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Pharmacology: A Case Study In Polypharmacy

2436 words - 10 pages

Case Study:Mrs A is a 71 year old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behaviour. Her daughter is concerned about her mother's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behaviour constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly mouldy. Her prescribed medications are:* Frusemide 40 mg daily ...view middle of the document...

" There are various drug treatments available for these conditions.Polypharmacy and Mrs A's problematic pharmacological managementA close examination of Mrs A's drugs, serves to reveal the problematic nature of her pharmacological management and the results of polypharmacy.Frusemide 40 mg daily in the morningLoeb, S (2001:649) includes the following factors in his outline of frusemide.Indications & dosage: Hypertension - adults 40 mg P.O. b.i.d. Adjust dose according to response.Adverse reactions: Hypokalemia (low potassium), fluid and electrolyte imbalances.Relevant interactions: Care should be exercised in patients receiving potassium depleting agents.Nursing considerations: Monitor serum potassium level. Watch for signs of hypokalemia (for example fatigue, muscle weakness and cramps). Give P.O. and I.M. preparations in a.m. to prevent nocturnia.Applications to case studyIt is likely that frusemide is being given to Mrs A as diuretic therapy to treat fluid retention typically associated with Congestive Cardiac Failure. Mrs A's dose of 40 mg daily in the morning is a standard initial dose however it should be adjusted according to response. Morning dose is correctly implemented to alleviate sleeplessness and reduce gastric disturbance.Frusemide could be increasing Mrs A's sensitivity to digoxin. As such, an alternate drug such as Zantac may be advisable. Moreover, a high potassium diet may help reduce potassium loss and the risk of hypokalaemia whilst eliminating the need for potassium supplements. Mrs A needs to be monitored for symptoms of hypokalaemia and her serum potassium levels checked.Digoxin 250 micrograms dailyMcKenry, L & Salerno, E (1989:454-458) includes the following factors in their outline of digoxin.Indications & dosage: In elderly patients, an initial dose of 500 to 750 micrograms may be given as a single dose. Maintenance dose for adults over 65 years is 125 micrograms P.O. daily and for frail or underweight elderly patients this may be only 63 micrograms daily or 125 micrograms every other day.Adverse reactions: Fatigue, muscle weakness, agitation, yellow-green visual disturbance, gastric irritation, arrhythmias.Relevant interactions: Diuretics - hypokalemia, predisposing patient to digitalis toxicity. Antacids - decreased absorption of oral digoxin.Nursing considerations: Obtain baseline data (heart rate and rhythm, blood pressure, and electrolytes) before giving first dose. Dose is adjusted to patient's clinical condition and is monitored by serum levels of cardiac glycoside, calcium, potassium, magnesium, and by ECG. Check for symptoms of toxicity.Applications to case studyDigoxin is being used to treat Mrs A's CCF. The dose of 250 micrograms daily far exceeds the regular maintenance dose for a patient of her age. It is thus almost certain that Mrs A is suffering from digoxin toxicity which is most likely being compounded by taking frusemide. Mrs A's symptoms of confusion, fatigue, irritability and visual...

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