Question

Mr. Jones is a retired 84 year-old farmer. He is still living in the farmhouse, but rents the farm land. He has an 8^th grade education. He is recently widowed, living alone, and adjusting to managing his health care on his own since his wife passed away. One area of concern is his medication management since he is taking 10 different prescription medications plus his 6 nonprescription medications. Mr. Jones is currently taking:

Ferrous sulfate 240 mg daily for anemia

Protonix 20 mg daily for GERD

Tums 1-2 tabs PRN for GERD

Flomax 0.4 mg daily for BPH

Restoril 15 mg as needed for sleep

Aspirin 81 mg daily for his heart

Lasix 40 mg daily for HTN

KCl 10 mEq daily for hypokalemia

Lisinopril 20 mg daily for HTN

Metoprolol 100 mg BID for HTN

Digoxin 125 mcg daily for A. Fib

Coumadin 4 mg on M/W/F and 5 mg on all other days for A. Fib

Nitroglycerin 0.3 mg q5 minutes PRN for angina

Acetaminophen 325 mg PRN for pain

Ginkgo Biloba 2 capsules daily for memory

St. John’s wort 1 capsule daily for anxiety

Directions:

Do any of these medications interact with each other? If so, which?

What effects can caffeine, nicotine, alcohol, or other nutrients have on the specific medications that Mr. Jones is taking?

How can age-related changes affect his medication effectiveness?

What other information would you like to know to ensure medication safety?

Answer 1

#1. A) Ferrous sulphate is an iron supplement drugs and Protonix is an antacid. Ferrous sulphate should be taken 1 or 2 hours before or after the meal. Avoid taking Protonix with ferrous sulphate because it make harder for the body to absorb ferrous sulphate.

B) Tums which is used to treat heart burn interact with Metoprolol (Beta blocker) which results in reduced or delayed absorption of medication.

C) Use of aspirin and beta-blockers potentially cause problems health problems. Moreover aspirin with blood thinners such as Coumadin increase the risk for more serious side effects.

#2. WHAT EFFECTS CAN CAFFEINE, NICOTINE, ALCOHOL OR OTHER NUTRIENTS HAVE ON THE SPECIFIC MEDICATIONS THAT MR. JONES IS TAKING? Caffeine and nicotine have been referred to as 'social drugs' because of their ability to induce pleasurable sensations. Nicotine increases metabolism and acts as an appetite suppressant and helps to remove the unpleasant effects of hunger. Drugs and chemicals may alter the nutritional status multiples of weights which further results in weight loss.

#3. HOW AGE-RELATED CHANGES AFFECT HIS MEDICATION EFFECTIVENESS? Drug absorption, distribution in the body , activity, metabolism and excretion can all change as a result of ageing. Drug absorption usually reduced in older patient due to a) loss of mucosal intestinal surface b) decrease in gastrointestinal blood flow and c) reduced gastric acidity. The pattern of drug distribution is carried around the body in the blood stream mainly by plasma and tissue protein. Due to decreased muscle and tissue mass that accompanies with ageing will reduce the blood flow to tissue and organs. The drug elimination process is mainly carried out by excretion or by liver metabolism. In this, the enzyme reduce the action of the liver enzymes resulting in slow metabolism and also reduce the renal blood flow with increasing age.

#4. WHAT OTHER INFORMATION WOULD YOU LIKE TO KNOW TO ENSURE PATIENT SAFETY? To ensure safety on administering medications, a) reconciliation should be done to avoid medication errors such as omissions, duplications, dosing errors or drug interactions b) medications should be adviced to take based on the time frame and c) provide relevant patient education about medication errors and drug interactions.