Four over-the-counter products missing from the chart, an anticholinergic burden score of 9 and two prescribing cascades organize NU569 Unit 8's review of one composite older woman's ten medications. Searches like "nu 569 unit 8 assignment example", "nu569 unit 8 sample" and "nu569 unit 8 example" land here.
Ten Containers From a Grocery Bag: A Geriatric Medication Review That Found Two Prescribing Cascades
[Student Name]
Purdue University Global
NU569: FNP I Clinical - Lifespan Health Focus
Unit 8 Geriatric Medication Review
[Instructor Name]
[Date]
The patient is a composite; doses, scores and values in brackets are illustrative, and each action is a proposal for the prescriber.
How the List Was Assembled
Mrs. [K.], 80, ran the town hardware store with her husband for forty years and still does its books. She was asked to bring every medicine, vitamin and over-the-counter product she takes, and her daughter brought them in a grocery bag. Three sources were compared: the bag, the pharmacy fill history and her own account of how she takes each one. Four products were absent from the chart: a nighttime [acetaminophen] product, [ibuprofen] bought from the pharmacy aisle, daily [aspirin] she started herself, and [meclizine] she buys for dizziness.
The Medication Table
1. [Lisinopril] [10 mg daily]. Reason: blood pressure. Started by: primary care. Beers flag: none alone. ACB: 0. Action: continue; see row 3.
2. [Hydrochlorothiazide] [25 mg daily]. Reason: blood pressure. Started by: primary care. Beers flag: caution for low sodium. ACB: 0. Action: consider replacing; see the cascade map.
3. [Ibuprofen] [200 mg, two tablets, most days]. Reason: arthritis in her hands. Started by: herself. Beers flag: avoid chronic use; avoid with an ACE inhibitor and diuretic. ACB: 0. Action: stop; offer [topical diclofenac] or scheduled [acetaminophen].
4. Nighttime [acetaminophen with diphenhydramine]. Reason: sleep. Started by: herself. Beers flag: avoid, strongly anticholinergic. ACB: 3. Action: taper and stop.
5. [Oxybutynin] [5 mg twice daily]. Reason: urinary urgency. Started by: urology, [two] years ago. Beers flag: avoid, strongly anticholinergic. ACB: 3. Action: reassess after the diuretic change.
6. [Meclizine] [25 mg as needed, most mornings]. Reason: dizziness. Started by: herself. Beers flag: avoid, strongly anticholinergic. ACB: 3. Action: stop once the sleep product is gone.
7. [Omeprazole] [20 mg daily]. Reason: none documented; started [six] years ago. Beers flag: avoid beyond eight weeks without a clear indication. ACB: 0. Action: review reason; taper if none.
8. [Aspirin] [81 mg daily]. Reason: prevention. Started by: herself. Beers flag: avoid for primary prevention. ACB: 0. Action: stop if no vascular disease.
9. [Atorvastatin] [20 mg daily]. Reason: cholesterol. Started by: primary care. Beers flag: none. ACB: 0. Action: continue.
10. [Vitamin D] [1,000 IU daily]. Reason: bones. Started by: herself. Beers flag: none. ACB: 0. Action: continue.
Anticholinergic Cognitive Burden total: 9. On the ACB scale, each additional point has been associated with a decline in cognition, and a total of 3 or more is considered clinically relevant (Boustani et al., 2008). Beers flags are from the 2023 update (American Geriatrics Society Beers Criteria Update Expert Panel, 2023).
The Flagged Rows, Read in This Patient
The risk in each flagged row is sharper in her than in older adults generally. She has had two near-falls in the past month, catching herself on furniture. Her creatinine clearance by Cockcroft-Gault is [44] mL/min. Her daughter reports that her mornings are "foggy" and that she has started double-checking the store's books.
Ibuprofen with lisinopril and hydrochlorothiazide. An NSAID taken with both a diuretic and an ACE inhibitor, a combination sometimes called the triple whammy, was associated with a higher risk of acute kidney injury than the diuretic and ACE inhibitor alone, particularly in the first weeks of use (Lapi et al., 2013). With a creatinine clearance of 44, she has little reserve.
Three strongly anticholinergic products. Diphenhydramine, oxybutynin and meclizine each block acetylcholine in the brain. Together they explain the foggy mornings better than age does, and they add to fall risk through sedation, dizziness and blurred vision.
The Cascade Map
Two prescribing cascades explain most of the list: a water pill that led to a bladder drug, and a sleep aid that led to a dizziness drug. A prescribing cascade occurs when an adverse effect of one drug is read as a new condition and treated with another (Rochon & Gurwitz, 1997).
Cascade 1. [Hydrochlorothiazide], started [three] years ago, increases urine volume, particularly in the hours after the dose. Mrs. [K.] developed urgency and frequency, was referred to urology and started [oxybutynin]. The diuretic's effect was never considered as the cause.
