Unit 1 Case Study Polypharmacy PDF

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Unit 2 CAM Paper by: Judith Gregory Submitted in Partial Fulfillment of the Requirements for the Degree of Master Science of Nursing at Herzing University NU 636-8A Advanced Pharmacology Dr. Amber Ennis March 15, 2020

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Mrs. G is an 88-year-old female with congestive heart failure and osteoarthritis. Her son has become progressively worried about his mother’s mental status and the ability for her to perform her usual activities of daily living. For the previous six months, Mrs. G. has shown increased disorientation, weariness, and issues with restlessness. After a complete review of her medications, there are multiple reasons for Mrs. G’s altered mental status and anxiety. Mrs. G’s daily medication regimen include furosemide, paracetamol, piroxicam, Mylanta, and Tylenol. These medications may seem as if they are not harmful to an average healthy patient, but, in conjunction with Mrs. G’s medical history and her age, these medications can cause unwanted side effects that can cause changes in personality and behavior. The use of furosemide and Mylanta can lead to hyperuricemia, hypocalcemia, hypokalemia, and hypomagnesemia, all electrolyte imbalances that can cause disorientation and weariness. (Medscape, 2020). With the combination of Mylanta and furosemide, there is an even higher chance of electrolyte depletion, which increases the risk for altered mental status, lightheadedness, and extreme fatigue. Medications such as paracetamol, piroxicam, and Tylenol, can also increase the possibility of kidney or altered liver functions, especially in an elderly patient with congestive heart failure. (Medscape, 2020). I believe that a combination of the medications Mrs. G was taking, her age, and her existing medical history have caused numerous side effects, which may be alleviated if her medications are adjusted, and the patient must be educated on monitoring her electrolyte balance in her home environment. The high occurrence of many prescription medications combined with elderly patients and their age-related alterations in polypharmacy makes elderly patients

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more susceptible to drug-related problems. (Thijs, Fred, de Lange and Egberts, 2006). Drug-related issues can be averted by the intermediation of the prescriber and the patients. (Thijs, Fred, de Lange and Egberts, 2006). The multitude of medications used by elderly patients can be enlightened by the excessive incidence of multiple comorbidities and the intensified accessibility of medication options in recent years. (Thijs, Fred, de Lange and Egberts, 2006). The dark side of polypharmacy use, also, is the numerous incidences of multiple drug-related problems such as harmful drug reactions, interactions of various drugs, and contraindications of medications. (Thijs, Fred, de Lange and Egberts, 2006). Elderly patients are more susceptible to drugrelated problems due to polypharmacy and injury due to age-associated pathophysiology that leads to reformed pharmacokinetics and pharmacodynamics that makes them more predisposed to adverse drug reactions. (Thijs, Fred, de Lange and Egberts, 2006). Medications arise into the body’s circulation system and are dispersed to direct organs, outlying storage locations in fat or muscle cells, the renal system for elimination, or the liver for filtering and metabolism. (Jacobson, 2013). The aging process modifies the circulation to outlying peripheral tissues due to a decrease in body mass. (Jacobson, 2013). The majority of medications are excreted by the kidneys, which is determined by the glomerular filtration rate. This rate decreases with age, so when a person is 80 years old, the glomerular filtration rate has decreased to about 50%, as well as a decrease in the blood flow to the liver. (Jacobson, 2013). The reduction of hepatic circulation and reduction of glomerular filtration causes a reduction in the metabolization of medications in aging patients, which causes an

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increase in drug concentrations with heightened medication effects and toxic properties. (Jacobson, 2013). This metabolic change is one of the main reasons for Mrs. G’s manners. The use of the above medications has become toxic in her system, causing her disorientation, weariness, and restlessness. Mrs. G also started taking Tylenol thinking it would help her “feel better,” and this led to even more toxic effects on her liver functions. The decline of her liver and kidney functions decreased the ability of her body to process all the prescription and over the counter medications, she was taking, which in turn led to the toxic side effects. Mrs. G should have been educated on the need for routine lab work to monitor her electrolytes, higher intake of fluids such as drinks with electrolytes, and a well-balanced diet. There is an increase in polypharmacy in aging individuals. Many medications are prescribed for similar medical conditions regardless of the probability of toxic effects on the hepatic and renal systems that could be overlooked by family members who would attribute it to the normal aging process. Mrs. G was one of the many individuals that suffered from the overuse of medications. With some modifications to her medications, Mrs. G. should be able to go back to her normal activities of daily living and have normal thought processes. Mrs. G and her son will need to be adequately educated on the warning signs of drug toxicity and electrolyte imbalances.

References:

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Furosemide dosing, indications, interactions, adverse effects and more. (2020, March 04). Retrieved March 4, 2020, from https://reference.medscape.com/drug/lasixfurosemide-342423#4. Jacobson, S., M.D. (2013). Effects of pharmacokinetic and pharmacodynamic changes in the elderly. Psychiatric Times, 30(1), 26-29. Retrieved from https://prxherzing.lirn.net/login?url=https://search.proquest.com/docview/1290583355? accountid= Mylanta dosing, indications, interactions, adverse effects and more. (2020, March 04). Retrieved March 4, 2020, from https://reference.medscape.com/drug/mylanta-mygelaluminum-hydroxide-magnesium-hydroxide-simethicone-341982 Paracetamol Tablet: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing. Retrieved March 4, 2020, from https://www.webmd.com/drugs/2/drug57595/paracetamol-oral/details Piroxicam dosing, indications, interactions, adverse effects, and more. (2020, March 04). Retrieved March 4, 2020, from https://reference.medscape.com/drug/feldenepiroxicam-343300 Thijs, H. A. M. V., Fred H P de, K., de Lange, T.M., & Egberts, T. C. G. (2006). Identification ofmpotential drug-related problems in the elderly: The role of the community pharmacist. Pharmacy World & Science, 28(1), 33-8. doi:http://dx.doi.org/10.1007/s11096-005-4213-4 Tylenol dosing, indications, interactions, adverse effects and more. (2020, March 04). Retrieved March 4, 2020, from https://reference.medscape.com/drug/tylenolacetaminophen-343346

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