1. Although most of the medications in this case have a clear indication, the cumulative effect is an enormous drug burden with pernicious ADR potential. Careful consideration is required to balance the potential for benefit for this patient versus a reasonable estimation of life expectancy
  2. Consideration of potential adverse impact of high drug burden on other vital areas, such as nutrition
  3. Strong potential for inadvertent high risk co-prescription for patients on such a long list of medications
  4. Difference in risk between trial populations and frail elderly
  5. Likely to have intercurrent illnesses and stressors requiring acute therapeutic review
  6. Review management of COPD
  7. Opportunity costs and potential savings are significant
  8. This complex medication regimen is likely to put strain on the carer as well as patient, affecting the health of the household