Pharmacology: A Case Study in Polypharmacy

Glucocorticoid - D.Q. should be taught to take this medication with meals due to the possibility of causing ulceration. He also needs to be aware of the possible side effects, including throat and mouth irritation. The use of a spacer can help prevent infections in the throat, as can rinsing his mouth with water after each dose. D.Q should also be aware of side effects which include headaches, euphoria, confusion, insomnia, weakness, nausea, vomiting, or signs of depression (Kee, et al., 2012)

In all cases of treatment, there is an interactive between medicines – for the most part your doctor has the information of drugs reacting with bliatumomab. When this is a known fact, your doctor may change the dose, frequency or suggest an alternative as a precaution before starting treatment.

Epinephrine is a sympathomimetic and rasagiline is a selective MAO-B irreversible inhibitor, the concomitant use causes vasoconstriction, which leads to severe hypertension. This patient uses EpiPen for anaphylaxis reactions, not every day. She needs to go to the emergency room if she needs to use the EpiPen. She also takes Lisinopril, which indicates that she might have hypertension. It's important to counsel her on her new medication as well as the potential drug-drug interaction between rasagiline and EpiPen, watch out for severe and prolonged hypertension if needed to use both medications. Reinforce the importance of knowing the full medication list and let the medical assistant people aware of it. Rasagiline may cause drowsiness or sleepiness, so avoiding activities that requiring mental alertness or coordination. It may lead to hypotension, orthostatic hypotension, hypertension, ataxia, dizziness, dyskinesia, weight loss, constipation, depression, altered mental status or behavior. Avoiding sudden discontinuation of rasagiline would be important. Avoiding food and beverages that have high tyramine contents (more than 150mg) while taking

When being prescribed with controlled release nifedipine, Mrs Luv would be advised to take great caution because she may be more sensitive to the effects of the drug because of her age. She would be instructed to swallow the medication whole (no chewing, breaking or crushing the tablet) with a glass of water and not to abruptly stop taking the medication without consultation with her physician. She would be informed that controlled release nifedipine may

Mr. Botts, age 76, reports to his physician that he is not feeling well and is fatigued. He has a history of a myocardial infarction 6 years ago, glaucoma, and intermittent ankle swelling. His medications are pilocarpine (Pilocar) and timolol (Timoptic) eye drops bid 1 drop both eyes; digoxin (Lanoxin) 0.125 mg daily PO (oral administration), and furosemide (Lasix) 20 mg daily

She is currently on a regimen of garlic and ezetimibe 10mg which is ineffectively treating or dyslipidemia. Ezetimibe which works by inhibiting absorption of cholesterol may only lower LDL by 10% and must be discontinued and replaced with another medication for M.T. (American Association of Clinical Endocrinologist (AACE), 2017). M.T. will be assessed for liver function, renal function and potential history of family intolerance to statins. With no possible complications assessed, M.T. will be prescribed pravastatin 40mg once daily in the evening. She will be instructed to take the medication in the evening for optimum effect and to be aware of possible side effects include GI upset and muscular pain (AACE, 2017). Pravastatin will be used secondary to an increased risk of new onset diabetes with the use of statins and is less common with the use of pravastatin (AACE,

Walking is a simple action that individuals often take for granted in their everyday lives. It is the simple activities though, that hold the key to resolve a hidden issue within the medical community. Psychotropic polypharmacy is the prescription of multiple psychotropic medications for a patient to take, in order to alter the mind. Commonly known psychotropic medications are antidepressants and anxiety medicine. Patients who have psychological disorders like autism, posttraumatic stress disorder, and age related depression often fall victim to psychotropic polypharmacy. The use of activities in a therapeutic way is the answer to diminishing psychotropic polypharmacy in patients. Recreational therapy has the power to heal the mind and body

This drug has many negative qualities, but also has several good qualities. The indications for this drug is to relieve swelling and pain associated with different arthritis’ acute pain, and menstrual cramps. “The contraindications of this drug includes patients who have known hypersensitivity to celecoxib, aspirin, or other NSAIDs, demonstrated allergic-type reactions to sulfonamides, experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAID, treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery, and patients with active gastrointestinal bleeding” (Waknine para. 2 ). The FDA has put out several warning about this product, which include an increased risk of myocardial infarction and a stroke. The continued use of this product also causes problems involving the kidneys, liver, and stomach. The increased uses of NSAIDs are said to break down the lining of certain internal organs. The drug even appeared on the advisory list to be taken off the market because of the serious effects that can result from this. “During the Pre-marketing Controlled Arthritis Trials, the adverse reactions that were seen in the body were Constipation, diverticulitis, dysphagia, eructation, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux, hemorrhoids, hiatal hernia, melena, dry mouth, stomatitis, tenesmus, vomiting, Aggravated hypertension, angina pectoris, coronary artery disorder, myocardial infarction, Allergy aggravated, allergic reaction, chest pain, cyst NOS, edema generalized, face edema, fatigue, fever, hot flushes, influenza-like symptoms, pain, peripheral pain, Leg cramps, hypertonia, hypoesthesia, migraine, paresthesia, vertigo, Deafness, tinnitus, Palpitation, tachycardia, Hepatic function abnormal, SGOT increased, SGPT increased, BUN increased, CPK increased, hypercholesterolemia, hyperglycemia,

It is very important to remember that a health care system is comprised of many parts and members, all having an important role in the function of its evolution. Healing is much more welcomed and prevalent in a system that performs in a balanced and effective way. The purpose of this essay is to incorporate key points about team quality improvement as it relates to my specific nine-month quality improvement plan. This essay will first give some background information about the plan before explaining how specific management techniques may be employed to ensure a smooth and successful health care organization. The essay will also include potential issues that might arrive during this process.

