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PHAR 1000 ASSIGNMENT: CASE STUDY

Pharmacology 1000 Case Study

Gouri Gopan

Northwestern Polytechnic College

PHARM 1000 C01

Carsyn Nichols

Assignment 1: Case Study

31 Jan 2024
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Primary medical diagnosis: Non-insulin dependent Diabetes (Type 2 Diabetes)

Secondary medical diagnosis: Depression

History: Smoker

Doctor’s order: Medications

• Amitriptyline hydrochloride (Elavil) 50mg oral once daily at bed time.

• Metformin hydrochloride (Glycon) 850 mg oral once daily 30 mi before morning meal

Medications Available on the unit:

• Elavil 25 mg tablets
• Metformin 850 mg immediate release tablets

Right Patient

Elavil: check the patient identity by asking the name, ID number, age, allergies and confirm with the
hand tag before drug administration (Lilley et. al, 2021)

Glycon: check the patient identity by asking the name, ID number, age, allergies and confirm with the
hand tag before drug administration (Lilley et. al, 2021)

Right medications and Right reason

Amitriptyline hydrochloride (Elavil)

• Amitriptyline is for Mrs. Kim diagnosis of depression

• Amitriptyline causes an “potentiates the effect of serotonin and norepinephrine in the CNS.”
• Amitriptyline Pharmacological class is Antidepressant (Vallerand & Sanoski, et. al 2021).

Metformin hydrochloride (Glycon)

• Metformin is for Mrs. Kim diagnosis of Type 2 Diagnosis

• Metformin causes “decreases hepatic glucose production. Decreases intestinal glucose
absorption. Increase sensitivity to insulin”. Thereby maintaining the blood glucose level.
• Metformin pharmacological class is Antidiabetic (Vallerand & Sanoski, et. al 2021).

Right route

• Elavil - Amitriptyline
▪ “the drugs come from oral route (tablet)” (Vallerand & Sanoski, et. al 2021).
• Glycon – Metformin
▪ “the drugs come from oral route (tablet or suspension)” (Vallerand & Sanoski, et. al 2021).
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Right dose and Right time

• Elavil
▪ The dose prescribed by the physician is found to be safe.
▪ Physician ordered amitriptyline 50 mg orally at bed time and the dosage should be
between 50-100 mg. (Vallerand & Sanoski, et. al 2021).
▪ The maximum dose per day is 150 mg (Vallerand & Sanoski, et. al 2021)
▪ Calculation:
(50 mg/25mg) x 1 tab = 2 tab
Hence 2 tablets of Elavil are taken at bed time orally.

• Glycon
▪ Physician order dose is safe
▪ Physician order – 850 mg orally once daily 30 minutes before morning meal
▪ Metformin can be given either in divided doses or 850mg once a day (Vallerand & Sanoski,
et. al 2021).
▪ Maximum dose – 2550 mg/day in divided doses (Vallerand & Sanoski, et. al 2021).
▪ Calculation:
(850mg/850mg) x 1 tab = 1 tab
Hence 1 tablet Glycon is taken orally 30 min before food

Right assessment

• Elavil
▪ Pre- assessment is monitoring Bp and pulse before therapy (Vallerand & Sanoski, et. al
2021).
▪ Post-assessment for suicide tendency (Vallerand & Sanoski, et. al 2021).
• Glycon
▪ Pre-assessment is done by serum glucose monitoring and monitoring of glycosylated
haemoglobin (Vallerand & Sanoski, et. al 2021).
▪ Post-assessment is observing the patient for hypoglycaemic reaction (Vallerand & Sanoski,
et. al 2021).

Right to patient education

Elavil: “advise patient to avoid alcohol and other CNS depressant drugs during and for 3-7 days after
therapy has been discontinued” (Vallerand & Sanoski, et. al 2021).

Glycon:” encourage patient to follow prescribed diet, medication and exercise regimen to prevent
hyperglycaemic or hypoglycaemic episodes” (Vallerand & Sanoski, et. al 2021).
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Right to refuse

NANDA diagnosis: “deficient knowledge related to lack of experience with medication regimen and
grade 2 grading level as an adult, as evidence by inability to perform a return demonstration and
inability to state adverse effects to report to the prescriber” (Lilley et. al, 2021)

Nursing Diagnosis: “ineffective health management related to poor health literacy as evidenced by
non-compliance of prescribed treatment regimen” (Doenges et. al, 2016)

SMART outcome: “verbalize acceptance of need and desire to change actions to achieve agreed-on
health goals within week” (Doenges et. al, 2016)

Intervention: “emphasize the importance of clients knowledge and uderstading of the need for
treatment of medication as well as the consequence of action and choices” (Doenges et. al, 2016)

Right documentation

Elavil: if the client refuses to take the medication, determine the reasons and document (Lilley et. al,
2021)

Glycon: document the date and time of administration of medication according to physician order and
specify the timing (Lilley et. al, 2021)

Herbal

Patient taking the St. john’s wort because she heard its effective in managing depression. Using St.
john’s wort with other antidepressant medication may increased the risk of adverse CNS reaction. It
also decreases the effectiveness and serum concentration of digoxin, alprazolam, amitriptyline,
imatinib, warfarin and protease inhibitors (Vallerand & Sanoski, et. al 2021).

Teachings:

➢ Provide adequate education about the use of herbal including its advantages and
disadvantages (Lilley et. al, 2021). Rationale: many patients believe that there is no risk with
the use of herbal products, this is crucial to know because their safety is our priority (Lilley et.
al, 2021)
➢ Provide instruction on how to read herbal products label (Lilley et. al, 2021). Rationale: there
are certain herbal that contains chemical ingredients that may alter our body system that
could lead to increased risk of adverse effect and toxicity (Lilley et. al, 2021).
➢ Emphasize the importance of taking herbals with extreme caution (Lilley et. al, 2021).
Rationale: this is to inform them the possible drug interactions that could decrease the
effectiveness of other drugs (Lilley et. al, 2021).
➢ Instruct patients to consult healthcare professional before taking herbal products
concurrently with St. john’s wort (Vallerand & Sanoski, et. al 2021). Rationale: it may
potentiate effect of sedatives and side effects of other antidepressants (Vallerand & Sanoski,
et. al 2021).
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References

• Doenges M.E., Moorhouse, M.F., Murr, A.C. (2016). Nurse’s pocket guide: diagnosis,
prioritized interventions and rationales (14th ed.). F.A. Davis Company.
• Lilley, L.L., Colins, S.R., Snyder, J.S., Swart, B. (2023). Pharmacology for Canadian healthcare
practice (4th ed., pp. 279, 548-550). Elsevier.
• Vallerand, A.H., Sanoski, C.A. (2021). Davis’s Candian Drug guide for Nurses (17th ed., pp. 145-
146, 839-841). F.A. Davis Company.