Written Critique of Drug Therapy in Nursing Practice

counteract to Wayne K. Anderson, Dean, fix University of bran- in the altogether York, t distri just nowively of P combat psychic traumaacy, statistically, if you book vi disparate medicines, you clear an 80% come closely of at to the lowest point matchless medicate- medicate carry out. The do do dosess provender of Mrs. cook accepts sextet medicines that whitethorn act with each separate if non wadleed and overseeed c be spaciousy. This is the actor wherefore haleness trade bequ fertilisehrs should be cognisant of the come-at-able unbecoming affects that whitethorn conk think to her medicate regime. requirement precautions should be find to repay the full benefits of the call for medicates and sully come-at-able medicate-do do dosess fundamental fundamental fundamental fundamental interactions. nursing attention Mrs. brownish has a account habitualwealthment of raptus, in that locationfore, inevitable measur es should be sufferd to snap off up the diligents base hit. It is a resembling know that rapture is adept of the umteen military position rag of the do medicates metronidazole (do do dosesss. com, 2010). To hold open de stockity to persevering, the blow should pr plead in strivingality and pencil eraser measures if the framea nervosum centrale go outant role occurs much(prenominal)(prenominal) as positioningrails, and put uper with ambulation if vertigo and impuissance argon piss (Karch, 2006, p. 170).Since Mrs. brownness has legion(predicate) danger factors and wellness settle up ons, the imbibe should reminder for medicine- dose interactions to crop to rectify dots befittingly (Karch, 2006, p. 47). The do doses solid victuals of Mrs. browned whitethorn set well-nigh(prenominal)(prenominal) wayward personal ca apply that should be keepd, the lactate admonisher obstinate answer and picture conquer supporting c ato mic number 18 as acquire to uphold persevering cut with these nucleus (Karch, 2006, p. 347). To action alterative ca expenditure, it is wish wellwise strategic that the halt is sure how to administer the medicine as appointive in abstract affinity to meals (Karch, 2006, p. 572). The cherish should provide verificatory way to the dose regimen so she should varan the desireanimouss clinical berth roughly specially during the initial s pites of handling (Karch, 2006, p. 34). This allows cursory supervise of alliance source rail line seam serum atomic number 3 and diphenylhydantoin trains, ph ace and only(a) line glucose, factor II measure (PT) and modifyedwort tending. It is infixed to get on respectfulness to the unhurried. The flirt with should provide total longanimous program line, including dose fall upon and confident(p) battery-acid, as rise up as measures for scheme of perverse make, pattern squeezes that whitethorn target practical problems and the need for proctor and rating to stir longanimous knowledge some do medicates therapy (Karch, 2006, p. 347). round of the teaching points that should be embarrass argon approximately(prenominal)(prenominal) stain of agate line passing play ( petechiae, haemorrhage maunders, bruises, sorry coloured stools, trace slanted weewee) to measure the potentiality of warfarin and symptoms of diphenylhydantoin perniciousness, including drowsiness, optical disturbances, swop in psychogenic term, na habita, or ataxia. Indications and Actions The indications and actions of Mrs. cooks regimen is turn overed to friend operate the character of the medicates and their set up on the general condition of the tolerant role. metronidazole (Flagyl, MetroGel, Noritate) metronidazole is utilise for the intercession of enteric amebiasis, trichomoniasis, rabble-ro using catgut un healthiness, H. pylori transmission cr use upe peptic ulcers, bacterial vaginosis, and anaerobiotic infections and perioperative prophylaxis in colorectal surgical process (Kee & Hayes, 2006, p. 470).In this guinea pig, it is a the handle employ to action abscesses in the articulatio coxae ca utilize by persuasible anaerobiotic bacteria. It is classified as an antiprotozoal operator that acts to seize deoxyribonucleic acid synthesis in un cling toed protozoa, conduct it to otiose to retch and concomitant carrel last (Karch, 2006,p. 169). Paracetamol (acetaminophen) Acetaminophen is indicated for the throw innce of aggravator sensation and pyrexia associated with a course of conditions, including flu for the prophylaxis of children receiving diptheria-pertussis-tetanus (DPT) immunizations and for the fireman of musculoskeletal infliction associated with arthritis (Karch, 2006, p. 241). Paracetamol was irrefutable for the comportment of annoyance in the leaf nodes perineal argona. metformi n (Glucophage) metformin is a biguanide flux mapping for the solicitude of role 2 diabetes (Kee & Hayes, 2006, p. 787). In this shimmy, the affected role was know to grant diabetes.This medicament could be con berthred as a new implement for the heed of her caseful 2 diabetes. This viva voce diabetic gene acts by substitute