Medications Interaction

 

Can an 87 years old patient suffering from insomnia, depression, panic disorder be prescribed the following medications at the same time? What are the possible implications?
Trazodone oral, fluoxetine oral, Remeron

 

Sample Solution

Medication Interaction

Insomnia, depression, and panic disorder are commonly seen in elderly populations and is associated with numerous individual and socioeconomic consequences. Elderly patients are more likely to suffer from chronic insomnia characterized by difficulty maintaining sleep than difficulty initiating sleep. Benzodiazepines and generic antidepressants (such as trazodone) are among the most popular classes of medications prescribed for elderly patients. However, trazadone together with mirtazapine (remeron) cannot be used together because it can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, increased heart rate, shivering or shaking, and blurred vision. Pharmacologic therapy should take into consideration the pharmacokinetic and pharmacodynamics changes in drug metabolism that typically accompany the aging process. Caution should be exercised in selecting appropriate medication and medication dosages for treatment of insomnia in elderly patients.

An offer must be recognised from all other statements made in the period of negotiating towards the contract so then offer could be accepted by the other party. However the acceptance must be communicated between the offeror (A&M LTD ) and offeree (Emma )but the terms of the acceptance has to match the terms of the offer. The agreement must be certain. An offer must be distinguished from an invitation to treat. This is because an offer should be clear ,specific and created with an intention to be bound if the offer is accepted. It is important to distinguish an offer from an invitation to treat because “An invitation to treat is where offers are merely invited, and then those being offered something are free to accept or reject the offer.”(Ltd, 2016)

The Yates Building Company v. Pulleyn (1975) case , the method of acceptance can be selected by the offeror, also there is another method of acceptance which can be used in this case where it shows no disadvantage to the parties . The communication of acceptance may be in writing,verbal or the offer could be accepted by conduct. A&M Ltd reached to Mr. Evens with the offer by email but when Mr. Evens accepted the offer ,A&M Ltd rejected the offer and proposed a new offer .

“An offer that provides new terms or conditions becomes a counteroffer. However, the offer may limit, change, or add some or all the terms of the original offer. There is no obligation of either party until they agree on a contract, which occurs once the counteroffer is accepted.”(Investopedia, 2016)

The issue, in this case, is the counter offer at this point , the original offer was terminated . So Mr. Evens can sue the Mr. Neil for breach of contract but the contract does not exist . This is because when the counter offer was introduced to Mr. Evens, the original offer was destroyed, therefore ,the offer is no longer open to Mr. Evens to accept .

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