Pharmacology For Health Professionals

Question:

Discuss about the Pharmacology for Health Professionals.
Answer:

Introduction:

There is possibility of two risks in Fazio due to consumption of these medications. These two risks are gastrointestinal bleeding and hypotension. Bleeding may develop in Fazio due to consumption of enoxaparin and aspirin. There may be hypotension in Fazio due to consumption of metoprolol, perindopril and glyceryl trinitrate.

Enoxaparin is prescribed as blood thinner in Fazio. This drug is administered subcutaneously for venous thromboembolism in Fazio. This drug acts by binding to the antithrombin and forms irreversible complex with it. This leads to the inactivation of clotting facto Xa. Due to inactivation of this clotting factor there is risk of bleeding in Fazio. There are more chances of bleeding if enoxaparin is taken along with other medications like warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen and antiplatelet drugs. Fazio is consuming aspirin also. Moreover, aspirin also has antiplatelet property. Hence, consumption of aspirin along with enoxaparin may lead to bleeding risk in Fazio (Xu et al., 2012; Sonoda et al., 2017). Aspirin is prescribed for pain relief in case of Fazio. Aspirin is non-steroidal anti-inflammatory class of drug. Long term use of aspirin may lead to gastrointestinal bleeding risk. Aspirin acts by inhibiting COX-1. As a result, there are chances of COX-2 upregulation for gastrointestinal tract defense. If aspirin is taken along with other COX-2 inhibitors there are chances of gastrointestinal tract erosion and bleeding (Huang et al., 2011; Iwamoto et al., 2013).

Hypotension may develop in Fazio due to consumption of glyceryl trinitrate . Glyceril trinitrate was prescribed for chest pain in case of Fazio. This medication can also be prescribed for heart failure and high blood pressure. Glyceryl trinitrate was administered through sublingual route and through this route there would be rapid absorption of the drug. Hence, glyceryl trinitrate produces rapid fall in the blood pressure. Glyceryl trinitrate acts by denitration of the nitrates to produce nitric oxide which is a vasodilator. Perindopril acts by inhibiting Angiotensin converting enzyme and improves heart function. Metoprolol is selective β1 receptor antagonist. All these drugs act by different mechanisms and produce blood pressure lowering action. As these drugs acts on different target, hence blood pressure lowering effect would be more. If different drugs act on the same target, there may be less chances of considerable blood pressure lowering due to saturation of target. Hence, consumption of these dugs together can lead to hypotension (Bryant and Knights, 2011; Zhao et al., 2016).

Nurse should play an important role in management of medications in Fazio. Nurse should have information about the drugs, give instruction for its consumption and organize the administration of drugs to Fazio. By virtue of this nurse can prevent risks associated with the administration drugs. Nurse should keep accurate record of medicines which comprises of list of generic and brand names of medicines, dose, frequency of administration, route of administration, dosage of administration and purpose of administration. Nurse should keep record of name, address and contact information of the all the medicine providers. Nurse should keep record of the expiry dates of all the medications. Nurse should display name and telephone number of medication supplier in the medical unit of Fazio. Nurse should not administer enoxaparin and aspirin together because both drugs can exaggerate bleeding property of each other (Iijima and Shimosegawa, 2015). Nurse should not administer both drugs along with other non-steroidal anti-inflammatory drugs and other anticoagulants. Enoxaparin should not be administered in patients with high blood pressure because hypertension exaggerate bleeding property of enoxaparin. Morevoer, Fazio has history of hypertension. Nurse should also monitor blood pressure of Fazio on scheduled time points. If there is more reduction in blood pressure, nurse can consult doctor. With consultation with doctor nurse can stop administration of any one of the medications or can reduce dose of the medicines (Yanagita and Kusanagi, 2016).

