Prescribed Drugs with CAMs
In the contemporary medical world, different complementary and alternative medicines (CAMs) are existent that most people rely on as they use prescribed drugs. Such reliance has had both positive and negative effects on the well-being of the individuals using the CAMs. That is the case given instances of both improved and deteriorated health status secondary to synergistic and unwanted interactions respectively. In essence, this paper aims to demonstrate the same by analyzing a case study involving Mr. NX who is taking both prescribed medications and CAMs. Central to the analysis are various themes encapsulated into two broad areas, namely, the pharmacological management plan for Mr. NX and evaluation strategies.
Pharmacological Management Plan
Precisely, this section will address the pharmacological management plan for Mr. NX, which includes consideration of possible contraindications for CAMs, prescriptive and non-prescriptive recommendations for management of acute pain and other ongoing disease processes.
CAMs Contraindicated with Current Prescriptions
Going by Mr. NX’s current prescription of Glyburide 3 mg daily, Lisinopril 20 mg daily and Coumadin 5 mg daily, restriction of certain CAMs is inevitable given their effect on the efficacy of the drugs. A case in point of such CAMs in use by Mr. NX is the garlic. That is the case since concurrent use of garlic, a blood thinner, with Coumadin, an anticoagulant, results in a synergistic action causing increased bleeding (Sucich, & Sanoski, 2011). Besides, utilization of garlic in a person taking antihypertensive like in this case Lisinopril, an ACE inhibitor, is not considerable. Such is the case because garlic reduces the potential benefits of the ACE inhibitor class of antihypertensive drugs (Approaching, 2017).
Secondly, the use of Coenzyme Q10 is also unthinkable for an individual on antihypertensive. Sucich and Sanoski, (2011) are of the opinion that the concurrent use of the Coenzyme Q10 with antihypertensive such as Lisinopril results in hypotension, whose effect to an individual is immense and disastrous.
Kava is another CAM that the healthcare personnel ought to contraindicate in Mr. NX’s management. That is the fact because utilization of kava interferes with Coudamin, an anticoagulant leading to the recurrence of the DVT reported by Mr. NX. Furthermore, the use of lisinopril concurrently with kava also propagates an increased risk of developing hepatotoxicity (Sucich, & Sanoski, 2011).
Lastly, the concurrent use of creatine with lisinopril is also harmful to human beings and therefore contraindicated. That is for sure because the simultaneous use of the two will result in an increased risk of developing nephrotoxicity (Mazze, & International Diabetes Center, 2012). Such an outcome is undesirable and thus a valid reason for contraindicating creatine for a patient on lisinopril.
CAMs Contraindicated with Diagnoses
Mr. NX’s diagnoses of diabetes, hypertension, and recurrent DVT also necessitate contraindications of CAMs that are worth mention. A typical example is his diagnosis of diabetes that requires the avoidance of CAMs such as creatine. That is for sure since creatine results in fluctuation of blood sugars and thereby making the regulation of sugar difficult (Sucich, & Sanoski, 2011).
On the contrary, in recurrent DVT, one has the contraindication of not using CAMs such as kava and garlic. Kava and garlic are blood thinners, which results in increased risk of bleeding for a DVT patient on warfarin (Sucich, & Sanoski, 2011).
Notwithstanding, Mr. NX’s hypertension also places a restriction on the range of CAMs that he can utilize for his enhancement of wellbeing. For instance, the creatine is not desirable given its effect on blood pressure. It results in increased blood pressure and therefore not the best when in a hypertensive patient (Sucich, & Sanoski, 2011).
Prescription for Back Pain
In consideration of the Mr. NX’s back pain, he befits being a candidate for further prescriptions that will aid in the relief of the pain. Central to his pharmacologic management is the use of various drugs such as acetaminophen. One should avoid NSAIDs containing Aspirin for the pain given the additive effect it may have on the Warfarin that the patient is taking. In case the pain is not subsiding with these mild analgesics, opioid analgesics and tramadol are the next in line for consideration. Additionally, administration of skeletal muscle relaxants such as tizanidine and cyclobenzaprine is of particular importance for the treatment of a backache (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2013).
Besides, a nurse practitioner must also incorporate non-pharmacologic prescriptions in the plan of care for Mr. NX’s backache since they are equally effective. A case in point of such non-pharmacologic interventions for this patient is the physical therapy, which entails several modalities. The physical therapy modalities include therapeutic exercise, traction, manual therapy and rehabilitative ultrasound imaging. Moreover, acupuncture is also beneficial in the relief of a persistent backache (Benjamin, 2014). All these interventions contribute to pain relief and thereby resulting in effective backache management.
