Medications in the Work Environment - Case Study Example

Administer and monitor medications in the work environment ADMINISTER AND MONITOR MEDICATIONS IN THE WORK ENVIRONMENT Titus Rock Manickam Order No. 290926 24 April 2009 ADMINISTER AND MONITOR MEDICATIONS IN THE WORK ENVIRONMENT Discuss the oral medications and their adverse drug reactions A number of drugs could be responsible for Mrs. Smith's fall. Mrs. Smith has been taking these tablets prior to her admission in the hospital as the result of a fall she had at home and was found unconscious by her neighbors. These drugs are: Lanoxin PG 62.5 mg, Frusemide 40 mg, and Atenolol 25 mg. Following are the oral medications and their adverse drug reactions. Lanoxin PG 62.5 mcg one tablet mane Lanoxin causes dizziness and could be responsible for Mrs. Smith's fall. It is a good medicine for treatment of cardiac failure where the dominant problem is systolic dysfunction. For certain heart ailments with hypokalaemic complications, Lanoxin may not be suitable. Hence, this tablet must be taken strictly according to the doctor's instructions. There is no mention about Mrs. Smith's age. If she is elderly with impaired renal function and low lean body mass, she has to take lower dose than what non-elderly patients do. Higher dose intake is known to cause dizziness, eye disorders, cardiac disorders, gastrointestinal disorders, and skin rashes (Lanoxin). Frusemide 40 mg one tablet daily Frusemide is used for hypertension as well as congestive heart failure, pulmonary, renal disorder in adults, children and infants. Diuresis is induced in an hour after the intake of Frusemide. Frusemide is rapidly absorbed from the gastrointestinal tract. The dose may comprise 20 mg to 80 mg two to four consecutive days per week, in single dose. If the response is not satisfactory, the dose may be increased by 20 mg to 40 mg after 6 to 8 hours from the first dose intake until the desired dose is established. Symptoms of headache, dizziness, dryness of mouth or visual impairment are known to occur. Patients with cirrhosis of liver are known to develop potassium deficiency. The tablet must be taken strictly under doctor's advice without any chance for overdose (Apo-Frusemide). Span K 600mg 2 tablet TDS p.C. Span K 600 mg is advised for patients with potassium deficiencies, cardiac failure and hypertension. 1 to 2 tablets are taken three times in a day, preferably during meals. This tablet must be withdrawn at once if there is vomiting or abdominal pains. Caution must be exercised for use for patients with chronic renal disease (Span K). Atenolol 25 mg Atenolol is used in treatment of angina and hypertension. It is also used in treatment to prevent heart attack. This medication must be taken with full glass of water and at the same time every day. Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. In case of patients with high blood pressure, it may be necessary to take this drug for the rest of the patient's life. Atenolol can also cause drowsiness, difficulty in breathing, swelling of the face, lips, throat or tongue. If any of these symptoms is noticed, call the doctor at once. Atenolol must be taken exactly as prescribed. Do not stop taking Atenolol without consulting the doctor (Atenolol). Celebrex 100mg SD Celebrex has been used for the treatment of osteoarthritis. It causes reduction in joint pain. Single dose of Celebrex provides pain relief within 30-60 minutes. Celebrex doses of up to 200 mg can be administered without regard to timing of meals. However, care must be taken while administering Celebrex to patients with arthritis. Start use with the lowest recommended dose. Celebrex is known to aggravate hypertension conditions. Also, sometimes, serious gastrointestinal toxicity such as bleeding, ulceration, or perforation of the stomach or intestine has been observed. Patients must stay alert for such symptoms and discontinue use of Celebrex if they occur (Celebrex). Outline if any of these medications would cause dizziness and or lightheadedness As indicated earlier, Lanoxin PG 62.5 mg, Frusemide 40 mg, and Atenolol 25 mg are known to cause dizziness. In Mrs. Smith's case, it is difficult to pinpoint the exact medication responsible for her dizziness and subsequent fall. However, Lanoxin appears to be the drug responsible if Mrs. Smith