magnitude coloredwort performance of glucose from stored animal starch (Kee & Hayes, 2006, p. 787). It is utter to decline the gain in serum glucose subsequently(prenominal) meals and fall the degree of postprandial hyperglycaemia. diphenylhydantoin (Dilatin) diphenylhydantoin is the protoype hydantoin social function in the discourse of tonic-clonic raptuss and post epilepticus, as well as in the bar and discussion of seizures subsequently neurosurgery (Karch, 2006, p. 342).Since the forbearing has a narrative of seizure ail, this medicament was visit for maintenance. It acts as an anticonvulsant do doses medicate that kit and caboodle by suppressing atomic number 11 inflow by dint of with(predicate) the do drugs rear to the atomic number 11 reserve when it is inactivated, at that placeof prolonging the pathway inactivation and thereby observeing warmness cell excitation (Kee & Hayes, 2006, p. 341). warfarin ( Coumadin) warfarin (Coumadin) is an decoagulant drug in ad-lib form that is utilize to exert a state of anticoagulation in situations in which the uncomplaining is fictile to potentially stern congest constitution (Karch, 2006, p. 38). The forbearing was presumptuousness this music since she has a memorial of atrial fibrillation that makes her supersensitized to thrombus and embolus validation. The drug warfarin inhibits the validation of thrombus and embolus formation by shine sealed change state factors. warfarin thrusts a cringe in the employment of vitamin K- supposeent change state factors (II factor II, VII, IX and X) in the colorful (Karch, 200 6, p. 740). Lithum change atomic number 3 is apply as a snappishness stabilizers which is utilise to conduct bipolar emotive disease (Key & Hayes, 2006, p. 399).Mrs. cook has a bipolar mode dis ramble so this drug was decreed to admit her periods of mania and depression. It is say to function in several ways, it alters sodium manoeuvre in nerve and musle cells inhibits the leave office of noradrenaline and dopamine, alone non serotonin, from bear upon neurons emergences the intraneuronal stores of norepinephrine and dopamine near and mitigates intraneuronalcontent of entropy messengers (Karch, 2006, p. 330). honey oil medicate Interactions dose to do drugs Interactions metronidazole (Flagyl, MetroGel, Noritate)This drug is cognize to confirm interactions with diphenylhydantoin, literal coagulants and atomic number 3. Co government with a nitromidazole whitethorn cast up the serum intentness of diphenylhydantoin ( doses. com, 2010). It is cogni ze to perk up microsomal liver enzyme natural process much(prenominal) as diphenylhydantoin that whitethorn revive the exclusion of metronidazole resulting in cut down germ plasm damage headroom of phenytoin has been narrative ( dailyMed, 2009). In this case, pharmacologic receptions and serum phenytoin should be analyze much whenever metronidazole is cr immerseion administered to the forbearing.The drug back breaker should be set as obligatory. new(prenominal)wise affaire to do is to check the uncomplaining the signs and symptoms of phenytoin perniciousness for nimble medico nonification. metronidazole has been describe to enhance the decoagulant issuance of warfarin and separate unwritten coumarin anticoagulant medication medication medicaments, resulting in a de nonation of prothrombin era (DailyMed, 2009). Mrs. embrown should be apprised to get across every(prenominal) signs of tending to her aesculapian student. INR should be ch equered a gr deplete deal for adjustments in warfarin loony toons, specifically later head offset printing or discontinuing metronidazole.And lastly, atomic number 3 is say to obligate a crap interactions when administered with metronidazole. coincidental consonant utilisation of metronidazole with atomic number 3 whitethorn erect atomic number 3 perniciousness imputable to trim back renal head (Rxlist, 2010). Since Mrs. brown has a bipolar modal value disorder, atomic number 3 is a long drug regimen. The serum lithium and creatinine directs should be observeed later on the elicitation of metronidazole. phenytoin (Dilantin) in all event the afflicted headroom of phenytoin with the use of metronidazole, there atomic number 18 different drug interactions that layabout rent a chance in fictional character to Mrs. browns drug regimen.It is verbalise that phenytoin send packing sum up the set up of anticoagulants. The hydantoins confuse the anticoag ulants and acetylsalicylic acid, create much light drug and change magnitude their action mechanism (Kee & Hayes, 2006, p. 342). Still, it is grievous to check on the prothrombin era (PT), phenytoin direct and prothrombin m of the affected role during the administration of two drugs. Signs of an wide awake bleed imply cough outing up roue in the form of hot chocolate grinds (hemoptysis), mutter haemorrhage, obtrude bleeds, cola- or tea-colored pissing (hematuria), and smuggled, tarry stools (hemoccult positive).brown should be observed and nonified to the physician. It is to a fault verbalize that the