary care. Current. Indication: stomach protection. Finding: appropriate while an NSAID continues.
15. [Atorvastatin]. Pharmacy C. Primary care. Current. Indication: cholesterol. Finding: appropriate.
Why Each Duplication Matters
Two thiazide-type diuretics. Rows 1 and 2 put hydrochlorothiazide and chlorthalidone in one body, the first hidden inside a combination name that does not say "diuretic." Both act on the same transporter in the distal tubule, so together they add little blood pressure benefit and compound their harms: loss of potassium, sodium and magnesium, and a rise in uric acid and glucose (Brunton & Knollmann, 2023). Row 10 is the evidence. A potassium supplement was added to treat low potassium that the duplication likely caused.
Two forms of metoprolol. Rows 3 and 4 are the same drug in two formulations. Cardiology switched her to the extended-release form for palpitations, but the primary care prescription for the immediate-release form was never canceled, and Pharmacy A kept filling it. If she takes both, her total beta-blocker dose is well above what either prescriber intended, with a risk of a slow heart rate, low blood pressure and fatigue.
Two NSAIDs. Rows 5 and 6 combine a prescribed NSAID with one she buys. Two NSAIDs do not relieve pain better than one, but they add gastrointestinal bleeding risk and strain the kidneys, especially alongside a diuretic and an angiotensin receptor blocker, a combination that reduces kidney perfusion from three directions.
Why Two Agents Outlived Their Reason
Folic acid was started because methotrexate interferes with folate metabolism, and folic acid supplementation is recommended with methotrexate in rheumatoid arthritis to reduce its side effects (Fraenkel et al., 2021). When rheumatology stopped methotrexate eight months ago and started [hydroxychloroquine] and [sulfasalazine], the folic acid should have stopped too. It continued because Pharmacy C's auto-refill does not know methotrexate ended at Pharmacy A.
Cyclobenzaprine was prescribed at an urgent care visit for a back strain last winter, a reasonable short course at the time. Mail-order auto-refill has delivered it every month since. It is sedating and has anticholinergic effects, and it has no current indication.
Each leftover agent was reasonable when it started; the problem is that nothing told any source when its reason ended.
The Question for the Patient
The fill records cannot answer the most important question about row 6. How often does she take the naproxen, how much, and for what pain? If she takes it for joint pain the meloxicam is not controlling, the answer is a conversation with rheumatology about her arthritis, not a second NSAID. If she takes it for headaches, a different analgesic may be safer. The reconciliation marks the question and does not answer it.
The Reconciled List (Proposed)
1. [Valsartan] alone, replacing [valsartan-hydrochlorothiazide], with [chlorthalidone] continued; recheck potassium and sodium in one to two weeks.
2. [Metoprolol succinate] alone; cancel [metoprolol tartrate].
3. [Meloxicam] alone, pending the naproxen conversation.
4. Stop [folic acid], after rheumatology confirms.
5. Stop [cyclobenzaprine].
6. Reassess [potassium chloride] after the thiazide duplication is resolved.
7. Continue rows 11 through 15.
Note to the Prescribers
Nothing has been stopped unilaterally. Each proposal goes to the prescriber who owns it.
To primary care: proposals 1, 2, 5 and 6. Your valsartan-hydrochlorothiazide duplicates cardiology's chlorthalidone; please consider valsartan alone. Your metoprolol tartrate appears to predate cardiology's switch to succinate; please confirm and cancel. The cyclobenzaprine from urgent care is auto-refilling; please stop it.
To cardiology: proposals 1 and 6, for agreement on which thiazide stays and on the potassium plan.
To rheumatology: proposals 3 and 4. Please confirm folic acid can stop now that methotrexate has ended, and note that she may be taking over-the-counter naproxen with meloxicam.
To Pharmacy C: please cancel auto-refill on folic acid and cyclobenzaprine once the prescribers confirm.
What Fill Data Cannot Show
Fill records show what was dispensed, not what she swallows. They do not show over-the-counter drugs or supplements she did not bring, samples given in a clinic, doses changed by phone without a new prescription, or whether she takes both metoprolol forms or only one. Only the patient can close those gaps.
References
Brunton, L. L., & Knollmann, B. C. (Eds.). (2023). Goodman and Gilman's the pharmacological basis of therapeutics (14th ed.). McGraw Hill.
Fraenkel, L., Bathon, J. M., England, B. R., St. Clair, E. W., Arayssi, T., Carandang, K., Deane, K. D., Genovese, M., Huston, K. K., Kerr, G., Kremer, J., Nakamura, M. C., Russell, L. A., Singh, J. A., Smith, B. J., Sparks, J. A., Venkatachalam, S., Weinblatt, M. E., Al-Gibbawi, M., ... Akl, E. A. (2021). 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care & Research, 73(7), 924-939. https://doi.org/10.1002/acr.24596
Mueller, S. K., Sponsler, K. C., Kripalani, S., & Schnipper, J. L. (2012). Hospital-based medication reconciliation practices: A systematic review. Archives of Internal Medicine, 172(14), 1057-1069. https://doi.org/10.1001/archinternmed.2012.2246
How this NU553 Unit 3 example is structured
The table is sorted by finding rather than alphabetically, so a prescriber scanning it meets the duplications first. Each duplication is explained by the mechanism that makes it matter: two thiazide-type agents compound potassium and sodium loss; overlapping metoprolol forms risk a slow heart rate and low pressure; two NSAIDs double gastrointestinal and kidney risk without extra benefit. The two leftover agents are traced to the event that once justified them, so the reader sees why each looked reasonable when it started. Nothing is stopped unilaterally. The reconciled list proposes, the note routes each proposal to the prescriber who owns it, and the question about the naproxen is marked for the patient: how often, how much, and for what pain. What fill data cannot show is named in the last line.
Get an NU553 Unit 3 example written to your instructions
Bring the medication list and any fill records from your NU553 Unit 3 case, plus its instructions and rubric; the case can be as long as the section made it. A free first sample returns in 24-48h, sorted by finding, with every duplication explained by mechanism and each proposal assigned to the prescriber who owns it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU553 Unit 3 questions, answered
How is a reconciliation different from a medication list?
A list records what the patient takes; a reconciliation compares sources and decides what should be taken. That means every item needs an indication, a prescriber and a finding, and every discrepancy needs a proposed resolution. Most prompts in this course grade the findings and the reasoning behind them far more heavily than the completeness of the list itself.
Should over-the-counter products and supplements be included?
Yes. Store purchases rarely appear in prescription records, and they are where many duplications live, especially pain relievers and antihistamines. The sample asks the patient directly and records the answer beside the product. If the case never mentions nonprescription use, noting that it was asked about, or should be, still earns more than silence.
Can the reconciliation simply stop the duplicate drugs?
Only if the case gives the author prescribing responsibility for them. Most cases involve several prescribers, and the stronger papers propose a change and route it to the clinician who started the drug, with a reason. Stopping another prescriber's medicine without contact is often marked as a safety and communication failure even when the pharmacology is right.