is elderly since Lanoxin 62.5 mg has a strong effect on the aged. Discuss the safety precautions when administering oral medications The patient must not involve in any type of activity requiring intense physical and mental strain after taking Lanoxin PG 62.5 mg, Frusemide 40 mg and Atenolol 25 mg. These drugs are known to induce dizziness. In the case of elderly patients, it is advisable to administer Lanoxin PG 62.5 mg in two doses in a day after splitting the tablet in half. There must be at least 6 hours gap between the administration of the two half doses. If blood test has to be made, blood should be removed six hours after the last dose of Lanoxin. Those with beri beri heart disease may not respond to Lanoxin if the underlying thiamine deficiency is not treated concomitantly. Frusemide alone may not be adequate for treatment of hypertension patients if such patients cannot be controlled with thiazides. Excessive use of Frusemide could result in dehydration and reduction in blood volume. Overdose could lead to severe renal impairment. Patients receiving Frusemide should be observed for signs of fluid or electrolyte imbalance. Such imbalance could be responsible for dryness of mouth, thirst, weakness, drowsiness, restlessness, muscle pain, muscular fatigue, hypotension, gastrointestinal disturbance and vomiting. Such occurrences may require temporary discontinuation of Frusemide. In the case of Span K 600 mg, it is necessary to withdraw the medication in case of severe vomiting and abdominal pain. Also, for mothers nursing babies it is necessary to either stop the medication or stop breast feeding the baby due to adverse reactions to the babies from oral potassium supplements. For Atenolol, care should be taken that there is no overdose. Such overdose can cause uneven heartbeats, shortness in breath, bluish color fingernails, fainting and seizures. One must not discontinue taking Atenolol without the doctor's advice. Suddenly stopping Atenolol can make conditions worse for the patient. Atenolol is not good for patients with slow heartbeats. Celebrex 100mg SD must be taken strictly under doctor's advice. Celebrex reduces joint paints. But Celebrex increases risks of patients with cardiovascular diseases. Use lower dose for shorter duration. Patients must be told about the risks and steps they must take when symptoms of severe cardiovascular toxicity arise. Explain to Mrs. Smith all about how and when to administer the Frusemide tablets The administration of Frusemide requires certain safeguards and observations. We have come to know that you have a history of cardiac failure, hypertension and osteoarthritis. You have also been diagnosed with a fracture to your femur from the fall that will require surgical repair. Apart from these symptoms, there is little information about your health conditions. There are more symptoms that must be addressed before and during the administration of Frusemide. The normal dose should not exceed 80 mg without clinical observation. Begin with a dose of 20 to 40 mg. If the diuretic response is not satisfactory, keep increasing the dose by 20 mg till the desired diuretic effect is achieved. This medication must be followed consecutively 2 to 4 days per week. Frusemide tablets are prescribed for oedema with congestive heart failure, pulmonary, renal and hepatic disorder. Frusemide causes diuresis within one hour of administration. It is rapidly absorbed from the gastrointestinal tract. Its diuretic effect last six to eight hours after it is taken. Two-thirds of Frusemide is excreted in the urine and the remainder is secreted in the faeces. It is advisable to discontinue Frusemide one week prior to surgery. Dryness of mouth, thirst, weakness, drowsiness, lethargy, restlessness, muscle pains and gastrointestinal disturbances warrant discontinuation of Frusemide at least temporarily. It is necessary to have a high potassium diet during long term therapy. Regular check of urine and blood glucose is necessary if diabetic is prevalent. The patient should be regularly observed for liver damage. Explain all about intravenous therapy, why it's beneficial and the complications involved Intravenous therapy is the administration of liquid substances directly into the vein. It can be continuous or intermittent. Continuous administration is also called