Question

GNUR 505 Case Study Polypharmacy

Rhonda, a 77 year old retired librarian, sees several physician specialists for a variety of health problems. She uses the pharmacy at a large discount store but also has prescriptions filled at a nearby pharmacy, which she uses when she doesn’t feel like going into the larger store. Her health history includes: CHF, Type II Diabetes, Hyperlipidemia, Osteoarthritis, osteoporosis with history of hip fracture 5 years ago, atrial fibrillation, insomnia and depression. Her medication list is as follows:

Amitryptiline 25 mg pohs

Citalopram 10mg pood

Lorazepam 1 mg pohs

Digoxin 0.25 mg pood

Glyburide 5mg po bid

Furosemide 40mg pood

Potassium tablets 40meq po bid

Metoprolol 50 mg po bid

Warfarin 2mg pood

Atorvastatin 10mg poqhs

Alendronate 70 mg weekly on the same day

Calcium carbonate 500 mg po OD

Vitamin D 1000 IU po OD

Multivitamin tablet for seniors

1. Would Rhonda’s medication use be considered polypharmacy? Yes or No?

2. What are 2 ways Rhonda could change her behavior to reduce risks associated with her current prescriptions and medication use?

3. Which medications may cause problems for Rhonda? Explain?

Condition	Medication	Potential Problems for Rhonda
Osteoarthritis
Osteoporosis
Insomnia
Depression
CHF
Atrial Fibrillation
Type II Diabetes Risk of falls

4. Rhonda visits the pharmacy to pick up some medications for a cold. She has chosen Phenylephrine nasal spray, Benadryl and Ibuprofen for her “aches and pains”. Should she use these medications? If not, why? And what advice would you give her about selecting OTC medications?

5. Are there any non-pharmacological treatments you could suggest instead of these OTC medications for her cold and “aches and pains”?

6. Rhonda comes into the ER experiencing dizziness and nausea. While doing a medication history she shows you her “pillbox” and you note that she takes all of her medications at the same time. The physician states that Rhonda’s new symptoms are due to polypharmacy. Rhonda protests saying “My dear, I’ve got news for that doctor! I’ve had to take lots of drugs at the same time all my life. It never bothered me before!” How would you explain 3 physiological changes that occur with aging to Rhonda and how these changes affect pharmacokinetics and/or pharmacodynamics.

Answer 1

Rhonda has been suffering from variety of health problems, namely type 2 diabetes mellitus, congestive heart failure, hyperlipedemia, depression, osteoarthritis, osteoporosis, atrial fibrillation, depression, insomnia, depression. For which she has been taking medication namely amitryptiline, citalopram, lorazepam, , digoxin, glyburide, Furosemide, potassium metoprolol, warfarin, atrovastatin, alendronate, calcium carbonate, vitamin D, Multivitamin tablet.

1. She has various health issues for which she is taking various medication. She has to obtain medication from poly pharmacy. Various medications are available in poly pharmacy.

2. Diet and exercise: she can consume high nutritious diet which should contain high calcium and vitamin rich diet such as vegetables, fruits, brown rice, fish, and white part of eggs, potassium rich diet mainly banana, coconut water. daily exposure to eraly sunlight can increase vitamin D production naturally  It reduce intake of potassium tablets, multivitamin tablets, sleeping pills, calcium tablets. She can do mild exercise such as walking because it improves cardiovascular and respiratory function. Because it increases oxygen delivers to all the structures of the body in addition to heart, muscle and respiratory system. Thereby it increases sleep and stands on their own legs for function and reduce pain in the joints due to osteoarthritis. Even She is librarian, so she can use walking exercise intermittently in all around inside library helps oxygen and nutrients usage by the her organ and reduce pain in the joints. Deep breathing and relaxation therapy can help her improve mental well being. This can reduce intake of sleeping medication and reduce dosage of other medication such as antihypertension, diabetic medication based on glucose measurements

3. AMITRYPTILLINE may cause dizziness, dry mouth, constipation, and headache. Rhonda has been suffering both depression and atrial fibrillation. Amiptryplline can cause atrial fibrillation because of QT prolongation by amitryptiline and; CITALOPRAM may cause palpitation due to fast heart beat, drowsiness, and nausea, looses tools, and diaphoresis, lack of sleep, rhinitis, and sore throat. Lorazepam may cause drowsiness, dizziness, insomnia, loss of balance.

Condition	Medication	Potential problems
Osteoarthritis Osteoporosis	Calcium carbonate Vitamin D Alendronate	Alendronate may cause muscle and joint pain, nausea, constipation, loose stools. vitamin D may cause nausea, vomiting, weakness. calcium carbonate may cause vomiting, abdominal pain, constipation.
insomnia	Lorazepam	Lorazepam may cause drowsiness, dizziness, insomnia, loss of balance.
Depression	Amitryptiline Citalopram	Amitryptiline may cause dizziness, dry mouth, constipation, and headache Citalopram may cause palpitation due to fast heart beat, drowsiness, and nausea, looses tools, and diaphoresis, lack of sleep, rhinitis, and sore throat.
CHF	DIGOXIN Furosemide Potassium metoprolol	Digoxin cause anorexia, blurred vision, dizziness
Atrial fibrillation	Warfarin	Joint pain, swelling , headache
Type 2 diabetes	glyburide	It cause nausea, dizziness, diarrhea, headache

4. She is suggested not use over the counter medications. She suffers cold and aches and pain due to side effects of the medication. Citalopram cause her rhinitis and amiptrylline cause her headache and drowsiness. Amitryptiline, citalopram, lorazepam may cause drowsiness and dizziness in addition if she takes Benadryl, phenylephrine it may cause dizziness and drowsiness and chance to fell. Moreover, She is elderly person, has chance to have loss of imbalance due to age and side effects of medication such as lorazepam, amitryptiline, citalopram.

5. Cardiovascular system: she is chance to have heart disease due to aging. Because it may cause increased blood pressure due to increased arterial stiffness and reduces cardiac output and capacity of heart. This is cause of taking cardiac medication. If she performs her regular exercise such as walking, highly nutritious diet, and relaxation therapy for stress, it increases cardiac performance and blood circulation to the all over the body. Muscular skeletal system: due to advanced age, there is a chance of loss of bone mass this result in osteoporosis and loss of balance. Osteoporosis may occur in post menopausal due to loss of estrogen. Therefore she is prescribed medication such as calcium supplements. therefore,  muscle exercise increase blood supply and nutreints to the body. Neuro system: there is a chance of loss of brain tissue because of advanced age and decreased blood supply to brain as a result of reduced cardiac output and slower conduction impulse of nerve. There is loss of consciousness, loss of balance, dizziness in elderly people, therefore sleeping medication can increase loss of balance and faitinting in addition aging induced loss of balance and dizziness. gastronintestinal system in which reduced production ofacid that cause the lack of absorption of nutrients mainly calcium, iron, vitamin b12. there is also reduced absorption of nutreint of food in the intestine. due to advanced age. therefore it may cause increase side effects of medication.