Mr. J.D. age 66 years old was

Mr. J.D. age 66 years old was admitted on July 12th, 2021, with a diagnosis of congestive heart failure, diabetes type 2, hyperlipidemia, hypertension, and cellulitis of his left calf. A central line was placed based on Mr. McDougal’s poor vascular status. The patient uses these drugs: Current At – Home Medications: Aspirin 325 mg po daily Digoxin (Lanoxin®) 0.125 mg po daily Carvedilol (Coreg®) 25 mg bid Furosemide (Lasix®) 40 mg bid Lisinopril (Zestril®) 5 mg po bid Simvastatin (Zocor®) 40 mg qhs Glyburide (Micronase®) 2.5 mg daily The physician orders: • Central line dressing as per hospital protocol • Wound care consult- sterile dressing to left thigh daily • Oxygen via nasal canula @ 2 L • Out of bed with assistance • 2000-gram ADA diet • Lactated Ringers 1000 cc to run over 8 hours via central line • Augmentin 500 mg PO q 8 hours, begin the first dose at 8 am – Stronger antibiotic than amoxicillin. • Morphine 5 mg/1mL IM as needed for moderate to severe pain every 4 hours • Hydrocodone 5mg and Acetaminophen 325 mg 5mg tab Q 4 hours as needed for mild to moderate pain – opioid analgesic and antitussive • Tylenol 650 mg PO Q 4 hours for temperature above 100.4 degrees • Fasting blood sugar AC and HS, Sliding scale with regular insulin for coverage as below: • Humulin R insulin sq.; based on ac/hs blood glucose level as follows: – glucose level 0-200 = 0 units – glucose level 201-300 = 2 units – glucose level 301- 400 = 4 units – glucose level > 400 = call physician What are the medication interactions and what could hold the physician order?

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