When discussing with the patient about the medications she takes, she was able to share each medication and understood why she takes it. This is important because it will help her know when to take it. Furthermore, it will help prevent her from taking unnecessary medications. Throughout researching the medications, I did not notice any safety concerns regarding interactions between two or more drugs. This makes sense because the patient has been on these medications for years. However, when looking at the side effects of them, I noticed how some include heartburn. This stuck out because the patient is already on medication to help her frequent heartburn. Hopefully, these other medications are not worsening it. Similarly, dizziness is another common adverse effect I saw throughout the medications she is on. This worries me because the patient has diabetes and if her blood sugar drops, it can also cause dizziness. It is crucial that she checks her blood glucose level frequently, especially if experiencing dizziness, so she can determine what is causing it. Lastly, none of the medications she was on acted in the same way which is good because that could lead to too much of the effect. However, if the patient was on two that worked similarly, I would advise her to mention it to her provider and question if both are necessary.
Client Name: BD Date of Review:10/30/2020
Allergies: (if stated, list effects/response): None
Storage of Medication (How and where does client store medication?): In a designated container on top of her dresser in her bedroom.
Keeps medications in original container? Yes or No. If no, please explain: Yes, she keeps them in their original container.
Access issues (in obtaining meds, trouble opening, reading labels, comprehension, functional issues – i.e. arthritis, hearing deficit, glasses)? No, she does not suffer with any issues that would make it difficult to access her medications.
How many providers does this client use? The client only uses one provider.
List all medications (prescribed, over-the-counter, herbal, supplements) that client takes.
| Drug (generic) | Trade Name | Dose | Where client obtains meds from? | Frequency | Intended Use | Patient Use (if different) | Demonstrates Understanding Yes or No |
| Omeprazole- prescription | Prilosec | 20 mg capsule | CVS | 1 capsule PO once daily in the morning | Heart burn, GERD, | Heartburn | Yes |
| Escitalopram | Lexapro | 20 mg tablet | CVS | 1 tablet PO once daily in the morning | Antidepressant, antianxiety | yes | |
| Metformin | Glucophage | 1000mg tablet | CVS | 1 tablet PO twice daily; one in the morning and one at night | Diabetes | Yes | |
| Atorvastatin | Lipitor | 10 mg tablet | CVS | 1 tablet PO once daily morning | Lowers cholesterol, raises HDL, lower chances of heart attack, slow progression of heart disease | Lower cholesterol level | Yes |
- Based on your review of the above individual’s medications, what do you feel are actual or potential safety concerns surrounding medication administration and why.
One of the long-term medications this patient is on is a 20mg capsule of omeprazole for her frequent heart burn. It works by preventing the acid from being made in the first place (Karch, A., 2011). This medication is non-selective meaning that it has effects all over the body. Some of these effects include headaches, malabsorption, nausea, vomiting and gas (Taylor, C., et al., 2012). The vomiting and gas stuck out to me because heartburn alone is already causing damage to her esophagus and vomiting is going to cause more irritation and discomfort. Also, the gas will likely cause more discomfort, especially if it is coming out as “burping”. Malabsorption is also dangerous because not only will it cause uncomfortable symptoms but a lack of nutrients being absorbed will make it harder for the body to fight infections and easier for bones to break (Medscape).
The patient is also taking escitalopram daily at 20 mg for its antidepressant effects. It does this by balancing the serotonin levels in the brain. Some adverse effects include dizziness, weakness, trouble sleeping, and flu like symptoms (Taylor, C., et al., 2012). Out of these adverse effects, the one that stuck out to me was dizziness because it may be hard to distinguish if it is being caused by this medication or low blood sugar. To help control her blood sugar, she is taking 1000mg tablet of Metformin twice a day. It works by decreasing the production of glucose but increasing the uptake of it. Metformin can cause heartburn, gas and weakness. This could be worsening her heartburn while she is taking omeprazole to help it. Also, the dizziness again could be confused with low blood sugar and gas could cause more discomfort.
Atorvastatin is the last medication the patient is on and she takes a 10mg tablet daily. It decreases her cholesterol and LDL (low density lipoprotein) levels while increasing her HDL (high density lipoprotein). This medication can cause headaches, blurred vision, upset stomach, heartburn, can even liver problems (Karch, A., 2011). As I said before, this is another drug that could be worsening her heartburn. Also, the blurred vision could be dangerous with her operating a vehicle. Lastly, her liver is important in metabolizing most drugs but also plays a role in her glucose levels. Since this drug could cause liver problems, it could do a lot more damage so she should try to control her cholesterol with non-pharmacological treatments.
- Considering concepts of safe medication administration and delivery, how would you approach a teaching plan with this individual to improve the safety of their medication delivery? Consider health care literacy as well as cultural considerations.
The omeprazole should be taken first thing in the morning (30-60 minutes before breakfast) to control her heartburn throughout the day when eating. Since a lot of drugs have vomiting and/or diarrhea as an adverse effect, it is important to monitor her electrolyte levels as diabetes can alter these as well. My patient could also be cautious of laying down after eating meals which could be contributing to her heartburn. Since escitalopram can cause nervousness and excitability, it could interfere with sleep. If she experiences trouble sleeping, I would recommend she talks to her doctor about taking it in the morning instead. She can take them with or without food but if she experiences an upset stomach, I would recommend starting to take it with food or a snack (Taylor, C., et al., 2012). Some nonpharmacological treatments for anxiety include listening to relaxing music, yoga, message, therapy, going for walks, journaling, meditation and even reducing caffeine intake.
On the other hand, metformin needs to be taken with food and should be taken fully (not crushed) with a glass of water. It is important she continues to take it even if she feels good. This medication should be coupled with exercise and a good diet. It is important she knows how to check her blood glucose levels and does this frequently so she can have a control on her diabetes. In addition, if it is low, she should refrain from driving.
It would be more beneficial for her to take the atorvastatin later on in the day/ evening since the body makes more cholesterol at night (Taylor, C., et al., 2012). Grapefruit juice can cause an increase in the serum levels of this drug so I would recommend she stays away from those juices to prevent toxicity. This drug also uses the liver heavily, so it is important that she refrains from consuming alcohol (Karch, A., 2011). As I mentioned before, she should pay attention to what she is eating; I suggest a low cholesterol diet and that she watches her carbohydrate and sugar intake for the diabetes. It is key that she incorporates exercise into her daily routine for this drug. Exercising will in turn also help lower her cholesterol and blood sugar level.
References
Drugs & Diseases.(n.d.). Medscape. Retrieved from https://reference.medscape.com/
Karch, A. (2011). Lippincott CoursePoint for Karch’s Focus on Nursing Pharmacology. [8th edition]. Retrieved from https://coursepoint.vitalsource.com/#/books/9781975157586/
Taylor, C., Lynn, P., & Bartlett, J. (2012). Lippincott CoursePoint for Taylor: Fundamentals of Nursing. [9th edition]. Wolters Kluwer. Retrieved from https://coursepoint.vitalsource.com/#/books/9781975101336/
