Access to over-the-counter medications, for most people, is as easy as going to a local grocery or convenience store. In many cases, this ease of access has probably increased the use of such nonprescription drugs. As a nurse, it is important to be aware of the adverse effects of over-the-counter medications as well as the synergistic effects of combining prescription medication with non-prescription.
Read the following case study on over-the-counter medications. While reading, reflect on your current knowledge of over-the-counter drugs and your role as a nurse in pathopharmacology.
You are an RN working in a community-based primary care practice. Mrs. G. is a 72-year-old woman brought to the office by her daughter for evaluation after a fall at home. When you ask what happened, the patient reports having an episode the night before of blurred vision when she got to the bottom of her steps and tripped on the rug in her front foyer. She denies any injury and seems embarrassed to be at the doctor’s office over what she views as a trivial matter. Her daughter is concerned about her mother alone in the home.
You know from reading her chart that Mrs. G is recently bereaved, her husband died four months ago following a brief illness. She has one adult son who lives out of town and one daughter who lives locally and presents with her today. She now lives alone in a two-story home.
The chart reveals a past medical history of coronary artery disease with a mild myocardial infarction at age 67, osteoarthritis of her knees and ankles, and a history of hypertension for the past 10 years. She is a non-smoker, and drinks alcohol socially. She has no reported drug allergies.
You ask her about the medicines she is taking and she reports taking the following medications as prescribed:
hydrochlorothiazide 25 mg daily,
diclofenac (Voltaren) 50 mg bid,
atorvastatin (LIPITOR) 10 mg daily
and one enteric-coated aspirin (325 mg) daily.
When you specifically inquire about over-the-counter or herbal medications, she responds that she has been taking Advil PM at bedtime for the past 10 days, per the recommendation of a friend for help with falling asleep, and is happy with this remedy as it provides additional pain relief from her osteoarthritis overnight.
Your review of systems is significant only for recent constipation and you note that she reports her occasional cocktail or glass of wine with dinner is now a daily event.
Reflect on the patient’s personal scenario presented in this Case Study and then respond to the following:
- 1. Examine Beers criteria for potentially inappropriate medication use in the elderly (http://consultgerirn.org/uploads/File/trythis/try_this_16rev.pdf).
- 2. Now reflect on what you know about medications in older adults and identify two concerns about drug interactions that the patient, Mrs. G, may experience.
- 3. Identify other nursing concerns.
- 4. What nursing interventions would you recommend?
Support your ideas or those of others with references from the professional nursing literature.
REFERENCE; (It is important to use reference required here)
- Course Text: Karch, A. (2013). Focus on nursing pharmacology(6th ed.). Philadelphia: Lippincott Williams & Wilkins.
- Chapter 1, “Introduction to Drugs“
This chapter introduces the different sources of drugs and how drugs are evaluated. It also discusses the legal regulation of drugs and explains the parts and functions of drug labels.
- Chapter 2, “Drugs and the Body”
How drugs affect the body and how the body acts on drugs is examined in this chapter. In addition, the factors that influence drug effects are discussed.
- Chapter 3, “Toxic Effects of Drugs”
Chapter 3 identifies the types of adverse reactions that the body can have to drugs. The chapter provides multiple examples of drug-induced tissue and organ damage demonstrating the toxic effects of drugs.
- Chapter 4, “The Nursing Process in Drug Therapy and Patient Safety”
The changing delivery of medical care is examined in this chapter. The key elements of nursing practice, assessment, nursing diagnosis, interventions, and evaluation are also explained
- Chapter 5, “Dosage Calculations“
Knowing the correct drug dosage to give to a patient is vital. This chapter discusses the past and present systems used to measure drug dosages. It also explains how to convert dosages between these different systems.
- Chapter 6, “Challenges to Effective Drug Therapy“
Today’s globally interconnected world has increased access of medical care to consumers. The influence that the media and the Internet have had on this movement is discussed, along with the impact this has on nurses and health care practices.
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- Campanelli, C.M. (2012). American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. Journal of the American Geriatrics Society,60 (4), 616-631.
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