LTC Pharmacy
A single LTC pharmacy serving SNF + AL + IL residents across the operator's portfolio. Every order runs through deterministic checks: Beers list (AGS 2023), drug-drug interaction pairs, renal-dose adjustments. Major alerts ping the prescribing physician AND the facility DON within minutes.
Active orders
52
12 residents
Major alerts
11
immediate review
Moderate alerts
4
next-shift review
Controlled subs
3
C-II / C-IV reconciliation
Resident regimens (sorted by alert severity)
4 active medications · 4 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| amiodarone | Class III antiarrhythmic | 200 mg | Daily | PO | 50 | — | Drug-drug interaction: Interacts with warfarin: Amiodarone potentiates warfarin → markedly increased INR + bleeding risk. Reduce warfarin ~30-50% and monitor INR weekly. Drug-drug interaction: Interacts with digoxin: Amiodarone doubles digoxin level → toxicity. Reduce digoxin ~50% and check level. |
| digoxin | Cardiac glycoside | 0.125 mg | Daily | PO | 50 | — | Drug-drug interaction: Interacts with amiodarone: Amiodarone doubles digoxin level → toxicity. Reduce digoxin ~50% and check level. |
| warfarin | Anticoagulant | 5 mg | Daily | PO | 50 | — | Drug-drug interaction: Interacts with amiodarone: Amiodarone potentiates warfarin → markedly increased INR + bleeding risk. Reduce warfarin ~30-50% and monitor INR weekly. |
| furosemide | Loop diuretic | 40 mg | Daily | PO | 50 | — | — |
4 active medications · 4 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| spironolactone | K-sparing diuretic | 25 mg | Daily | PO | 28 | — | Drug-drug interaction: Interacts with lisinopril: Both K-sparing → hyperkalemia. Monitor potassium weekly initially. Renal dose: Avoid spironolactone if eGFR < 30 (hyperkalemia risk). |
| metformin | Biguanide | 500 mg | BID | PO | 28 | — | Renal dose: Avoid metformin if eGFR < 30 (lactic acidosis risk). |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 28 | — | Drug-drug interaction: Interacts with spironolactone: Both K-sparing → hyperkalemia. Monitor potassium weekly initially. |
| atorvastatin | Statin | 40 mg | QHS | PO | 28 | — | — |
3 active medications · 2 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| trimethoprim-sulfamethoxazole | Antibiotic | DS | BID | PO | 60 | — | Drug-drug interaction: Interacts with warfarin: Bactrim displaces warfarin → INR rise + bleeding risk. Avoid; substitute alternative antibiotic. |
| warfarin | Anticoagulant | 5 mg | Daily | PO | 60 | — | Drug-drug interaction: Interacts with trimethoprim-sulfamethoxazole: Bactrim displaces warfarin → INR rise + bleeding risk. Avoid; substitute alternative antibiotic. |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 60 | — | — |
4 active medications · 2 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| tramadol | Opioid analgesic | 50 mg | Q6H PRN | PO | 65 | C-IV | Drug-drug interaction: Interacts with sertraline: Serotonin syndrome risk. Avoid combination; substitute analgesic. |
| sertraline | SSRI | 50 mg | Daily | PO | 65 | — | Drug-drug interaction: Interacts with tramadol: Serotonin syndrome risk. Avoid combination; substitute analgesic. |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 65 | — | — |
| atorvastatin | Statin | 40 mg | QHS | PO | 65 | — | — |
4 active medications · 2 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| warfarin | Anticoagulant | 5 mg | Daily | PO | 65 | — | Drug-drug interaction: Interacts with amiodarone: Amiodarone potentiates warfarin → markedly increased INR + bleeding risk. Reduce warfarin ~30-50% and monitor INR weekly. |
| amiodarone | Class III antiarrhythmic | 200 mg | Daily | PO | 65 | — | Drug-drug interaction: Interacts with warfarin: Amiodarone potentiates warfarin → markedly increased INR + bleeding risk. Reduce warfarin ~30-50% and monitor INR weekly. |
