An 82-year-old man arrives at the hospital complaining of chest pains. An electrocardiogram reveals congestive heart failure, and he is treated with various drugs, including a diuretic and an ACE inhibitor. His condition stabilizes, and he is discharged. Seven days later, he experiences nausea and confusion. His doctor treats the nausea but does not treat the confusion, assuming it is related to senility. The patient develops a tremor in his hands, which is an adverse effect of the drug prescribed for his nausea. He is given benztropine, which then causes constipation. The doctor gives him docusate tablets for the constipation, but the patient’s confusion increases until he is extremely anxious. Next, the doctor prescribes an antipsychotic, which calms the patient down but results in depression. The doctor prescribes an antidepressant, but the patient soon dies from ventricular tachycardia.

1. What action by the physician may have led to this patient’s death?

2. What are the principles that might have helped the physician make different drug therapy decisions for the patient?

3. What assumptions did the physician make early in the course of therapy that may have been unwarranted or incorrect?