Posted: May 24th, 2022
Drug Therapy Case Study
You are on a medical unit and caring for a new admission, Ms. Polly Pharm a 65-year-old grandmother. Polly has the presenting problems of Type 2 diabetes, osteoarthritis and gastritis. Ms. Pharm’s current medication regime is
Glimepiride 2mg mane (morning)
Ibuprofen 200mg tds (3x day)
Lansoprazole 30mg daily
One of the foremost responsibilities of a professional nurse is the proper administration of pharmaceutical drugs and prescription medications. While the correct dosage of a particular medication may achieve the desired effect of minimizing symptoms, managing pain, or reversing an infection’s spread through the system, many of the most commonly prescribed drugs are capable of causing adverse interactions when they are improperly combined. As the nurse in charge of caring for Ms. Polly Pharm, it is critical that I am fully aware of her past intake of certain medications, her propensity for allergic reactions, and any other mitigating factors which may affect the proper administration of vital medications. It is also extremely important that I apprise myself of her current drug regimen, including the dosage and the potency of the medications, to determine whether or not these drugs may actually inhibit here recovery rather than enhance it.
1.) What are the indications and actions of the prescribed medications?
As an elderly individual coping with diabetes mellitus type 2, Ms. Pharm has been prescribed the sulfonylurea Glimepiride every morning, which acts to lower her blood pressure by causing the pancreas to produce increased amounts of insulin (Mims Online, 2011). According to Harvard’s Guide to Drugs, Glimepiride is an “orally active sulfonylurea agent that stimulates insulin release from functioning pancreatic cells” (Tiziani, 2010, 172).
As an elderly women suffering from the typical effects of aging, which include decreased bone density and osteoarthritis, Ms. Pharm also takes an ibuprofen pill three times each day to relieve general aches and pains. Generic ibuprofen is classified as a simple analgesic and is indicated as an effective remedy for the relief of mild to moderate pain (MIMS Online, 2011).
Ibuprofen is also in a class of medications known as NSAIDs, and acts “by stopping the body’s production of a substance that causes pain, fever, and inflammation” (PubMed Health, 2010).
Finally, due to her history of gastritis, Ms. Pharm has been prescribed Lansoprazole, a common heartburn medication which is also known by the trade name Prevacid. Typical indications that a patient would benefit from regular dosages of Lansoprazole include “duodenal and benign gastric ulcers & #8230; in patients with gastritis or duodenal ulcer to heal and prevent relapse of the ulcer” (MIMS Online, 2011). Lansoprazole is classified as a proton pump inhibitor, and acts to achieve significant reductions in the body’s production of gastric acid (Tiziani, 2010, 395).
2.) What are the most common interactions of the prescribed medications including: drug to drug, drug to food / herbal interactions?
Glimepiride is widely known to interact adversely with the following drugs: NSAIDs, salicylates, phenylbutazone, oral anticoagulants, MAOIs, ACE inhibitors, ?-blockers, chloramphenicol, disopyramide, fibrates, rifampicin, azole antifungals, cimetidine, corticosteroids, diuretics, phenothiazines, tetracyclines, quinolones, clarithromycin, allopurinol, probenecid, sulfinpyrazone, cyclophosphamide, and pentoxifylline (Mims Online, 2011).
Continual use of Ibuprofen should be crosschecked with Ms. Pharms medical history to avoid drug to drug interactions with the following medications: Aminoglycosides, anticoagulants, nitric oxide, diuretics, quinolones, antihypertensives, cardiac glycosides, lithium, methotrexate, ciclosporin, mifepristone, other NSAIDs, corticosteroids (MIMS Online, 2011).
Phenytoin, carbamazepine, theophylline, warfarin, oral contraceptives, antacids, sucralfate (MIMS Online, 2011) are the major sources of drug to drug interactions involving regular ingestion of Lansoprazole.
When considering the risk of harmful drug to food interactions, Ms. Pharm would be well advised to avoid consuming foods cooked with garlic, as this common cooking ingredient may pose a risk of hypoglycemia when combined with Glimepiride (MIMS Online, 2011). Ibuprofen poses no serious risk of drug to food reactions, while Lansoprazole should not be taken in con junction with a diet high in spicy or acidic foods.
3.) Discuss six (6) adverse medication reactions of the prescribed medications.
For patients taking a regular regimen of Glimepiride, expected side effects can include nausea, dizziness, diarrhea, and unusual bruising or bleeding (PubMed Health, 2011). The majority of Glimepiride’s known side effects are gastrointestinal in nature, and if symptoms such as “hypoglycemia, GI upset, skin reactions & #8230; hepatic function abnormalities, hepatic failure, hepatitis, jaundice, blood dyscrasias, or transient visual disturbances” (MIMS Online, 2011) occurred in the case of Ms. Pharm, I would advise her to immediately discontinue use in favor of alternative treatment.
Ibuprofen has been known to cause adverse medication reactions when combined with “aminoglycosides, anticoagulants, nitric oxide, diuretics, quinolones, antihypertensives, cardiac glycosides, lithium, methotrexate, ciclosporin, mifepristone, other NSAIDs, corticosteroids” (MIMS Online, 2011). Because patients with a “history of, or active peptic ulcer & #8230; aspirin/anti-inflammatory allergy & #8230; or severe heart failure” (MIMS Online, 2011) can experience gastrointestinal hemorrhaging, Ms. Pharm’s current gastritis condition poses a significant risk and as her nurse I must control her dosages of both drugs with professional precision.
Lansoprazole reacts harmfully when taken in conjunction with “phenytoin, carbamazepine, theophylline, warfarin, oral contraceptives, antacids, sucralfate” (Tiziani, 2010, 396), and again the fact that Ms. Pharm regularly takes an antacid necessitates close and careful monitoring of her drug ingestion to prevent complications.
MIMS Online Database. (2011). Glimepiride. Available: http://www.mims.co.uk/Drugs/diabetes/oral-and-parenteral-hypoglycaemics/glimepiride/. Last accessed 24th Oct 2012.
MIMS Online Database. (2011). Ibuprofen. Available: http://www.mims.co.uk/Drugs/pain/pain-fever/ibuprofen/. Last accessed 24th Oct 2012.
MIMS Online Database. (2011). Lansoprazole. Available: http://www.mims.co.uk/Drugs/gastrointestinal-tract/peptic-ulcer-z-e- syndrome/lansoprazole/. Last accessed 24th Oct 2012.
Tiziani, A. (2010) Harvard’s Nursing Guide to Drugs. 8th ed. Sydney, Australia: Elsevier- Mosby
PubMed Health Online Database. (2010). Ibuprofen. Available: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000598/. Last accessed 24th Oct 2012.
PubMed Health Online Database. (2011). Glimepiride. Available: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000981/#a696016-sideEffects. Last accessed 24th Oct 2012.
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