| metoprolol | Beta blocker | 25 mg | BID | PO | 65 | — | — |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 65 | — | — |
6 active medications · 3 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| gabapentin | Anticonvulsant | 300 mg | TID | PO | 45 | — | Renal dose: Reduce gabapentin if eGFR < 60 (CNS toxicity risk). |
| amitriptyline | TCA | 25 mg | QHS | PO | 45 | — | Beers list: amitriptyline is a Beers list item — avoid in adults ≥65 unless benefits clearly outweigh risks. |
| cyclobenzaprine | Muscle relaxant | 5 mg | TID PRN | PO | 45 | — | Beers list: cyclobenzaprine is a Beers list item — avoid in adults ≥65 unless benefits clearly outweigh risks. |
| oxycodone | Opioid | 5 mg | Q6H PRN | PO | 45 | C-II | — |
| lorazepam | Benzodiazepine | 0.5 mg | QHS PRN | PO | 45 | C-IV | — |
| omeprazole | PPI | 20 mg | Daily | PO | 45 | — | — |
4 active medications · 2 alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 55 | — | Drug-drug interaction: Interacts with spironolactone: Both K-sparing → hyperkalemia. Monitor potassium weekly initially. |
| spironolactone | K-sparing diuretic | 25 mg | Daily | PO | 55 | — | Drug-drug interaction: Interacts with lisinopril: Both K-sparing → hyperkalemia. Monitor potassium weekly initially. |
| potassium chloride | Electrolyte | 20 mEq | Daily | PO | 55 | — | — |
| metoprolol | Beta blocker | 25 mg | BID | PO | 55 | — | — |
4 active medications · 1 alert
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| glyburide | Sulfonylurea | 5 mg | Daily | PO | 55 | — | Beers list: glyburide is a Beers list item — avoid in adults ≥65 unless benefits clearly outweigh risks. |
| atorvastatin | Statin | 40 mg | QHS | PO | 55 | — | — |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 55 | — | — |
| metoprolol | Beta blocker | 25 mg | BID | PO | 55 | — | — |
4 active medications · 1 alert
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| diphenhydramine | 1st-gen antihistamine | 25 mg | QHS PRN | PO | 70 | — | Beers list: diphenhydramine is a Beers list item — avoid in adults ≥65 unless benefits clearly outweigh risks. |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 70 | — | — |
| atorvastatin | Statin | 40 mg | QHS | PO | 70 | — | — |
| omeprazole | PPI | 20 mg | Daily | PO | 70 | — | — |
3 active medications · no alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| metoprolol | Beta blocker | 25 mg | BID | PO | 50 | — | — |
| atorvastatin | Statin | 40 mg | QHS | PO | 50 | — | — |
| apixaban | DOAC | 5 mg | BID | PO | 50 | — | — |
8 active medications · no alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| apixaban | DOAC | 5 mg | BID | PO | 65 | — | — |
| tamsulosin | Alpha-1 blocker | 0.4 mg | Daily | PO | 65 | — | — |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 65 | — | — |
| amlodipine | CCB | 5 mg | Daily | PO | 65 | — | — |
| atorvastatin | Statin | 40 mg | QHS | PO | 65 | — | — |
| metoprolol | Beta blocker | 25 mg | BID | PO | 65 | — | — |
| levothyroxine | Thyroid hormone | 50 mcg | Daily | PO | 65 | — | — |
| omeprazole | PPI | 20 mg | Daily | PO | 65 | — | — |
4 active medications · no alerts
| Drug | Class | Dose | Freq | Route | eGFR | CS | Alerts |
|---|---|---|---|---|---|---|---|
| amlodipine | CCB | 5 mg | Daily | PO | 75 | — | — |
| lisinopril | ACE inhibitor | 10 mg | Daily | PO | 75 | — | — |
| metoprolol | Beta blocker | 25 mg | BID | PO | 75 | — | — |
| atorvastatin | Statin | 40 mg | QHS | PO | 75 | — | — |
Alert detection is deterministic via lib/verticals/ltc-pharmacy/{detectDrugInteractions, detectRenalDoseIssues, isBeersListItem}. v0.1 covers ~20 high-impact Beers items, 10 major drug-drug pairs, and 6 renal-dose rules; production plugs in commercial DUR engines (Medi-Span / First Databank) for the full ~thousands-of-rules surface.