For preventing hypotension nurse should give proper instructions to Fazio. Nurse should teach him about medication name, purpose of its administration and its medical effects. In case of metoprolol, perindopril and glyceryl trinitrate  administration, nurse should specifically teach Fazio and his family members about the adverse effects of these medications. Nurse should enquire with him about his concerns related to these medicines.  In case, Fazio is experiencing hypotension, nurse should consult doctor. With the consultation of doctor nurse should make required changes in the medicines. Nurse should keep record of medicine consumption of Fazio. From this record nurse would come to know excess administration of antihypertensive drugs to Fazio which reduces blood pressure (Ignatavicius and Workman, 2015). Nurse should also monitor blood pressure of Fazio on scheduled time points.

Patient participation is very important in medication management. If patient possess all the information about the effects and side effects of the medication, it would be easy for nurse to convince Fazio to continue or stop certain medication. With the knowledge of medication, Fazio can assess himself for effects of medications and inform it to nurse. This would be helpful for the nurse to take timely action and prevent further complications. Due to this participation in medication management Fazio can inform nurse about the inventory of medicines and order medications under supervision of nurse (Richard et al., 2016). Fazio can take medicines on scheduled time in the absence of nurse. In literature, it has been mentioned that time constraint is the major barrier for nurse to look into medicine administration (Vogelsmeier et al., 2011). By incorporation of Fazio in medication management nurse can focus on other tasks in providing nursing services to Fazio. With the knowledge of generic names and trade names, Fazio would not get confused with change in trade name of medicine and would not be worried about consuming wrong medication (Lang et al., 2016).

With incorporation of Fazio in medication management, he would get opportunity to interact with different healthcare providers and learn about medications. By virtue of this, Fazio can use medication therapeutically and safely.  Fazio may require consuming medications for long term. In such case, Fazio should have knowledge of all the medications. Hence, he can take medications on his own without help of healthcare provider. Knowledge of medication for patient also helps to avoid from readmission to the hospital. Involvement of patients in medication management is also helpful in improving the quality and safety of medication management. Patient education about the medications is also helpful in reducing the medication errors. Nurses are susceptible for medication error due handling different patients at the same time. In such case patients can help them in correction of error (Kinney, 2015; Tarn et al., 2012).

Nurse should give encouragement and support to Fazio to improve his role in medication management. Nurse should ask him about medication knowledge. Based on the level of knowledge, nurse can give information to Fazio about medication management. Nurse should ask him names of drugs, action of drug on particular symptom, side effects, dosage and schedule of drugs. By virtue of this nurse would get the information about the level of his understandings about the medical terminologies. If he don’t have much knowledge about the medical terminologies, nurse should give him information in simple language (Tarn et al., 2013). Nurse should also use few pictures and videos to make him understand action and side effects of drugs. Nurse should tell him few stories of regarding medication errors. These stories should be from her experience in the hospital and she should show him documents related to the medication errors. By virtue of this Fazio, may understand the importance of medication management and try to involve him in the medication management (McTier et al., 2015).

Nurse should develop trust relationship with Fazio to improve his involvement in medication management. Nurse should listen to his queries very carefully and answer them in very simple language. This would be hateful in building trust relationship between nurse and Fazio. Fazio may be afraid to participate in the medication management. Nurse should give him confidence that he can do it. This encouragement by the nurse would help in improving willingness of Fazio in acquiring knowledge about the medication management. Nurse should give information about the medication to his family members also. His family members can educate him about medications in simple way and also they can assist him in medication management.

Nurse should also provide suitable environment for Fazio to learn about medication management (Tarn and Flocke, 2011). Nurse should discuss with him about medication management in very relaxed and friendly manner. Nurse should discuss with him at his bedside. Nurse should arrange meetings of Fazio with doctor, hence he would take more interest in learning about medications. Nurse should also encourage him to participate in open discussion with doctor.  Nurse should give Fazio examples of patients who participated in the medication management. This would be helpful as inspiration for Fazio to take part in medication management. Nurse should keep all the discussions related to medication management Fazio centered and there should be continuity in these discussions. Three should be mutual respect and acknowdgement between nurse and Fazio (Mixon et al., 2015).

