Case Study: Prescribed Drugs with CAMs
Prescribed Drugs with CAMs
Instructions:
Case Study: Prescribed Drugs with CAMs
A 35-year-old male, Mr. NX, presents to your clinic today with complaints of back pain and “just not feeling good.” Regarding his back, he states that his back pain is a chronic condition that he has suffered with for about the last 10 years. He has not suffered any specific injury to his back. He denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, and denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. He describes the pain as a constant dull ache and tightness across the low back.
He states he started a workout program about 3 weeks ago. He states he is working out with a friend who is a body builder. He states his friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so he started those medications at the same time he began working out. He states he also takes Kava Kava for his anxiety and garlic to help lower his blood pressure.
His historical diagnoses, currently under control, are:
Type II diabetes since age 27
High blood pressure
Recurrent DVTs
His prescribed medications include:
Glyburide 3 mg daily with breakfast
Lisinopril 20 mg daily
Coumadin 5 mg daily
Directions:
*****This Assignment must be submitted as an APA formatted paper of four (4) pages excluding title page and references.
Based on the above case study, address each section of the Unit 9 Assignment template. Be sure to first view the Unit 9 Assignment Grading Rubric (found in the Grading Rubrics section under Course Resources) and use it to guide your completion.
- Download the Unit 9 Assignment template or make a PowerPoint presentation.
- Complete the template, basing your responses on the case study above.
- Support your arguments with appropriate evidence from the literature, citing and referencing in APA 6th edition style.
Template for assignment 9
Case Study: MN553 Advanced Pharmacology
Unit 9 Case Study
“Prescribed Drugs with CAMs”
Student Name
Date of Submission
This paper addresses a pharmacological management plan for Mr. NX, including consideration of possible contraindications for CAMs, prescriptive and non-prescriptive recommendations for management of acute pain and other ongoing disease processes, followed by evaluation strategies.
Pharmacological Management Plan
CAMs Contraindicated with Current Prescriptions
CAMs Contraindicated with Diagnoses
Prescription for Back Pain
Changes in Prescribed Drugs
Follow-Up Evaluations
Time-Frame
Strategies for Evaluating Side/Adverse Effects
Strategies for Evaluating Effectiveness
References (examples)
Romm, A. (2011). Overprescribing of antibiotics for children’s upper respiratory infections. Alternative options to consider. Alternative and Complementary Therapies, 17(6), 306–309. Retrieved from http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=rzh&AN=2011411466&site=eds-live
Singh, J. A., Furst, D. E., Bharat, A., Curtis, J. R., Kavanaugh, A. F., Kremer, J. M.,…Saag, K. G. (2012). Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. InU.S. Department of Health and Human Services, Agency for Health Research and Quality, National Guideline Clearinghouse. Retrieved from http://www.guideline.gov/content.aspx?id=36892&search=rheumatoid+arthritis
Solution
Case Study: Prescribed Drugs with CAMs
Prescribed Drugs with CAMs
Introduction
In administering care, pharmacological plans are imperative especially when it comes with apt management. This paper will outline and address the effective pharmacological plan for 35-year old male, Mr. NX, inclusive of a critical consideration of the conceivable contradictions for complementary and alternative medicines (CAMs), non-prescriptive and prescriptive recommended management of acute pain as well as another apparent disease process. Furthermore, this paper will evaluate strategies for better management of Mr. NX’s pharmacological plan.
Pharmacological Management Plan
Part I: Complementary and Alternative Medicines with Contraindicated Prescriptions
According to Brosnan and Brosnan (2016), it is evident that Creatine is contraindicated if administered with Lisinopril, in that the combination of the two drugs is found to trigger risks of developing toxicity of the kidneys, nephrotoxicity. Furthermore, Ramzan, Rowe, and Zhang, (2011) suggest that Kava Kava is related to the risk of developing severe hepatitis accompanied with augmented levels of HDL, reduced platelet counts, and hypertension. As such, this analogy predisposes Kava Kava supplements as a non-recommended drug for long-term and unremitting use. Additionally, when taken with Lisinopril, the combination of the two medicines will heighten the risk of an individual of developing hepatic toxicity, a chemical-propagated liver damage (Teschke, 2010).
