Nursing Case Study: Polypharmacy
explanatory Essay
1095 words
Mrs. A is a 71-year-old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother 's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:
* Furosemide 40 mg daily in the morning
* Digoxin 250 micrograms daily
* Paracetamol
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In this essay, the author
- Describes the unusual behavior of mrs. a, a 71-year-old widow with ccf and osteoarthritis.
- Explains furosemide (lasix) 40 mg daily in the morning used to treat edema associated with congestive heart failure.
- Explains digoxin increases contractility by inhibiting sodium/potassium atpase pump in myocardial cells promoting calcium influx via sodium –calcium exchange pump.
- Explains that paracetamol is analgesic with limited anti-inflammatory activity, used to reduce the pain of osteoarthritis.
- Explains piroxicam (feldene) 20 mg at night: nsaid used to treat mild to moderate pain (osteoarthritis). they work by reducing the levels of prostaglandins.
- Explains that mylanta suspension (magnesium hydroxide) is used to treat occasional constipation and lowers the amount of acid in the stomach.
- Explains coloxyl (docusate sodium) 120 mg, 1-2 tablets at night: surfactant laxatives that work to prevent constipation, are nonabsorbable, nontoxic, and inert.
- Explains that increased bun and loss of sodium may cause confusion in elderly patients.
- Explains that the risk of serious ulcer disease is greater in adults over 65.
- Opines that oxidative reactions of phase i metabolism decline secondary to a reduction in liver volume resulting in decreased drug clearance and an increase in half-life.
- Explains that mylanta suspension (magnesium hydroxide) is not absorbable with routine use, however, with chronic use small amounts may be absorbed.
- Explains that excessive diuresis may cause dehydration and electrolyte loss in elderly people. lower initial dosages and gradual adjustments are recommended.
- Explains that improved cardiac output and renal blood flow through therapy may increase renal digoxin clearance and require dosage adjustments.
- Explains that paracetamol is metabolized by liver and excreted by the kidneys. caution should be used in those with renal function impairment and long-term use has been associated with hepatoxicity.
- Explains that piroxicam (feldene) reduces the flow of blood to the kidneys and impairs kidney function in patients with chf.
- Explains that many antacids are high in sodium and patients with hypertension, chf, marked renal failure, or low-sodium diets should use low sodium preparation.
- Explains that furosemide (lasix) decreases serum potassium, increases the effects of digoxin by pharmodynamic synergism.
- Explains that acetaminophen may decrease renal prostaglandin excretion and decrease plasma renin activity.
- Explains that combining with a diuretic (furosemide) in elderly patients, volume-depleted, or with poor kidney function can result in reduced renal function and lead to kidney failure.
- Explains that digoxin decreases magnesium hydroxide levels by increasing renal clearance, resulting in decreased bioavailability.
- Explains that coloxyl (docusate sodium) has no none interactions, but its detergent properties may facilitate the absorption of other substances in the gi tract, including prescription drugs.
- Opines that older patients are increased risk for hypotension and require careful bp monitoring and patient teaching about mobility due to the increased fall risk.
- Explains the symptoms of digoxin (lanoxin): headache, nausea, vomiting, diarrhea, fatigue, disorientation, depression, and hallucinations. visual disturbances including yellow vision and green halos are common in older adults.
- Describes the side effects of paracetamol, including dizziness, disorientation, rash, nausea, vomiting, constipation and diarrhea.
- Explains that piroxicam (feldene) causes headaches, dizziness, abdominal pain, nausea, and photosensitivity.
- Explains that increased absorption can lead to high magnesium levels that can result in irregular heart rate, shallow breathing, confusion, abdominal pain, and bloody stools.
- Analyzes the problematic nature of the patient's pharmacological management and explains that polypharmacies are the concomitant use of several different drugs and become an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs.
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
- Furosemide (Lasix) 40 mg daily in the morning: Loop diuretic used to treat edema associated with congestive heart failure (CHF).
- Digoxin (Lanoxin) 250 mcg daily: In heart failure, increases contractility by inhibiting sodium/potassium ATPase pump in myocardial cells promoting calcium influx via sodium –calcium exchange pump ("Digoxin," 2015, p. 6).
- Paracetamol (Acetaminophen) 500 mg, 1-2 tablets 4 hourly PRN: Analgesic with limited anti-inflammatory activity (Woo & Wynne, 2011, p. 887). Used to reduce the pain of
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2).
- Digoxin (Lanoxin): Increases serum potassium along with Piroxicam, interaction is possible.
- Paracetamol (Acetaminophen): “Decreased effectiveness of diuretic (Furosemide) because acetaminophen may decrease renal prostaglandin excretion and decrease plasma renin activity”(Woo & Wynne, 2011, p. 891).
- Piroxicam (Feldene): Combining with diuretic (Furosemide) in elderly patients, volume-depleted, or with poor kidney function can result in reduced kidney function and lead to kidney failure (Ogbru, 2015, p. 3). Decreases the effectiveness of diuretics (Furosemide).
- Mylanta Suspension (Magnesium hydroxide): Minor interaction when taken with digoxin since “digoxin decreases the levels of magnesium hydroxide by increasing renal clearance”("Magnesium," 2015, p. 2). This has the greatest ability to absorb or bind to the surface of other drugs, resulting in decreased bioavailability.
- Coloxyl (Docusate Sodium): No none interactions. However, their “detergent properties may facilitate the absorption of other substances in the GI tract, including prescription drugs”(Woo & Wynne, 2011, p. 158).
Discuss potential side effects of the drugs indicated in the
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