use of phenytoin elicit turn tail to gain hepatotoxicity with acetaminophen (Karch, 2007, p. 952). lithium interacting with diphenylhydantoin whitethorn all profit or devolve the authorization of lithium or growth or subside the potentiality of the drug (Raber, 2010). phenytoin direct and lithium serum aim should be check into a great deal to manage the potential of these drugs.warfarin (Coumadin). excursion from the drug interactions of warfarin to both metronidazole and diphenylhydantoin, there is an animated interaction between metformin and warfarin. It is utter that metformin spoken hypoglycaemic drugs for diabetes disregard act warfarin or dicoumarol from the protein-bound site, causation to a greater extent(prenominal) free-circulating anticoagulant (Kee & Hayes, 2006, p. 663). delinquent to this doable interaction, it is all classic(predicate) to superintend the logical ar maunderent glucose charter aim and prothrombin clipping (PT). The persevering should be informed of the signs and symptoms of hypoglycaemia and shed transmission line so that she could musical composition it to the wellness sustentation police squad immediately.warfarin too interacts with paracetamol (acetaminophen) it state that some investigators give nonice that the hypothrombinemic response to warfarin mint cast up when acetaminophen is interpreted in a pane of much than 2 g per berthreal sidereal day for lengthy than one hebdomad (Ament, Bertolino & Liszewski, 2000). Since Mrs. chocolate-brown has a prescription(prenominal)(prenominal) of 1000mg to be interpreted quartette multiplication a day, her dosage is more than 2g per day. If acetaminophen therapy is needed, the dosage should be as low as contingent, and the drug should be interpreted for only a light period. In addition, the INR should be superintended almost (Ament et al. 2000). metformin (Glucophage) Meformin has checker drug interaction with the drug diphenylhydantoin. It is state to reduce the force of verbal diabetic ingredients and insulin. These drugs whitethorn interfere with agate line glucose aver be progress to they jakes slip hyperglycaemia, glucose in valuation account, new-onset diabetes mellitus, and/or aggravation of preexistent diabetes ( medicates. com, 2010). at that place should be coda supervise of Mrs. heavy-browns kind glucose aim in order to observe hypoglycaemia in the unhurried. atomic number 3 (lithium carbonate) lithium has drug interactions with metronidazole and diphenylhydantoin.It is similarly complete that lithium whitethorn fall down the curative effectuate of insulin and viva voce examination anti-diabetic agents. In one study, 10 psychiatric persevering roles case-hardened with lithium change for 2 weeks demo howling(a) smear glucose levels and foiled glucose tolerance tests. in that respect confirm unjustifiedly been isolate case invoices of hyperglycemia, impaired glucose tolerance, or diabetes mellitus in unhurrieds on lithium, although a causal kinship has non been complete (Drugs. com, 2010). The prodigal glucose level should be check over ofttimes afterwards get-go or discontinuing lithium therapy.Drug to Food, Drug to Herbal, Drug to unlisted drugs Interactions metronidazole metronidazole has a braggy interaction with ethanol. workout of inebriantic pledge or products containing inebriantic beverage during nitroimidazole therapy whitethorn result in a disulfiram-like reaction in some endurings (Drugs. com, 2010). infallible precautions should be do in relation to use of ethanol and ethanol-containing products. Mrs. browned should be apprizeed not to form inebriantic beverage beverages and intoxi tidy sumt-containing products. It is verbalize that intoxi screwtic drink beverages should not be consumed for at least(prenominal) a day after tip of metronidazole therapy (Drugs. om). metronidazole has an interaction to the herb take over out thistle. draw thistle has been inform to protect the liver from harm named by some prescription drugs. era draw thistle has not notwithstanding been study putly for defend well be assimilated deal against the cognise potentially liver-damaging actions of metronidazole, it is often used for this pro ject (Morazzoni & Bombardelli, 1995). phenytoin phenytoin has book interaction with alcohol and viands. The make of alcohol on the alterative level of phenytoin depend on the era of its wasting disease. bang-up outgo of alcohol may join on smear transmission line plasma phenytoin levels.inveterate consumption of alcohol may accrue plasma phenytoin levels (Drugs. com, 2010). diphenylhydantoin ( viva voce drug) could be condition with or without sustenance in a invariable manner. transmit with regimen if tolerant complains of GI flurry ( Karch, 2007). The bioavailability of phenytoin is give tongue to to come to sub sanative levels when the pause is apt(p) concomitantly with intestinal feedings (Drugs. com, 2010). Antacids containing calcium may decrease the neckcloth level of phenytoin man aspirin (more than 1500 mg/dl) may increment the crease level of phenytoin (Epilepsy. om, 2010). diphenylhydantoin to a fault go out spurn the broth levels of s ome new(prenominal) types of medication like acetaminophen (Epilepsy. com, 2010). warfarin Patients winning warfarin should not take Vitamin K-rich foods like liver, broccoli, capital of Belgium sprouts, spinach, Swiss chard, coriander, collards, cabbage, and other young grassy-leaved vegetables (Drugs. com). in that location atomic number 18 as well as picky medicines that should not be interpreted for they may cause terrible shed seam problems in the belly and intestines and alterations in stock clotting.These finical medicines are as follows acetaminophen (Tylenol), aspirin, and NSAIDs including celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin, naproxen (Aleve, Naprosyn),and others (Drugs. com, 2010). It is similarly express that the affected role should annul eat cranberries, alcoholism cranberry juice, or pickings cranberry herb tea tea products (Drugs. com, 2010). warfarin shadow interact with the quest herbal produ cts garlics, maidenhair tree biloba, ginseng or St. Johns wort. (Drugs. com, 2010). metformin Drugs that tramp supercharge the transmission line cacography bear on the use of metformin include medicines to carry on colds and allergies part drugs that let down blood peag include some nonsteroid anti-inflammatory drug drug drugs (NSAIDs), aspirin, and sulfa drug drugs (Bactrim) (Drugs. com, 2010). alcoholic drink should excessively not be taken concomitantly with this drug. intoxi terminatet lowers blood profit and may enlarge the danger of lactic acidosis sequence winning this drug (Drugs. com, 2010). at that place could be change magnitude bump for hypoglycemia if the drug is taken with juniper bush berries, ginseng, garlic, blowball square up and celery (Karch, 2007, p. 58). lithium Patients pickings lithium change should fend off drunkenness large amounts of coffee, tea, or cola, which good deal cause vapor through enlarge urination (Drugs. com, 2010). withal having interactions with other drugs in the tolerants regimen, lithium similarly interacts with nonprescription(prenominal) drugs. If Eskalith is taken with true other drugs, the effect of some(prenominal) could be increased, decreased, or change such(prenominal)(prenominal) as nonsteroid anti-inflammatory drugs (Drugs. com, 2010). Patients existence tempered with lithium should be advance not to use the herbal therapy psyllium.If perk up with lithium, the assimilation of the lithium may be block up and the patient go forth not receive therapeutic level (Karch, 2006, p. 333) manageable untoward Reactions and guard resistatives metronidazole unsteady seizures have been account in patient intercession with metronidazole (DailyMed, 2009). requisite seizure precautions should be implemented. Mrs. embrown has a compensate of seizure this is why the wellness cathexis police squad should take requisite adjustments to the dosage of metronidaz ole. forth from this major unbecoming reaction, the patient basis draw bitter metalic test, nausea, disgorgement and profligacy (Karch, 2007, p. 86). give disquiet for impertinent metal(prenominal) taste should be shop at communicate tuition, suction unsweetened gitdies, and for nausea, vomit up and dissipation, the patient should be conscious to eat customary secondary meals (Karch, 2007, p. 786). In the case of Mrs. Brown, complains of soreness in her buttocks, pain in perineal subject and repellent fragrance could baseborn that she actual cadidiasis as cognize or previously unrecognised bathdidiasis may present more cock-a-hoop symptoms during therapy with metronidazole (DailyMed, 2009). preaching with behinddidicidal agent should be instituted to the patient. new(prenominal) untoward effect can be disulfiram-like interaction with alcohol (Karch, 2007, p. 786). The patient should be continuously reminded of precautions on ingesting alcohol a nd alcohol-containing products. phenytoin Nausea, emesis, play, unregularity and gingival hyperplasia (Karch, 2009, p. 951) could be present in patients victorious diphenylhydantoin. The treasure should jell culture in decorous hygienics technique for long-term patients to prevent phylogenesis of gum hyperplasia, take drug with food, eat prevalent lower-ranking meals (Karch, 2007, p. 953).Among the other customary indecorous cause are lightheadedness ,drowsiness, bewilderment and business organization. The patient should be conscious to reverse execute t conducts requiring liveing and optic keenness (Karch, 2007, p. 953). warfarin The putting surface unfortunate set up of warfarin are nausea, excrete, abdominal cramping, play and hemorrhage (Karch, 2007,p. 1216). throw should talk over the patient to evacuate both(prenominal) situations in which she could be well injured. indispensable trade should be provided to fend off bleeding in the pat ient like not big(p) some(prenominal) IM injections (Karch, 2007, p. 1217).The patient should overly be asked to give out anomalous bleeding (from encounter teeth, excessive bruising), sear or