Additionally, studies suggest that Coenzyme Q-10 is contraindicated if administered with Coumadin since the combination of the two drugs decreases the effectiveness of Coenzyme Q-10 related to the potentiality of pro-coagulation of vitamin-K substances (Saha & Whayne, 2016). Furthermore, garlic cannot be used when Coumadin is administered since the combination of the two is related to elevated risks of bleeding (Amagase, Petesch, Matsuura, Kasuga, & Itakura, 2001; Leikin, Merei, Dahan, & Blum, 2005; Santhosha, Jamuna, & Prabhavathi, 2013).
Part II: Complementary and Alternative Medicines with Diagnoses
Regarding medical history for Mr. NX, it is evident that he had a history of DVT. Studies suggest that patients diagnosed with DVT should not use Co-enzyme Q-10 due to its striking characteristics that trigger the coagulation effect (Bates, 2012; Motto, 2011). Furthermore, Mr. NX, at the age of 27 was diagnosed with Type II diabetes, as such, he is contraindicated to the use of garlic. A study by Mateen, Rani, Naidu, and Chandrashekar (2011) suggest that garlic has a latent effect of a protracted drop in blood sugar levels and bleeding as well as affects blood clotting process.
Part III: Back Pain Prescription
Mr. NX claims that he had back pains for the past ten years with no likely factor contributing to these back pains. As such, Mr. NX opted for over-the-counter medication to lessen this pain. Furthermore, it is imperative to consider the fact that liver inflammation can trigger back pain (Szabo & Csak, 2012). The side effects of Kava Kava causes interference with Lisinopril since it is metabolized in the liver, as such, it would be more advisable to consider an alternative medication to Kava Kava. This will be the first-line prescription stage of medication for Mr. NX.
Second, acetaminophen 1000 mg, for four to six hours, will be essential to lessen pain. As such, patients are advised not to take in more than 4000 mg a day. This drug is recommended since it has no “anti-inflammatory effect” and it relieves pain easily since it is geared to switch off the pain perception in the brain. In cases of chronic pain, an interdisciplinary approach coupled with lifestyle changes are the recommended ways to manage such symptoms as well as relieve pain. As such, the patient will be counseled and invigorated to stick to a particular routine that will help in improving muscle strength, which will later aid in relieving back pains (Smith, Pappagallo, & Stahl, 2012).
Changes in Prescribed Drugs
The patient, in this case, is advised to cease taking all complementary and alternatives medication and to stick to the officially prescribed medication. As such, he must discontinue the use of Coumadin and start on Xarelto medication. Xarelto is recommended as it has reduced risks of Deep Vein Thrombosis relapse, a disorder present in the patient in case (RxList, 2016). Furthermore, studies suggest that Coumadin is not an effective therapy to a patient with DVT (Bates et al., 2012). Angiotensin-converting-enzyme inhibitors (ACEs) have been found to have fewer effects on the metabolism of glucose, renal function, and lipid profiles even though they are considered the best since the depict as reduced risks for diabetic neuropathy (Izzo & Weir, 2011). Last, it is stalwartly suggested that use of Garlic Supplements, Kava Kava and Creatine be ceased until further physician’s assessments that will further find out the source of anxiety as well as proper treatment.
Follow-Up Evaluations
Part I: Time-Frame
A 30-day follow-up will be effective to assess the efficacy of Naproxen. The major goal of treatment here is to reduce pain and patient improvement with activities of daily activities. The 30-day time frame is adequate for Mr. NX to establish a routine relative to the treatment plan. If the initial treatment plan is adhered to, supplementary prescriptions with replenishments will be administered with 2-month follow-up for sustained specialist care for pain management. As such, Mr. NX will be advised to seek further medication if the other problems arise.
