Question 1 (FM)
The case study presented illustrates an 80-year-old woman who is experiencing several health issues. The patient had been living with various health conditions such as hyperlipidemia, gastroesophageal reflux disease, osteoarthritis, hypertension, as well as heart failure. Besides, she has been taking several medications associated with these conditions, such as metoprolol succinate 12.5 mg, lisinopril 10 mg, acetaminophen 650mg, tramadol 25mg, furosemide 40mg, and pantoprazole 40mg. She has visited a healthcare facility for her condition to be monitored and medications reviewed regularly. According to the most recent review, the results indicate that the patient’s condition has improved significantly due to her adherence to the medications prescribed. By comparing her previous and the current review, her weight has reduced by 5lbs, there is minimal arthritis pain, gastroesophageal reflux disease symptoms have disappeared, and her lungs are clear. Based on the health issues that the patient experiences, various aspects have been discussed where some of them include medications necessary to be de-prescribed, medication to be reduced after completing prednisone, as well as medication adjustment due to the absence of exacerbation of heart failure.
Medications Necessary to be De-prescribed
After reviewing the condition of the patients, several drugs need to be de-prescribed. In this case, some drugs need to be stopped while others need to be reduced in terms of dosage. One of the medications that need to be stopped is the tiotropium inhaler. Tiotropium inhaler is a type of medication used to treat lung issues since it is a bronchodilator (Messerli et al., 2017). The medication assists in opening and relaxing airways to enhance breathing. According to the patient’s review, her lungs appear to be clear without any issues that can lead to breathing problems. Therefore, there is no need to use tiotropium inhaler anymore.
The other medication that needs to be stopped is the pantoprazole 40mg. This medication belongs to the class of proton pump inhibitors. It assists in reducing the level of acid in the stomach, especially for a patient with gastroesophageal reflux disease (GERD) (Di Palo & Barone, 2020). According to the case study presented, the patient shows no signs of GERD after review. This implies that pantoprazole 40mg needs to be stopped since it currently has no benefit to the patient.
Rather than terminating the use of acetaminophen 650mg and tramadol 25 mg, these drugs need to be reduced. These drugs are considered to be pain relievers, and therefore they assist the patient in relieving pain. According to the review conducted, the patient has minimal arthritis pain, and therefore only a minimal dose of pain relievers is needed.
Medication to be reduced after completing Prednisone
Prednisone is used to treat issues associated with arthritis since it is considered a steroid drug (Pfeffer, 2016). This drug reduced inflammation, thus minimizing pain. When the patient completes this medication, other drugs, especially the pain relievers, need to be reduced. Some of these pain relievers include acetaminophen 650mg and tramadol 25mg (Pfeffer, 2016).
Medication Adjustment due to Absence of Exacerbation of Heart Failure
There are several medications associated with heart failure that were prescribed to the patient. Some of them include metoprolol succinate 12.5 mg, lisinopril 10 mg, and furosemide 40mg. Since the review of the patient’s condition indicates that there is no exacerbation of heart failure, these medications can be eliminated or reduced.
References
Di Palo, K. E., & Barone, N. J. (2020). Hypertension and heart failure: prevention, targets, and treatment. Heart failure clinics, 16(1), 99-106.
Messerli, F. H., Rimoldi, S. F., & Bangalore, S. (2017). The transition from hypertension to heart failure: a contemporary update. JACC: Heart Failure, 5(8), 543-551.
Pfeffer, M. A. (2016). Heart failure and hypertension. Hypertension, An Issue of Medical Clinics of North America, E-Book, 101(1), 19-28.
Question 2 (CCY)
1) In reviewing her medication list and current symptoms and clinical signs, which
medication could the nurse practitioner consider de-prescribing.
The medication the nurse practitioner may consider de-prescribing include pantoprazole as she does not have symptoms of GERD. Pantoprazole works by reducing the quantity of acid the stomach generates. It is used to treat heartburn, acid reflux, and gastroesophageal reflux disease (GERD).
The nurse may also de-prescribe atorvastatin as her healthy diet may be fat-free or include ingredients that lower the production of cholesterol. Atorvastatin is used together with a good diet to help reduce ‘bad’ cholesterol and fats while raising good cholesterol in the blood. The healthy diet currently being observed by the patient necessarily provides good cholesterol and inhibits the production of bad cholesterol. Since there is no exacerbation of heart failure, which may be as a result of too much bad cholesterol, the patient may be off atorvastatin.
The other medication that may be de-prescribed is furosemide, as she has no symptoms of edema. A diuretic, furosemide, is used in the treatment of high blood pressure, heart failure, and edema (Ellison, 2017). Edema is the buildup of fluid in the body. The patient does not need this drug at the moment because she does not have edema and exacerbated heart failure.
2) Once the patient has completed the prednisone taper, which medication could the nurse
practitioner begin to reduce given the patient’s reported symptoms.
The nurse may begin to reduce the use of acetaminophen as completion of prednisone taper will mitigate arthritis in the patient. Prednisone taper is a steroid and provides relief for pain occasioned by inflammation of body areas (Mayo Clinic). It is also used to treat several conditions like inflammation, severe allergies, arthritis, adrenal issues, blood, or bone marrow problems, among others. Tapering provided by prednisone taper can stop the inflammation of the joints that causes arthritis to stop altogether. Because the drug is also a pain reliever, the patient may require reduced use of tramadol, which is also a pain reliever. Tramadol is a strong painkiller that is used as needed.
3) Given the absence of an exacerbation of heart failure and compliance with a reduced
sodium diet, what other medication(s) adjustments could the nurse practitioner consider at
this time?
The other medicine the nurse may consider is metoprolol succinate. This medication is used in the treatment of chest pain (angina), heart failure, and high blood pressure, and heart rate. It is a beta-blocker that functions by blocking how certain natural chemicals act in the body, thus lowering the heart rate, blood pressure, and extra strain on the heart. A healthy diet, regular exercises, and reduced sodium intake, which the patient is observing, have similar results to the use of metoprolol succinate. Therefore it may not be necessary to use it.
The nurse may also reconsider the prescription of Lisinopril. Lisinopril is a medication used in the treatment of high blood pressure and heart failure. At the time of discharge, the patient had no exacerbated heart failure, which makes the need for this medicine unnecessary. The patient has also lost weight and is on a healthy diet and exercise, which helps in improving the functioning of the heart.
References
Ellison, D. H., & Felker, G. M. (2017). Diuretic treatment in heart failure. New England Journal of Medicine, 377(20), 1964-1975.
Mayo Clinic. (2020).Prednisone (Oral Route).https://www.mayoclinic.org/drugs-supplements/prednisone-oral-route/side-effects/drg-20075269?p=1#:~:text=It%20is%20used%20to%20treat,ulcerative%20colitis%2C%20and%20flare%2Dups
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Advanced Practice Nursing in the Care of Older Adults. (2nd ed.). Philadelphia, PA: F. A. Davis Company.
American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.).