Question

Co-morbid chronic illness often requires that many prescribed medications often resulting in what is referred to as “polypharmacy”. This can result in several problems. Adherence to a medication regimen is a key factor in promoting health and quality of life in those with chronic illness. Non-adherence can be attributed to a multitude of factors including cost, complexity of the medication regimen, and actual or perceived side effects (Ferdinand et al., 2017). Side effects and adverse drug reactions are other problems associated with polypharmacy. Nurses in both acute care and community or public health settings play an integral role in increasing medication regimen adherence and reducing adverse medication reactions for those with chronic illness (Shin & Haberman, 2016). For this assignment, evaluate a medication list and search for an evidence-based interventions to increase quality of life and promote health through improved medication adherence.

Consider an 80-year old patient, Mrs. X.   Mrs. X has a long list of medications, both prescribed and OTC.

Altace 5 mg qd for congestive heart failure

Adalat CC 60 mg qd for hypertension

Cardizem LA 180 mg qd for coronary artery disease

Lasix 40 mg qd for edema

Hydrochlorothiazide 25 mg qd for hypertension/edema

Baby aspirin 81mg qd to prevent clots

Lipitor 10 mg qd for hypercholesterolemia

Synthroid 0.125 mcg ac qd for hypothyroidism

Tylenol 650 mg q4-6h for pain (arthritis)

Aleve 250 mg q6-8 hrs for prn for pain (arthritis)

Amrix 15 mg qd for pain/muscle spasms

Glucosamine 500 mg bid for pain

Amitriptyline 75 mg qhs for pain/sleep

Paxil 20 mg qd for depression

Oxazepam 15 mg hs for insomnia

Tylenol PM 1 tab qhs prn for insomnia

Benadryl 25 mg prn for allergy/itching

Prilosec 40 mg ac qd for gastric reflux/heartburn

Fiber laxative in water qd for constipation

Colace 50 mg bid for constipation

Multivitamin 1 qd

1. What are your first thoughts as you see this list? What are your impressions of Mrs. X’s health?

2. What potential problems and concerns do you have for Mrs. X related to side effects and drug interactions?

3. What health promotion strategies would you use to address these concerns about side effects and drug interactions?

4. What evidence-based interventions would you recommend to help Mrs. X remain compliant with her medications?

Answer 1

1) According to the list it can be seen that Mr X is suffering from cardiovascular diseases, autoimmune disease that is arthritis. He is depressed also has chronic pain, insomnia, gastric reflux and hypothyroidism.

2) Antacid prilosec taken for acid reflux may decrease the absorption of syntroid thus they are not taken together.

Paxil if taken along with aspirin increases the risk of bleeding

Benadryl taken along with antidepressants increases the side effects like dizziness, drowsiness, confusion and difficulty in concentration

3 To avoid these drug interactions these medications should be taken at a different time in a day or atleast at a gap of one hour apart

4) Fixed dose combination drugs, counselling and explaining the importance and need for taking medications regularly, fixing the schedule of drugs, treatment in pharmacist clinic are some of the evidence based practices to remain compliant with medications