Controlled Release Nifedipine Case Summary

Polypharmacy, described as an individual taking more than four medications, can be concerning with the aging population. Polypharmacy concerns include adverse drug reactions, drug interactions, higher cost, decreased mobility, decreased quality of life and cognition impairment. Those at greater risk of negative polypharmacy consequences include elderly, psychiatric patients, recently hospitalized, individuals with multiple doctors or pharmacies and people with impaired vision or dexterity. There are times that polypharmacy is at times needed to help a person with their diagnosis, an example of this is using multiple medications to treat congestive heart failure which can include digoxin, diuretics, and angiotensin-converting enzyme inhibitors

Make sure you can read the prescription and directions for use. If anything is illegible, ask the prescriber to re-write or type it.

Human health and theIR quality of life have been improving in the past 100 due to changes in medicine and in public health (Mattes et al., 2013). Patients are placed on multiple medications at the same time and it important to understand their safety, efficacy, drug interaction, and toxicity (Mattes et al., 2013). As Mr. Cynthia Nurse practitioner, my job is to understand what affect her prescribing medication is having on her body. I have place Mrs. Cynthia on Lisinopril for her hypertension and metformin for her type II diabetes.

I will override this DUR alert and dispense rasagiline (Azilect) to her. I will tell her that rasagiline is helpful in controlling her Parkinson's disease. The instruction is to take 1 tablet by mouth daily. If she needs to use the EpiPen, use it because it is lifesaving, although she might be experiencing severe and prolonged hypertension symptoms. Informing the medical assistance people that she takes rasagiline and Lisinopril daily, so they would know that they need to carefully monitor blood pressure for her. Rasagiline may cause drowsiness or sleepiness, advise her to avoid activities that requiring mental alertness or coordination such as driving. It may also cause hypotension, orthostatic hypotension, and hypertension. Watching

Ms. Castellanos reports she suffers from arthritis, dizziness, and headaches due to a head injury, hypertension, and cataract (both eyes). Client reports she underwent cataract surgery 10/8/15 in the left eye and 10/25/15 in the right eye. Client continues to reports she is currently taking the following medications: Meclizine 25mg, Simvastatin 40 mg, Gabapentin 300mg, Oyster Shell Calcium tab 500-200mg, Omega-3 Ethyl Esters 1mg, Losartan-HCI 100-12.5mgG, Amitiza 24 mg, and Sertraline. Client continues to report she is seen by Dr. Molinas Alveris tel3 718-4264747 located at 9319 Roosevelt Ave Fl 1, Jackson Heights, NY 11372.

D-This writer agreed to meet with the patient as he was placed hold to attend group. Reported stability on his current dose and denies the need for a dose increase when offered by this writer. This writer reviewed the patient's record and learned that he obtained his 3rd take home bottle on 01/04/2017. The patient is aware that he in order for him to obtained the 4th take home bottle, he must attend the take home bottle group. Addressing his medication, this writer noticed that the patient has not refilled the following medications:

Which of the following should be considered for hypertensive therapy in a 66 Y/O woman with CHF?

Drug therapy always carries risks, but in older populations, that risk is at times amplified due to normal physiological variations. When considering drug therapy for an older

On November 19, 2015, we attended the disciplinary hearings at the Missouri State Board of Nursing. The first case we heard was that of T. O., who had violated the terms of her settlement agreement with the State Board that took effect back in June. Originally disciplined for being under the influence and testing positive for benzodiazepines and opiates, she failed to call the third party administrator of her random drug screens daily on several occasions. She also tested positive for oxazepam on at least one occasion.

* Nursing Implications: This medication is heavily metabolized by the liver therefore do not give to patients if they have elevated liver enzymes or liver disease.

Age plays an important factor when considering prescribing drugs as the very young and the elderly will have difficulty with the metabolism and excretion of drugs. Even the healthiest of the ageing population will have a degree of renal impairment which delays excretion through the kidneys, increasing the duration of action. However when dealing with an acute illness, which are the patients I encounter, a further and rapid reduction in clearance will exacerbate this process. Liver function may also be impaired during acute illness resulting in delayed drug metabolism (Beckworth & Franklin, 2007). Therefore, before any prescribing can take place a diagnosis must be accurately made and underpinned by an understanding of basic pathophysiology eg, a recent review of bloods to assess renal

Moreover, patients may be advised to remove several foods from their diet because of possible side effects that the combinantion of food-drug might have. In summary, the caregiver should inform the patient the drug’s brand and generic names, its purpose, administration routes, potential side effects, and specific precautions to take prior administration of the drug. The patient should show understanding of the taught material back to the caregiver as a summary or

Optimizing drug therapy is an essential part of caring for an older person. The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient's physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation. Multiple factors contribute to the appropriateness and overall quality of drug prescribing. These include avoidance of inappropriate medications, appropriate use of indicated medications, monitoring for side effects and drug levels, avoidance of drug-drug interactions, and involvement of the patient and integration of patient values.

2015). So many strategical methods can be applied to achieve a safety use of the off label medications, such as collaboration of the regulatory agencies, the provider/prescribers and the pharmaceutical companies in determining a common and safe guideline. Also, using the patient’s height and weight to calculate appropriate dosage needed. In addition, a small starting dose should be prescribed and increased dosage gradually as tolerated as long as the liver and kidney functions are within normal range. Finally, parents should be instructed to stop the medication and report to the health care provider once an adverse reactions are

Propranolol HcL drug to drug interactions: general anesthesia, IV phenytoin, and verapamil may cause additive myocardial depression. Additive bradycardia may occur with digoxin. Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. Levels may be decreased with chronic alcohol use. Concurrent use with amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrinemay result in unopposed alpha-adrenergic stimulation (excessive hypertension, bradycardia). Concurrent thyroid administration may decrease effectiveness. May alter the effectiveness of insulin or oral hypoglycemics(dose adjustments may be necessary). May decrease effectiveness of beta-adrenergic bronchodilatorsand theophylline. May decrease beneficial beta cardiovascular effects of dopamine or dobutamine. Use cautiously within 14 days of MAO inhibitor therapy (may result in hypertension). Cimetidine may increase blood levels and toxicity. Concurrent NSAIDs may decrease antihypertensive action. Smoking increases metabolism and decreases effects; smoking cessation may increase effects. May increase levels of lidocaine and bupivacaine.