Introducing Mrs. J

PHARMACOLOGICAL CASE STUDY

Presented by Yvette Johnson, BSNAlverno College Graduate Student

Social/Family History 73YEARS AA woman Widower, seven children & a host of

grandchildren &great grandchildren Lives alone Enjoys spending time with families and

friends Enjoys watching TV and traveling, cooking

and baking Does not exercise regularly/Sedentary

lifestyle Drinks 3-4 beers/day sometimes

Health History

Resistance hypertension/primary aldosteronism

Obesity Liver mass Broader line diabetesHiatal hernia with GERD Diverticulitis OA of knees Peripheral neuropathy

Generic & Trade Name

Dosage Classification/usage

Five Common Side effects

Clonidine/catapres 0.3mg BID orally &0.1mg BID as needed

Therapeutic: antihypertension

Pharmacologic: adrenergics(centrally acting

Drowsiness, bradycardia,hypotension

Withdrawal phenomenon

Diltiazem/Cardizem

240mg/24hours cap-EROrally QD

Therapeutic: antianginals, antiarrhythmic, antihypertensive

Pharmacologic: CCBs

Abnormal dreams, blurred vision, cough, dyspnea,peripheral edema

MEDICATION SHEET

Generic & Trade Name

Dosage Classification/usage

Five Common Side effects

Losartan potassium/Cozaar

100mg orally once daily

Therapeutic: antihypertensive

Pharmacologic: angiotensin ll receptor antagonists

Dizziness, anxiety, hypotension, hyperkalemia, nasal congestion

Nebivolol/Bystolic

20mg orally once day

Therapeutic: antihypertensive

Pharmacologic: beta blockers(selective)

Dizziness, fatigue, HA

MEDICATION SHEET

Generic & Trade Name

Dosage

Classification/usage

Five Common Side effects

Omeprazole/Prilosec

40 mg delayed release capsule once daily

Therapeutic: antiulcer

Pharmacologic: proton pump inhibitor

Dizziness, drowsiness, fatigue, headache, abdominal pain

Spironolactone/Lactone

50mg orally once day & 50mg once daily prn

Therapeutic: diuretics

Pharmacologic: potassium-sparing diuretics

Dizziness, clumsiness, HA, hyperkalemia, muscle cramps

MEDICATION SHEET

Generic & Trade Name

Dosage

Classification/usage

Five Common Side effects

Gabapentin/Neurontin

300mg orally BID

Therapeutic: analgesic adjuncts, anticonvulsants, mood stabilizers

Unlabeled use: Neuropathic pain

Suicidal thoughts, confusion, depression, drowsiness

Acetaminophen/tylenolol

325mg – 650mg q4-6hr(not to exceed 4g/24hr) 4 hours

Therapeutic: antipyretics, non-opioid analgesics

Hepatotoxicity, Rash, urticarial

MEDICATION SHEET

Generic & Trade Name

Dosage

Classification/usage

Five Common Adverse Reaction/Side effects

Ibuprofen/Motrin 400 – 800mg 3-4 times daily as neededNot to exceed 3200mg/day)

Therapeutic: antipyretics, antirheumatics, non-opioid analgesics, NSAID

Pharmacologic: non-opioid analgesics

Headache, dizziness, constipation, dyspepsia, N& V, hypertension

Salicylates/Aspirin

325mg once daily

Therapeutic: antipyretics, non-opioid analgesics Pharmacological: salicylates

GI bleeding, dyspesoa, epigas, nausea, hepatotoxicity

MEDICATION SHEET

Health Insurance Information

Client is connected to a medical home & also followed by a cardiologist

Has both private insurance & Medicare

Out of the pocket cost for medication is a~ $80.00/month

ALCOHOL may interact with ACETAMINOPHEN (in Tylenol Tablets)

This interaction is poorly documented and is considered moderate in severity.

ALCOHOL may interact with ASPIRIN (in Aspirin Tablets) This interaction is poorly documented and is considered minor in severity.

Potential Interactions

Interactions

LOSARTAN (in Losartan) may interact with GRAPEFRUIT JUICEThis interaction is poorly documented and is considered minor in severity.

DILTIAZEM (in Diltiazem Extended-Release Capsules) may interact with GRAPEFRUIT JUICEThis interaction is poorly documented and is considered moderate in severity.

Potential Interactions

SPIRONOLACTONE (in Spironolactone Tablets) may interact with LOSARTAN (in Losartan) This interaction is poorly documented and is considered major in severity.

SPIRONOLACTONE (in Spironolactone Tablets) may interact with ASPIRIN (in Aspirin Tablets) This interaction is poorly documented and is considered minor in severity.

Potential Interactions

ASPIRIN (in Aspirin Tablets) may interact with IBUPROFEN (in Motrin) This interaction is poorly documented and is considered major in severity.

Potential Interactions

ASPIRIN (in Aspirin Tablets) may interact with IBUPROFEN (in Motrin) This interaction is poorly documented and is considered major in severity.

Potential Interactions

Mrs. J’S Concerns

ACTUAL PROBLEMS

Bradycardia – HR 45-48

Significant drowsiness & general weakness secondary to medications

SOB with exertion & Left

lower edema 2+

POTENTIAL PROBLEMS At risk for hyperkalcemia

secondary to medications

At risk for complications secondary to obesity & sedentary life style

Hepatotoxicity secondary to ETOH use and use of drugs with potential for hepatotoxicity

Recommendations: Based on the AHA 2008 GUIDELINES

NONPHARMACOLOGIC

Managed identified risk factors

1. Weight loss

2. Exercise

3. Dietary salt restriction

4. Limited alcohol intake

5. Follow up & routine lab testing of potassium level

HEALTH TEACHING

Drug to drug & food to drug potential interactions

Side effects of medications

Teaching regarding high potassium & high sodium foods

Follow up with cardiologist to monitor bradycardia & fatigue/taper med and then d’c or explore need for pace marker

Medication Recommendations

Avoid ingesting potential hepatotoxic medication with ETOH

Avoid ETOH with centrally acting medications, such as clonidine

Discontinue the ibuprofen and recommend over the counter glucosamine 500mg orally daily or COX2 inhibitor/celecoxib 1oomg BID for osteoarthritis

Enteric ASA & avoid taking ASA @ same time as omperprazole

Discontinue the diltiazem which is causing the SOB & LLE edema

ReferencesClip art. Retrieved from http://images.google.com/Drug to drug interactions sheets. Retrieved from http://www.drugdigest.org/wps/portal

American Heart Association hypertension treatment guidelines. (2008). Retrieved fromwww.aafp.org/afp/2008

Edmunds, M.W. & Mayhew, M.S. (2009). Pharmacology for the primary care provider ( 3rd ed.). St. Louis, MO: Elsevier Saunders