Changes in Prescribed Drugs
Given the interactions between the prescribed medicines and the CAMs, alterations to the pharmacologic treatment plan are inevitable and worth mention. For instance, the interaction between creatine and lisinopril necessitates a reduction in dosage or substitution of the latter (lisinopril) with an Angiotensin II Receptor Blockers (ARB) like Losartan. That is the case given continual reliance on lisinopril while consuming creatine will result in increased risk of nephrotoxicity (Mazze, & International Diabetes Center, 2012).
Follow-Up Evaluations
Time Frame
For the antihypertensive (Losartan or Lisinopril if maintained) in the initial phase, one must consider monitoring the patient weekly for two to three weeks to establish the signs of toxicity. During the maintenance phase, the monitoring should be every 3months if one tolerates well to the drugs (Mazze, & International Diabetes Center, 2012).
On the contrary, according to Benjamin, (2014), if chronic low back pain persists 1month after initiation of treatment, follow-up with an orthopedist is of the essence.
Strategies for Evaluating Side/Adverse Effects
Central to the evaluation of side effects of the therapeutic interventions employed in the management of Mr. NX are strategies that are worth mention. A case in point is the use of laboratory services for the establishment of different physiological status variables such as serum creatinine, blood sugar, and serum platelet level. Such a laboratory evaluation will ensure that one establishes derangements in these parameters and link them to the possible causative agents in the treatment plan. For example, increased creatinine levels may be suggestive of the lisinopril toxicity (Mazze, & International Diabetes Center, 2012). Additionally, the measurement of vital signs can help evaluate the existence of side effects. For instance, in this case, hypotension may indicate the side effect of lisinopril and necessitate a change of the drug (Aschenbrenner, &Venable, 2012). Evidently, the laboratory values for body parameters and measurement of vital signs can be essential in the evaluation of the side effects of the treatment plan instituted.
Strategies for Evaluating Effectiveness
Primarily, the assessment of the efficacy of the interventions used in the management of Mr. NX is achievable through various strategies that are worth noting. A befitting example of such a strategy is the monitoring for improvement of patients’ presenting complaints (Aschenbrenner, & Venable, 2012). For instance, in this case, if the patient reports diminished low back pain or complete relief after therapy then the interventions employed were effective.
Another strategy entails the monitoring of the patient for side effects. Aschenbrenner and Venable, (2012) are of the opinion that a therapy used is effective if it exerts an appropriate response in a sick person and not a side effect. As such, in this case, the measures used to improve the health status of the patient are effective if the side effects after their use are non-existent.
Conclusion
Concisely, this discussion aimed at analyzing a case study involving Mr. NX, who is on both prescribed medications and CAMs. Central to the analysis were various themes encapsulated into two broad areas, namely, the pharmacological management plan for Mr. NX and evaluation strategies. Indeed, the scrutiny has covered these areas in details, and several implications for nursing practice are apparent. A case in point is the need for comprehensive assessment of the CAMs a patient is using. Such a consideration is of utmost significance given that most CAMs interact with pharmacological remedies that a patient is to undertake. In the absence of such, an individual becomes prone to health risks secondary to the interactions, which can be disastrous to his/her well-being. As such, going into the future, healthcare professionals must undertake a comprehensive assessment of the CAMs utilized by a patient if the harsh effects of such an omission are to become non-existent.
References
Approaching. (2017). A Pharmacist’s Guide for Collection of Complementary Alternative Medication (CAM) and Dietary Supplement Information from Patients (1st ed., pp. 1-2). Retrieved from https://www.public-health.uiowa.edu/cert/education/CAMDataTool.pdf
Aschenbrenner, D. S., & Venable, S. J. (2012). Drug therapy in nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Benjamin, C. (2014). Low Back Pain – Acute. The New York Times. Retrieved from http://www.nytimes.com/health/guides/disease/low-back-pain-acute/overview.html
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, Mo.: Elsevier Health Sciences.
Mazze, R. S., & International Diabetes Center. (2012). Staged diabetes management. Hoboken: John Wiley.
Sucich, M. I., & Sanoski, C. A. (2011). Herbal notes: Complementary & alternative medicine pocket guide. Philadelphia, Pa: F.A. Davis.