Cascade 2. The nighttime [diphenhydramine] product, which she began taking for sleep after her husband's death, leaves a hangover of sedation and unsteadiness the next morning. She interpreted the morning unsteadiness as dizziness and began taking [meclizine], itself an antihistamine and anticholinergic, which adds to the problem it is meant to treat.
Why Start With the Over-the-Counter Products
The plan begins with products she chose herself, for three reasons. They carry the most harm on her list: the NSAID threatens her kidneys, and the sleep product is the root of one cascade. They are the easiest to stop, since no other prescriber owns them and no one else's plan depends on them. And stopping them first tests the review's central claim. If her mornings clear once diphenhydramine and meclizine are gone, the fog was the drugs; if not, a cognitive evaluation moves forward. Stopping the prescribed products first, oxybutynin in particular, would have taken a drug away while the cause of her urgency remained.
What She Was Told
She was told plainly that nothing she brought was foolish. Each product made sense when she started it, and several were sold to her without a word of warning about the others. The problem is how they add up. She agreed to the first step, the ibuprofen and the sleep aid, on the condition that her hands would not be worse, and that condition is written into the plan: if her hand pain rises, the topical and scheduled acetaminophen doses are reviewed before anything else changes. Her daughter will help her set out the tablets in a weekly organizer so that the tapering schedule is easy to follow.
A Three-Visit Plan
Changes are sequenced so that only one or two shift at a time and any new symptom can be traced to one step.
Visit 1, today. Stop [ibuprofen]; start scheduled [acetaminophen] [composite amount], within the daily limit, with [topical diclofenac] for her hands. Begin tapering the nighttime [diphenhydramine] product: every other night for one week, then stop, with sleep hygiene measures and a discussion of her grief. Watch: kidney function in one week; sleep; hand pain.
Visit 2, in [three] weeks. Stop [meclizine], once the sleep product is gone and mornings are clearer. Stop [aspirin] if she has no vascular disease. Discuss replacing [hydrochlorothiazide] with [amlodipine]. Watch: morning dizziness, blood pressure, falls.
Visit 3, in [six] weeks. If urgency has improved after the diuretic change, taper [oxybutynin] with urology's agreement. Review [omeprazole]'s indication and taper if none. Watch: urinary symptoms, heartburn, cognition, repeated with her daughter's report.
At every visit, the updated list goes into the chart, including the over-the-counter products, and she brings the bag again at the last one.
References
American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C. (2008). Impact of anticholinergics on the aging brain: A review and practical application. Aging Health, 4(3), 311-320. https://doi.org/10.2217/1745509X.4.3.311
Lapi, F., Azoulay, L., Yin, H., Nessim, S. J., & Suissa, S. (2013). Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: Nested case-control study. BMJ, 346, e8525. https://doi.org/10.1136/bmj.e8525
Rochon, P. A., & Gurwitz, J. H. (1997). Optimising drug treatment for elderly people: The prescribing cascade. BMJ, 315(7115), 1096-1099. https://doi.org/10.1136/bmj.315.7115.1096
How this NU569 Unit 8 example is structured
The review moves from source to finding to plan. It opens with how the list was assembled, the bag, the pharmacy fill history and her own account, and records the four products the chart lacked. After the table, each flagged row gets a short paragraph explaining the risk in this patient rather than in older adults generally: her two near-falls, a creatinine clearance of 44 mL/min by Cockcroft-Gault, and a daughter's report of foggy mornings. The cascade map is the analytic center. It draws the diuretic leading to urgency and then to oxybutynin, and the sedating sleep product leading to morning dizziness and then to meclizine. The plan sequences changes across three visits so that only one or two shift at a time, begins with the over-the-counter products she can stop most safely, and names what will be watched after each change.
Get an NU569 Unit 8 example written to your instructions
Paste the medication list from your Unit 8 case, including anything bought without a prescription, along with the prompt and rubric. We sort it against the current Beers Criteria, add up the anticholinergic load, and sequence changes in a plan written for the prescriber, with every dose bracketed. Your first sample is free and arrives in 24-48h. 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.
NU569 Unit 8 questions, answered
Which edition of the Beers Criteria should a review cite?
The current one, which is the 2023 update from the American Geriatrics Society, cited with its year. Earlier editions differ on several drugs, including aspirin for prevention, so an old citation can produce a wrong flag. Many sections also accept STOPP/START alongside it. Name whichever tool you use in the first paragraph so the grader knows the standard.
Do supplements belong in a geriatric medication review?
Yes. Supplements interact, add cost and sometimes duplicate prescribed drugs, and patients often leave them off a list unless asked directly. A review that records them, notes any interaction with the prescribed regimen, and states whether each has a reason to continue is more complete. The sample gives over-the-counter products and supplements the same columns as prescriptions.
What is a prescribing cascade?
A chain of prescriptions: one drug produces an adverse effect, a clinician reads that effect as a fresh problem, and a second drug follows to treat it. A diuretic causing urgency that is then treated with a bladder antimuscarinic is a classic example. Graders reward reviews that spot a cascade, because stopping the first drug can remove the need for the second and the risks it carries.