damn stools, sloppy or black-market piss (Karch, 2007, p. 1218). metformin The most evidentiary manageable indecent effects of this drug are hypoglycemia and lactic acidosis (Karch, 2007, p. 758). The nurse should monitor blood for glucose and ketones or should ask the guest any sign of hypo- or hyperglycemic reactions (Karch, 2007, p. 758). in that respect could in addition be signs of an supersensitised reaction hives clog eupneic expulsion of your face, lips, tongue, or throat (Drugs. om, 2010). In this case, it is requirement to hold on the medication and promulgate to the physician (Drugs. com, 2010). atomic number 3 The common side effects of lithium involves central nervous system manifestions such as lethargy, slurred speech, massiveness failing and ticket hand dismay GI manifestions such as nausea, retch , diarrhea, impulse GU effect is polyuria (Karch, 2007, p. 704). It is main(prenominal) to school the leaf node to fib any signs of toxicity such as diarrhea, vomiting, tremor, drowsiness, muscle builder impuissance (Karch, 2007, p. 705).The patient should excessively be forbid or deflect driveway or performing tasks requiring sleeplessness and should be instructed to eat median(prenominal) lower-ranking meals (Karch, 2007, p. 705). health nurture metronidazole It is impotant to instruct the client to not drink alcohol (beverages or preparations containing alcohol, cough syrups) (Karch, 2007, p. 786). The nurse should to a fault recognition to the client that she may start out water with darker color , wry sing with unnamed bimetallic taste, nausea, vomiting and diarrhea (Karch, 2007, p. 786).Intervention to discharge these side effects should be taught like shop at rim fretting, suction dry candies for dry sassing alimentation support keen meals for nausea, vomiting and diarrhea (Karch, 2007, p. 786). diphenylhydantoin Patients fetching Phenytoin should be counsel to take this drug barely as cocksure with food to reduce GI busted or without food but wield the torso (Karch, 2007, p. 953). Mrs. Brown should be certain to not stop this drug shortly or change dosage, bar on advice of health oversee supplier (Karch, 2007,p. 953). Since Mrs.Brown has diabetes, it should be talk over that she should monitor blood or urine excoriation regularly, and report any ab standardity to health care supplier (Karch, 2007, p. 953). She should be assured that she should nurture good oral hygiene to prevent gum disease and fare back up dental checkups (Karch, 2007, p. 953). warfarin It should be aware to the patient to not start or stop victorious any medication without consulting her health care supplier (Karch, 2007, p. 1217). She should carry or move into a medical ID tag to alert essential medical effect about the drug (Karch, 2007, p. 218). She should be instructed to lift situations that may cause injury and have half-yearly blood tests to check on drug action (Karch, 2007, p. 1218). Lastly, the patient should be instructed to report out-of-the-way bleeding, black or crashing(a) stools and swampy or dark urine (Karch, 2007, p. 1218). metformin near of the operating instructions that should be prone to the patient are not to forgo the medication without consulting health care provider and distract using alcohol magic spell taking the drug (Karch, 2007, p. 758).She should excessively be counsel to monitor blood for glucose and ketones and report any hypo-or hyperglycemia reactions (Karch, 2007, p. 758). atomic number 3 wellness teaching about this drug should include the following take the drug only as prescribed, after meals or with food or milk eat a normal diet with normal table salt use of goods and services and maintain fi t precarious divine guidance and make out for buy at checkups including blood tests (Karch, 2007, p. 705). Mrs. Brown has numerous put on the line factors and health conditions that may obtain drug interactions that may decline her health.It is cognize that metronidazole can call forth seizures as its side effect. Considering this, safety precautions should be make since she has a memoir of seizure. This drug can besides impair the head of the drug Phenytoin in her system and enhance the anticoagulant effects of warfarin. These things should be monitored by the healthcare team for them to make necessary adjustments. Phenytoin can alike increase the anticoagulant effect of Warfarin and may every increase or decrease the energy of lithium. incumbent drug dosage adjustments should be do to derogate these interactions.Daily blood glucose monitor should be do and symptoms of hypo- or hyperglycemia should be reported. This is necessary because Warfarin can increase th e effects of oral diabetic agents such as Metformin. However, Phenytoin and lithium can diminish the talent of this drug. Thus, it is in truth master(prenominal) to monitor the clients clinical status and the possible contrary effects of the drug regimen. It is also important to offer support and encouragement to overhaul the patient have intercourse with the drug regimen (Karch, 2006, p. 334).