intravenous drip. It is the fastest way of delivering fluids and medications into the body. Intravenous therapy is arranged with a syringe and an attached hypodermic needle. The needle is inserted into the vein through the skin and the contents injected through the needle into the bloodstream. The benefits of intravenous therapy lie in quick administration of fluid and medicines into the body system. For some usage such as administration of blood, intravenous therapy is the only way. Its complications lie in its potential to cause infection in case the instruments are not properly sterilized. There is also the fear of injecting the wrong dose and in such cases it becomes very difficult to reverse the mistake. Show calculations formula and setting out The maintenance dosage for Lanoxin should be based upon the percentage of the peak body stores lost each day through elimination. The following formula has had wide clinical use: Maintenance dose = Peak body stores x daily loss in percent 100 Where:- Peak body stores = loading dose Daily loss (in percent) = 14 + creatinine clearance (Ccr)/5 Ccr is creatinine clearance corrected to 70kg bodyweight or 1.73m2 body surface area. If only serum creatinine (Scr) concentrations are available, a Ccr (corrected to 70 kg bodyweight) may be estimated in men as Ccr = (140 - age) Scr (in mg/100mL) NOTE: Where serum creatinine values are obtained in micromol/L, these may be converted to mg/100mL (mg %) as follows:- Scr(mg/100mL) = Scr (micromol/L) x 113.12 10,000 = Scr (micromol/L) 88.4 Where 113.12 is the molecular weight of creatinine. For women, this result should be multiplied by 0.85. (Lanoxin) Explain why or why not you would administer pain relief to Mrs. Smith I would proceed with great care in administration of pain relief to Mrs. Smith. I have to administer pain relief post-surgery to Mrs. Smith. But it has to be done with great amount of care and observation because administration of pain relief increases risk of cardiovascular disease. Mrs. Smith is known to be suffering from cardiac failures. Outline the observations you would perform to assess Mrs. Smith's pain and explain how you would evaluate if the pain medication is effective or not Celebrex is available as 100 mg and 200 mg tablets. Post-surgery I would administer Celebrex 100 mg and this is sufficient to reduce pain in the next 30-60 minutes. Celebrex has tremendous potential to reduce pain. Patients have widely shown tolerance with this capsule. However, Mrs. Smith has cardiac problems. Hence, prolonged use of Celebrex could increase the risk factor of cardiac attack. There are chances that Celebrex may be effective with Mrs. Smith even if she has a history of cardiac failure. If it is effective, I would continue the treatment. In case it is not effective, and Mrs. Smith shows symptoms of cardiac problems, I will discontinue the use of Celebrex at once. Discuss other alternative pain relief methods to Mrs. Smith There is the encouraging use of neuraxial analgesia for the purpose of pain reduction for post operation patients. There is interest in this method especially because apart from pain reduction the patient also recovers fast. Speedy recovery goes a long way in promoting pain reducing drugs. Then there is morphine or hydrocodone administered every 3-5 minutes until hypertension is controlled. The pain is brought down to 60/100 level. Risk or complications, if any, are monitored continuously. This pain relief medication has been used successfully in majority of the cases of post-surgery for cardiac patients (Nader D. Nader et al). Sources: APO - Frusemide, Data Sheet, Information for Health Professionals, http://www.medsafe.govt.nz/Profs/Datasheet/a/Apofrusemidetab.htm Atenolol, Drugs & Treatments, http://www.revolutionhealth.com/drugs-treatments/atenolol Celebrex, Data Sheet, Information for Health Professionals, http://www.medsafe.govt.nz/profs/Datasheet/c/Celebrexcap.htm Lanoxin, Data Sheet, Information for Health Professionals, http://www.medsafe.govt.nz/profs/datasheet/l/Lanoxintabelixinj.htm Nader D. Nader et al, Potential Beneficial Effects of Intrathecal Opioids in Cardiac Surgical Patients, http://www.uam.es/departamentos/medicina/anesnet/journals/ija/vol4n2/ito.htm Span K, Data Sheet, http://www.aspenpharma.com.au/PDF/NZDS/NZDS_SpanK.pdf Read More