Pharmacology For Nursing Practice

Question:

Discuss the Pharmacology in Nursing Practice.

Answer:

Treatment protocol for high cholesterol with atorvastatin

Use with Clinical Indication

Ramrakha, 2013.chapter 5 page 236).

Criteria for Inclusion

* Heart disease

* Type 2 diabetes patients are at greater risk of developing heart problems

* Coronary Heart Disease

* For children and adults aged over 10 years

Criteria for Exclusion

* Allergy for atorvastatin

* Liver disease

* Kidney Disease

* Not recommended to breastfeed mothers

* Not recommended to pregnant women

(Frandsen, Pennington 2013, p. 136)

Chapter 8.p 136)

Pharmacodynamics (Mechanism of Action).

HMG–CoA reductase is responsible for converting HMG–CoA to mevalonate during the pathway of biosynthesis of cholesterol.

HMG-CoA reduces by atorvastatin and causes a gradual decrease in the levels hepatic cholesterol.

The decrease in levels of hepatic cholesterol stimulates the activation of the hepatic Low Density Lipoproteins Cholesterol receptors (LDLC). This results in an increase of LDL-C uptake in the liver and a decrease in serum LDL cholesterol (Moscou, 2012).

Chapter 24, p. 393)

Pharmacokinetics

Administration and absorption

Oral administration of Atorvastatin with or without food is rapid.

You can take the medication at any time, but it is recommended to do so at approximately the same time each day.

Atorvastatin is completely bioavailable at approximately 14%, while the systemic availability HMG-CoA inhibitory action is at about 30%.

Distribution

The plasma concentration is at its maximum within 1-2 hours of administration.

The plasma volume average is 381 litres. It contains approximately 98% of the plasma membrane’s protein.

Metabolism

Atorvastatin is metabolized into its ortho and para-hydroxylated derivatives as well as to its many products of beta oxygenation.

HMG-CoA reductase inhibition activity of about 70% has been attributed to active metabolites.

Excretion

After extrahepatic or liver metabolism, atorvastatin can be eliminated in the bile.

In urine, less than 2% is found from the orally administered doses of atorvastatin (Frandsen und Pennington 2013, 2013).

Chapter 8.p.134

Drug Interactions

* Antibiotics like erythromycin may cause an increase in serum concentrations.

* Antifungal medication such as fluconazole- The risk of serious adverse effects is likely higher when fluconazole has been combined with atorvastatin

* Ciprofloxacin- Ciprofloxacin and atorvastatin increase the risk of serious adverse effects

Ciprofibrate – The severity of myopathy, myoglobulin and rhabdomyolysis may be increased when ciprofibrate combined with atorvastatin is taken (Moscou, Snipe 2012.

Chapter 24, p. 394).

Adult: Dosage, Route, and Duration

Dose and route

Initial dose: 10mg, 20mg orally twice daily.

Patients with a lower LDL-C level than 45% should receive an initial dose 40mg (Frandsen, Pennington, 2013).

Chapter 8.p 134)

Maintaining dose: 10mg – 80mg taken orally once daily

The duration of therapy

Two to four weeks. Evaluation of lipid levels.

Adverse Effects

Diarrhoea and heartburn, gas, and joint pain (Frandsen, Pennington, 2013,

Chapter 8.p 136)

Hypersensitivity

Allergic reactions include hives, trouble breathing, swelling of your throat, tongue and lips, as well as swelling of your face (Roberts (2014)).

Confusion and memory problems, unexplained muscular pain or tenderness (Frandsen, Pennington, 2013, chapter 8.p.

Response to Adverse Events (This is directed at the practitioner in order to respond to an adverse incident that has occurred).

* Stop using the medication immediately

* Identify the reason for the adverse effect.

* Offer an alternative solution, based on the reason for the adverse effect

* Document the adverse events

Critical discussion

Nursing care requires clinical decision-making to ensure safe and quality drug therapy. (Standing 2017.

Chapter 1, p. 7.

This paper focuses on the safety and proper usage of diabetic medication.

The paper examines how clinical decision-making processes of implementation, assessment and evaluation are applied to Mavis’ medication.

It also discusses cultural and patient education as well nursing responsibilities for the patient and her medication.

Assessment

Assessment should include the ability to comprehend the treatment and medications.

Mavis should be aware that she has diabetes type 2, and that her cholesterol and triglycerides are high, which could lead to a heart attack.

Mavis was prescribed metformin and glibenclamide.

Mavis was already taking metformin. It is therefore important to determine if Mavis understands the side effects and hypersensitivity of the medications being given.

She should be informed if she requires further clarification.

Mavis didn’t use both atorvastatin nor glibenclamide. Understanding these medications is essential.

Noting that metformin and/or glibenclamide both have been approved for type 2 diabetes treatment, the side effects tend be the same.

Mavis should also be informed that she should immediately contact her doctor if she experiences an adverse reaction to any medication.

Mavis has already gained weight. It is important to monitor her weight as this can be a side effect.

Below is information about Mavis’s medication, as well as important points Mavis needs to be aware of.

Both are used in the treatment of type two diabetes.