Part II: Evaluating Side Effects
Strategies for assessing the side effects will be analyzed through objective as well as individual patient’s medical data. As such laboratory test will be conducted such as blood glucose levels, cholesterol levels, hemoglobin tests, liver and kidney function, and PT/APTT (Raj, 2011). There will be more consideration of the Mr. NX’s complaint regarding back pain, as such, if the patient depicts that the back pain is resolved, the current treatment plan will be adhered to the latter. If the back pain persists, I would order an x-ray of the patient’s back and follow a chronic pain management plan to help the patient feel free of pain. Also, an assessment of lifestyle changes will be conducted. Also, Mr. NX will undergo patient education on ways to keep logs of blood glucose sugar, blood pressure, and daily pain scales.
Part II: Evaluating Effectiveness
Emphasis will be
on Mr. NX’s subjective reports and logs.
Furthermore, lab results will be assessed
for any problems with the patient. Additionally, there would a change of
lifestyle styles within the given time-frame.
References
Amagase, H., Petesch, B., Matsuura, H., Kasuga, S., & Itakura, Y. (2001). Intake of garlic and its bioactive components. The Journal of Nutrition, 131(3), 955–962.
Bates, S. M. (2012). Diagnosis of DVT. CHEST Journal, 141(2_suppl), e351S. https://doi.org/10.1378/chest.11-2299
Bates, S. M., Jaeschke, R., Stevens, S. M., Goodacre, S., Wells, P. S., Stevenson, M. D., … American College of Chest Physicians. (2012). Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e351S–418S. https://doi.org/10.1378/chest.11-2299
Brosnan, M. E., & Brosnan, J. T. (2016). The role of dietary creatine. Amino Acids. https://doi.org/10.1007/s00726-016-2188-1
Izzo, J. L., & Weir, M. R. (2011). Angiotensin-converting enzyme inhibitors. Journal of Clinical Hypertension (Greenwich, Conn.), 13(9), 667–75. https://doi.org/10.1111/j.1751-7176.2011.00508.x
Leikin, A., Merei, M., Dahan, E., & Blum, A. (2005). Coumadin-induced hepatitis. European Journal of Internal Medicine, 16(1), 61–62. https://doi.org/10.1016/j.ejim.2004.08.011
Mateen, A. A., Rani, P. U., Naidu, M. U. R., & Chandrashekar, E. (2011). Pharmacodynamic interaction study of Allium sativum (garlic) with cilostazol in patients with type II diabetes mellitus. Indian Journal of Pharmacology, 43(3), 270–274. https://doi.org/10.4103/0253-7613.81514
Motto, D. (2011). Clues to DVT pathogenesis. Blood. https://doi.org/10.1182/blood-2010-11-315879
Raj, J. (2011). A guide to the prevention and treatment of back pain. Armour Pub. Retrieved from https://books.google.co.ke/books?id=2R1NwX9_VYcC&dq=Treatment+for+back+pain&source=gbs_navlinks_s
Ramzan, I., Rowe, A., & Zhang, L. Y. (2011). Toxicokinetics of kava. Advances in Pharmacological Sciences. https://doi.org/10.1155/2011/326724
RxList. (2016). Xarelto (Rivaroxaban Film-Coated Oral Tablets) Drug Information: Clinical Pharmacology.
Saha, S. P., & Whayne, T. F. (2016). Coenzyme Q-10 in Human Health: Supporting Evidence? Southern Medical Journal, 109(1), 17–21. https://doi.org/10.14423/SMJ.0000000000000393
Santhosha, S. G., Jamuna, P., & Prabhavathi, S. N. (2013). Bioactive components of garlic and their physiological role in health maintenance: A review. Food Bioscience, 3, 59–74. https://doi.org/10.1016/j.fbio.2013.07.001
Smith, H. S., Pappagallo, M., & Stahl, S. M. (2012). Essential Pain Pharmacology : The Prescriber’s Guide. Cambridge University Press.
Szabo, G., & Csak, T. (2012). Inflammasomes in liver diseases. Journal of Hepatology. https://doi.org/10.1016/j.jhep.2012.03.035
Teschke, R. (2010). Kava hepatotoxicity: Pathogenetic aspects and prospective considerations. Liver International. https://doi.org/10.1111/j.1478-3231.2010.02308.x