Thank you for your information. You mention an important point to get the initial lab for BUN. I would change to CMP due to Lasix can lead to lower the level of Ca, K and Mg in a person. Loop diuretics reduce K+, Ca++ and Mg++ reabsorption (Wittner et. al, 1991, p1). We can correct the electrolyte imbalance before the treatment and prevent individuals from developing electrolyte imbalance after treatment. In addition, Lasix can cause the renal failure or worse the kidney problem. We can use the BUN and Creatinine to adjust the dose of loop diuretics. "Other side effects include hearing loss, confusion, drowsiness, problems with memory or speech and jaundice " ("Drugs", n.d.). As nurses, we are the eye of a physician. We need to

A heartbeat that is too fast is called tachycardia. A heartbeat that is too slow is called bradycardia” (National Institutes of Health, 2011). Digoxin toxicity, or digoxin digitalis starts with stomach pain, nausea and vomiting, visual disturbances, and bradycardia. These symptoms can be mistaken for the cold or flu. It is important to report any of these symptoms along with a decreased heart rate less than sixty or an increased heart rate above one hundred beats per minute to the doctor. If digoxin is being used with thiazide or loop diuretics, hypokalemia, or a decrease in potassium is common. It is important not to take any beta blockers, or additional antiarrhythmic medications, because it can lead to a slow and decreased heart rate. Sympathomimetics increase the risk of arrhythmias and thyroid hormones decrease therapeutic effects. Licorice needs to be avoided because it increases the risk of potassium depletion and high fiber meals can decrease the absorption of digoxin. If the patient feels that the digoxin is not working, causing flu like signs and symptoms, or feels muscle weakness, muscle cramps or constipation due to not enough potassium, the health care provider needs to be contacted immediately. While the patient is taking digoxin, follow up exams are very important. A blood test is done to check the levels of electrolytes of potassium, magnesium, and calcium as well as kidney and liver

The kidneys are responsible for excreting waste and other things from the body. According to Alpert and Gatlin (2015), “it appears that normal kidney vasculature is maintained until the fourth decade of life whereby a 10% loss in vascular flow occurs each decade”. “Approximately one-half of older individuals eventually develop chronic kidney disease” (Alpert and Gatlin, 2015, page 3). The decrease in kidney function can cause a significant difference in how medications are to be excreted from the body. In addition to reduced kidney function, the liver function and serum albumin levels decrease. A decrease in hepatic blood flow can cause a difference in how the body metabolizes medications. “As we age the amount of serum albumin decreases by 15 to 20 percent” (Alpert and Gatlin, 2015, page 4). Both causing more than normal or possibly toxic levels of these medications in the patients’ blood

Polypharmacy is an essential treatment regimen for patients who suffer from a chronic medical condition that requires different combination drugs, to treat or maintain an individual medical predicament. However, Flesch & Erdmann (2006, p. 217) asserted that polypharmacy could result into multiple quandaries such as patient non-adherence, financial hardship and notably unforeseeable drug interactions. By the same token, Chao et al. (2015, p. 5) believes, polypharmacy can amplify the hazard of geriatric syndromes including, sphincter incontinence, cognitive deterioration, and vestibular impairment.

Polypharmacy is generally defined as the use of multiple prescription and/or over-the-counter medications simultaneously. “The incidence of risk for adverse drug events, reactions, and interactions increases proportionately with the number of drugs taken, such that the use of five or more compounds increase risk for adverse drug events to more than 50% while the use of seven or more drugs results in a risk of more than 80% (Heuberger, 2012).” Having multiple prescribers, different filling pharmacies, medications taken with no clinical indication, and having multiple dose schedules increases the likelihood of polypharmacy (Edlund, 2012). Adverse drug events arise when the effects of a drug are altered by the co-administration of another drug or food substance, causing drug-drug interactions and/or food-drug interactions (Brewer, 2013). These drug-drug and food-drug interactions have been recognized as substantial components that increase the likelihood of morbidity and mortality in patients (Cheng, 2005).

The case study of Mrs. A has numerous factors that constituted in her health problems and manifestations. In her symptomatic scenario, the patient has been presenting some indications comprising of irritability, ostensible obsessive-compulsive behavior, confusion, and fatigue. The patient’s daughter is anxious about her mother's ability to stay independent and wishes to pursue nursing home admission arrangements and the fear that her mother might progress to dementia illness. On the other hand, based on her prescribed medications, several conclusions can be observed.