References:

Bryant, B.J., and Knights, K. M. (2011).  Pharmacology for Health Professionals. Elsevier Australia.

Huang, E.S., Strate, L.L., Ho, W.W., Lee, S.S., and Chan, A.T. (2011). Long Term Use of Aspirin and the Risk of Gastrointestinal Bleeding. American Journal of Medicine, 124(5), 426–433.

Iijima, K., and Shimosegawa, T. (2015). Risk Factors for Upper GI Damage in Low-Dose Aspirin Users and the Interaction Between H. pylori Infection and Low-Dose Aspirin Use. Current Pharmaceutical Design,  21(35), 5056-65.

Ignatavicius, D.D., and Workman, M. L. (2015).  Medical-surgical Nursing: Patient-centered Collaborative Care. Elsevier Health Sciences.

Iwamoto, J., Saito, Y., Honda, A., and Matsuzaki, Y. (2013). Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy. World Journal of Gastroenterology, 19(11), 1673-82.

Kinney R.L., Lemon, S.C., Person, S.D., Pagoto, S.L., and Saczynski, J.S. (2015). The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review. Patient Education and Counseling, 98(5), 545-52.

Lang, S., Velasco, G. M., and Heintze, C. (2016). Patients’ views of adverse events in primary and ambulatory care: a systematic review to assess methods and the content of what patients consider to be adverse events. BMC Family Practice, 17(6). doi: 10.1186/s12875-016-0408-0.

McTier, L., Botti, M., and Duke, M. (2015). Patient participation in medication safety during an acute care admission. Health expectations, 18(5): 1744–1756.

Mixon, A.S., Neal, E., Bell, S., Powers, J.S., and Kripalani, S. (2015). Care transitions: a leverage point for safe and effective medication use in older adults–a mini-review. Gerontology, 61(1), 32-40.

Richard, C., Glaser, E., and Lussier, M.T. (2016). Communication and patient participation influencing patient recall of treatment discussions. Health Expectations, 21, doi: 10.1111/hex.12515.

Sonoda, A., Kondo, Y., Tsuneyoshi, Y., Iwashita, Y., Nakao, S., et al. (2017). Predictive factors for effectiveness and safety of enoxaparin for total knee arthroplasty in aged Japanese patients: a retrospective review. Journal of Pharmaceutical Health Care and Sciences, 3:6.

Tarn, D.M., and Flocke, S.A. (2011). New prescriptions: how well do patients remember important information?. Family Medicine, 43(4), 254-9

Tarn, D.M., Paterniti, D.A., Orosz, D.K., Tseng, C.H, and Wenger, N.S. (2013). Intervention to enhance communication about newly prescribed medications. Annals of Family Medicine, 11(1), 28-36

Tarn, D.M., Paterniti, D.A., Wenger, N.S., Williams, B.R., and Chewning, B.A. (2012). Older patient, physician and pharmacist perspectives about community pharmacists’ roles. International Journal of Pharmacy Practice, 20(5), 285-93.

Vogelsmeier, A. (2011). Medication Administration in Nursing Homes: RN Delegation to Unlicensed Assistive Personnel. Journal of Nursing Regulation, 2(3), 49-55.

Xu, H., Cai, H., Qian, Z., Xu, G., Yan, X., and Dai, H. (2012). Dosing practice of low molecular weight heparins and its efficacy and safety in cardiovascular inpatients: a retrospective study in a Chinese teaching hospital. BMC Cardiovascular Disorders,  12:118.

Yanagita, T., and Kusanagi, H. (2016). Safety and Effectiveness of Enoxaparin as Venous Thromboembolism Prophylaxis after Gastric Cancer Surgery in Japanese Patients. American Surgeon, 82(12), 1232-1237.

Zhao, N., Xu, J., Singh, B., Yu, X., Wu, T., and Huang, Y. (2016). Nitrates for the prevention of cardiac morbidity and mortality in patients undergoing non-cardiac surgery. Cochrane Database of Systematic Reviews, (8):CD010726. doi: 10.1002/14651858.CD010726.