(Anwar Ahmad Karagianni & Lindow 2018, 2018.

Both reduce blood sugar.

Nausea (Frandsen, Pennington, 2013, p. 136)

Chapter 8.p 136)

Dark urine, mood and mental changes, dizziness, long diarrhoea, dizziness, blurred vision, depression, and signs of infection like sore throat and yellowing of the eyes and skin.

Other severe side effects should be reported immediately to your doctor.

Take care when using drugs

Both drugs need to be complemented by healthy diet and regular exercise

Drowsy people should not drive or use machinery.

Dosage administration

Metformin should only be taken orally 500mg twice daily.

Glibenclamide should only be taken orally 5mg each morning until the entire dose has been completed

For high cholesterol, medication is used (Ramrakha 2013.chapter 5 p.236)

Confusion and memory issues, dry lips, unexplained pain or tenderness in the muscles, fruity smell, urinating less frequently than usual or not at all.

Be aware

Grape juice is best avoided

Include proper nutrition and exercise in your daily routine

Dosage administration

You should take orally 40mg every other night until you finish the dose

Implementation

Mavis must be informed that exercise and diet are key factors in her treatment (Ramrakha 2013, chapter 5, p. 52).

She may also need to be reviewed on a weekly basis and a diet plan.

It may be necessary to develop an exercise program for Mavis. Inquire with any family members who will be helping with the exercises.

Mavis should be monitored to ensure she understands the proper dosage and administration of her medications. (Avorn (2018), p. 690).

It is necessary to create a care plan so that all education can be implemented.

Evaluation

There are key aspects that must be taken into consideration during an evaluation.

Mavis must be capable of acknowledging that she understands the drug and that it is helping her (Olupeliyawa 2017 p.59).

Verbally, she should also acknowledge that she has been consulted by a dietician to create a meal plan for her treatment.

Mavis’s complete medical history is enough to ensure that her medication is safe and that she fully understands it (Konduru et. al., 2017, p. 37).

Mavis must also be evaluated to confirm the effectiveness of the medication. If Mavis isn’t responding well, she should be informed by her physician and the outcome documented.

Effective patient education allows the patient to put into practice what she was taught (Sherifali, et al. 2018, p.S40).

Mavis has to participate in patient education. She must also be involved in determining the best teaching strategy for her.

Mavis’s medical history shows that she cannot read the time on her watch. This means that teaching with printable materials might not be an effective option.

You can also assess if any family members are available to teach her how to use the printable materials at home (Sherifali, et al. 2018, p. S45).

Mavis needs to feel safe when administering her medications. This should include one-on-one teaching. Mavis has already shown that she does not care much about her condition from her clinical history.

She must understand the risks involved in not taking her medication on time and the importance to keep it up.

Mavis should be capable of explaining everything she has learned regarding diabetes.

Cultural Requirements

Mavis is an Indigenous woman who believes in the values and principles of her culture.

To ensure Mavis is safe with medication, it is important to be knowledgeable about Mavis’s culture so that she can quickly determine her medical needs.

It will be possible to assess her attitude and identify any interactions rules or communication practices. This will allow us to communicate the best information about her medication.

Mavis must be able to communicate with her about her medication in layman’s terms. It is essential for her safe administration.

Understanding medical terms can be complicated.

Mavis’s safety is ensured by being sensitive to our actions and avoiding any misinterpretations.

Mavis will leave hospital feeling happy that she was well taken cared of and that her cultural requirements and concepts were met (Clarke 2017 pp. 2 and 3).

Conclusion

In providing nursing care, it is crucial to use clinical decision-making.

The nurse can focus on the specific details of the patient and how to administer the medication by focusing on the assessment, implementation, then evaluation.

The nurse can better understand the patient and assess if they are making progress.

Safe medication administration is possible through effective patient education.

Pp. 39-40) This ensures that patients feel comfortable talking to nurses about their needs and are able to communicate with them.

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New England Journal Of Medicine, 378(8) 689-691. doi : 10.1056/nejmp1714987

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Journal Of Healthcare Communications 02(04), P.1-3.

Abrams’ clinical drugs therapy.

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Diabetes Care, 41(Supplement 1, S51-S53.

Assessment of Diabetes Related Knowledge and Attitude among Diabetics and Other Diabetics by using the Self-Prepared Questionnaire for Awareness on Health Promotion.

Metformin treatment of gestational diabetes in women: A retrospective, case-control study.

Journal Of Clinical Medicine, 7(3) 50. doi: 10.3390/jcm7030050

Pharmacology and Pharmacy Technicians (pp.

Chapter 24. Page 393).

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Journal Of The Postgraduate Institute Of Medicine. 4(2):59. doi 10.4038/jpgim.8174

Oxford handbook in cardiology.

Oxford University Press.

Self-Management Education and support.

Canadian Journal Of Diabetes, 42: S36-S41

Clinical judgement and decision making for nurses (pp.

chapter 1, page 7.

Providing Lifelong Education & Support: Updates to the 2017 National Standards for Diabetes Education & Support.

Clinical Diabetes 35(4), 239-241. doi : 10.2337/cd17-0100