Pathophysiology and Pharmacology: Mrs Margaret Green

Part 3: Pharmacology
Note: All medications need to be on one table so any drug interactions etc can be obvious to the student and marker. This table should be written in size 9 font & please ensure that headings are repeated on each page (if you don’t know how to do this ask your lecturer) Names of medication and dosage
Mode of Action and
Why is it ordered for this patient Pharmacokinetics related to the patient
A Absorption
D Distribution
M Metabolism
E Excretion
HL Half Life
P Peak MAIN side-effects related to patient
Contra indications & DRUG interactions related to patient
Metoclopramide
10mg IV/O/IM every 8hrs as neededMetoclopramide inhibits gastric smooth muscle relaxation produced by dopamine, therefore increasing cholinergic response of the gastrointestinal smooth muscle. It accelerates intestinal transit and gastric emptying by preventing relaxation of gastric body and increasing the phasic activity of antrumMendeley Citation{c83a7f61-f5e0-48d2-b0e3-9b3f7d173110} Prev{(Spratto & Woods 2005)}(Spratto & Woods 2005). This medication was ordered for the patient in relation to her nausea and vomiting episodes. A: Metoclopramide is given orally and is readily absorbed in the GI tract Mendeley Edited Citation{854a5f6b-a187-4990-9047-447aa4ee7fd9} Prev{(Aschenbrenner & Venable, 2008)}(Aschenbrenner & Venable, 2008).
D: The drug is not extensively bound to plasma proteins (about 30%). The whole body volume of distribution is high (about 3.5 L/kg) which suggests extensive distribution of drug to the tissues.
M: Metabolism mainly hepatic.
E: Approximately 85% of the radioactivity of an orally administered dose appears in the urine within 72 hr. Of the 85% eliminated in the urine, about half is present as free or conjugated metoclopramide
HL: 4-6 hours
P: Peak plasma time is 60-120 min for oralHepatic encephalopathy patients experience headache, decrease in level of consciousness, dizziness and other CNS disturbances, it is best to watch out for worsening drowsiness, dizziness, tiredness, trouble sleeping, agitation, headache, and diarrheaMetoclopramide has no direct contraindications related to the patient. However, absorption of other oral drugs from the stomach may be diminished by metoclopramide, whereas the rate and/or extent of absorption of drugs from the small bowel may be increased Mendeley Citation{c83a7f61-f5e0-48d2-b0e3-9b3f7d173110} Prev{(Spratto & Woods 2005)}(Spratto & Woods 2005)


Note: All medications need to be on one table so any drug interactions etc can be obvious to the student and marker. This table should be written in size 9 font & please ensure that headings are repeated on each page (if you don’t know how to do this ask your lecturer) Names of medication and dosage
Mode of Action and
Why is it ordered for this patient Pharmacokinetics related to the patient
A Absorption
D Distribution
M Metabolism
E Excretion
HL Half Life
P Peak MAIN side-effects related to patient
Contra indications & DRUG interactions related to patient
Lactulose
45ml O QIDLactulose is a synthetic disaccharide used in the treatment of constipation and in hepatic encephalopathy. Lactulose reaches the colon virtually unchanged. There it is metabolised by colonic bacteria to lactic acid and other short chain carboxylic acids. The end result is a change in the osmotic pressure and acidification of the colonic contents resulting in an increase in stool water content with resultant distension and softening of the stool which in turn promotes increased peristalsis and bowel evacuation. Aside from softening of the stool, lactulose also decreases nitrogenous intoxication by decreasing blood ammonia concentration Mendeley Citation{953ec147-f0de-4648-bfaa-4ad120ae6d59} Prev{(ALPHA PHARMACEUTICALS LTD n.d.)}(ALPHA PHARMACEUTICALS LTD n.d.). A: Not appreciable
D:
M: Metabolised by colonic bacteria to lactic acid and other short chain carboxylic acids.
E: absorbed lactulose is excreted in urine, unabsorbed lactulose & its metabolites are minimally excreted in feces & bile
HL: Unknown
P: UnknownSide effects that the patient may experience are: nausea, flatulence, and diarrhea.There are no significant contraindications related to the client.
There are no known significant interactions Mendeley Citation{c83a7f61-f5e0-48d2-b0e3-9b3f7d173110} Prev{(Spratto & Woods 2005)}(Spratto & Woods 2005)

Note: All medications need to be on one table so any drug interactions etc can be obvious to the student and marker. This table should be written in size 9 font & please ensure that headings are repeated on each page (if you don’t know how to do this ask your lecturer) Names of medication and dosage
Mode of Action and
Why is it ordered for this patient Pharmacokinetics related to the patient
A Absorption
D Distribution
M Metabolism
E Excretion
HL Half Life
P Peak MAIN side-effects related to patient
Contra indications & DRUG interactions related to patient
Furosemide
40mg IV/O BIDFurosemide is a loop diuretic that inhibits reabsorption of Na+ & Cl- at proximal & distal tubules & Loop of Henle Mendeley Citation{c83a7f61-f5e0-48d2-b0e3-9b3f7d173110} Prev{(Spratto & Woods 2005)}(Spratto & Woods 2005). Mrs. Green presented with bilateral edema, hence furosemide will allow decrease water retention by increasing urine output.A: fairly rapidly absorbed from the GI tract; Oral bioavailability = 60-70%, reduced for patients with renal failure
D:
M: liver, approximately 10%
E: Renal, 80-90% excreted through the urine.
HL: 1-2 hours, prolonged half-life for patients with hepatic and renal failure
P: 1-2 hours (oral); <30mins (IV)Regarding Mrs Green’s condition, the side effects that should be observed are the following: dizziness, vertigo or headache, blurred vision, constipation, nausea and vomiting, jaundice, weakness. These side effects may further aggravate or put Mrs. Green’s safety in jeopardy.Monitor GCS and electrolytes before administering. Furosemide should be cautiously given in relation to other antihypertensive or nephrotoxic medications.Multi-Vitamin B Forte (Vitamin B-Complex)
3 tabs PO dailyVitamin B-complex stimulates metabolic function which is needed for haematopoiesis, cell replication, and nucleoprotein and myelin synthesis. In Mrs. Green’s case, the combination in vitamin B-complex is intended for gastrointestinal disorder interfering with absorption of vitamins, intoxication, alcohol abuse and liver cirrhosis.A: Water-soluble, synthesized by bacter...