Question

Choose a medication type from the following list, note why the medication is used, and consider adverse effects. Invent a scenario where giving this medication could result in an ethical or legally charged situation. Try not to choose a category that has been well addressed by your peers.

Bethanaechol / cholinergics: Consider risks of inducing urgency or bradycardia in a clients with dementia issues

Benztropine /anticholinergics: Consider harms that can occur with comorbidities like glaucoma or BPH

Albuterol /adrenergics: Consider harms that can occur is asthmatic children are in charge of their own inhalers

Atenolol/ beta blockers: Consider harms that could occur if heart rate was low or patient was asthmatic

Lorazepam /benzodiazepines: Consider vulnerability issues related to sedation and induction of memory loss

Oxycodone / opiates: Consider addiction, drug seeking and patient vulnerability in impaired nurses

Amitriptylline /tricyclics: Consider vulnerability issues with risk of suicidal overdose given anticholinergic effects

Phenelzine /MAOIs: Consider consequences of nonadherence to dietary restrictions on these medications

Haloperidol / neuroleptics: Consider risks of chemical sedation, especially long term risks

Lithium: Consider risks of mismanagement by clients whose behaviors are unpredictable

Phenytoin / antiepileptics: Consider risks of Class D in young women vs risks of going without anti-epileptics

Secobarbital / barbituates: Consider risks related to availability of barbituates to teens via the internet

Kava or Valerian: Consider risks of availability of compounding poorly controlled over the counter sedatives

Sumatriptan / triptans: Consider risks of cerebral ischemia when giving vasoconstrictors for migraine control

Cyclobenzaprine for back spasms: Consider risks of impaired function when nurses take muscle relaxants

Prednisone / steroids: Consider long term effects, when other immune suppressors are too expensive to access.

Aspirin / NSAIDs: Consider vulnerability of elders due to over the counter, affordable nature of this analgesic

Answer 1

1). Cholinergic or the cholinergic nervous system agonists enhance memory, especially in memory deficit patients. The cholinergic provide the precursors of neurotransmitters (acetylcholine) necessary for the memory neural circuits. These drugs are used in the treatment of Alzheimer’s diseases (e.g. donepezil). The drugs are particularly effective in the early phases of the disease. Cholinergic agonists such as Bethanechol are used to treat constipation and urinary retention.

Bethanechol is a selective muscarinic receptor (parasympathomimetic) stimulant that is used to stimulate urination as in cases of urinary retention. Acetylcholine increases the urination by promoting the bladder contraction (contraction of detrusor muscle) and relaxation of urinary sphincters. Thus, Mr. Jhonson is prescribed to have Bethanechol.

The side effects of bethanechol include dizziness, wheezing, diarrhea, cramping, excessive sweating, Parasympathomimetics do not alter the arterial blood pressure because vascular smooth muscles are mainly innervated by the sympathetic neurons.

Bethanechol can be given to a patient with dementia only if the patient is hospitalized, and provided with urinal, bedpan, and call light. Bethanechol must not be given to outpatients with dementia who cannot take care of personal needs because it increases the frequency of urination. If appropriate measures are not taken, it impairs the quality of life of an individual, so it is ethically and legally chargeable.

2). Lorazepam /benzodiazepines: Benzodiazepines (Eg: diazepam, lorazepam,) are the sedative-hypnotics that act through the increased transmission of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter. In lower doses, they are used to treat anxiety and at higher doses, they can induce sleep and used in the treatment of insomnia.

Benzodiazepines by their own, do not cause respiratory depression even at higher doses. But, they do in the presence of alcohol and increase the risk of death from respiratory depression. Cognitive impairment, sedation, and addition are the two most common side effects of benzodiazepines. Appropriate prescription and patient analysis prior to prescribing the BDZs is most important to avoid legal issues. For example, as the benzodiazepines impair the cognition and induce sedation, they interfere with driving abilities. So, this drug must be tried for one week on the patient without driving and must inform the patient about the drug's possible effect on driving. Failure to do so can result in the claim of negligence against the physician.