The problem and how you would address the problem

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. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.

1. A 52-year-old man was recently discharged from the hospital following treatment for atrial fibrillation. He was discharged on Warfarin 5 mg po q day and Amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make?

2. A 44-year-old women is currently taking Glipizide and Phenytoin. She has a new prescription for Ceftriaxone. All three medications are known to be highly protein bound. What effect does protein binding have on drug availability? How would you manage this patient’s medication?

3. Name two drugs that are highly affected by the first pass effect. As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect?

4. James is a 49-year-old male that was prescribed atenolol for his high blood
pressure. James states that he only occasionally takes the medication because he does not like the side effects. What information would you provide to the patient at his visit? How would you manage his medication?

 

 

Sample Solution

Scenario 1:

  • Problem:The INR of 8.8 indicates warfarin toxicity. Warfarin and Amiodarone are known to interact, increasing the risk of bleeding due to Amiodarone’s potential to inhibit Warfarin metabolism.
  • Solution:Consulting a healthcare professional is crucial. They will likely discontinue Amiodarone and adjust the Warfarin dosage or switch to a different anticoagulant medication while closely monitoring the INR.

Scenario 2:

  • Problem:All three medications (Glipizide, Phenytoin, and Ceftriaxone) are highly protein-bound. This means they compete for binding sites on plasma proteins, potentially displacing each other and increasing the free, active drug concentration in the bloodstream, which could lead to toxicity.
  • Solution:A healthcare professional should monitor the patient for signs and symptoms of drug toxicity for each medication. They may need to adjust the dosage of one or more medications or choose alternative medications with less protein binding.

Scenario 3:

  • Highly affected drugs by the first-pass effect:Examples include Propranolol (beta-blocker) and Lidocaine (antiarrhythmic).
  • Prescribing considerations:
    • Increased dosage:May be necessary to compensate for the first-pass metabolism.
    • Alternative route of administration:Bypassing the first-pass effect, such as intravenous (IV) or sublingual administration, might be considered.

Scenario 4:

  • Problem:Medication non-adherence due to side effects.
  • Solution:A healthcare professional will:
    • Emphasize the importance of adherenceto control high blood pressure and prevent complications.
    • Discuss alternative medicationswith potentially fewer side effects.
    • Explore strategies to manage side effects, such as adjusting the dosage or timing of the medication.

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