Pharmatherapeutics Assignment
Personal and Medical history
Mr. JP is an 86 year old Caucasian male who leaves with his wife in an assistance leaving home and receives help from a home health aide, who usually is there every morning to assist him and his wife with all their needs. Mr. JP started experiencing severe pain around his shoulder although he usually experience pains in his joints because of arthritis, after the fourth day his pain escalated to the point where he could not hold it any longer and started having a temperature of 103, therefore he decided to go to the emergency room. Mr. JP arrived to the emergency room complaining of joint pain in his left shoulder region and fever. The ER Physician’s diagnosis was, “Pain joint, shoulder region, left septic arthritis, bacteremia.” The physician decided to admit him for a few days and treat his infection and avoid any further complication. Mr. JP was ordered to be in contact isolation for the protection of him and others.
His past medical history are significant for Type II diabetes which he was diagnose at the age of 48, follow with hypertension, glaucoma, CHF, arthritis, Neurogenic bladder, Carotid artery disease, COPD, Urinary obstruction, Mixed hyperlipidemia, chronic anemia, Gangrene of toe and Gout.
Analysis of the individual Variables’ influence on Medications
There are many factors that can affect when prescribing a medication to a client such as age, sex, genetic diseases, culture, ethnicity, allergy, health belief and use alternative therapies/herbal supplement. In the following paragraphs we will analyze factors that can affect Mr. JP and the medications he is presently taking, however due to that fact that Mr. JP has an

extended list of medication I will be only using five top drugs that are influencing some of the factors mention before.
The usage of medications require health providers to use caution because of the age-related changes in pharmacokinetics and pharmacodynamics. Particularly care must be taken when prescribing a dose for an older adult. During the development stage of older adults, many patients have changes in their body system. For instance, changes in body fat relative to skeletal muscles can lead to an increase volume of distribution of a medication. Patient also may experience a decrease drug clearance from the natural decline in renal function. In the case of Mr. JP because of his age and taking Lasix he has a high risk for dehydration, according to the journal of Gerontology, “There are a greater prevalence of dehydration and salivary gland dysfunction among the elderly” (Ship, 1997). Consequently age can have greater impact during the use of medications.
Another individual variables that influence on medications are Sex. According to Food and Drug Administration, “Certain drugs has been cut the recommended dose, it turns out men and women metabolize medication differently” (Kweder, 2014). An example of this is the most popular sleep drug, Zolpidem (Ambien). FDA found that women were to be more susceptible to zolpidem’s side effects, largely because it is cleared from the body more slowly in women than in men.
Ethnicity, culture and Genetics plays another important role in the diversity of diseases and usage of medication. For example Caucasian have a higher risk for Sickle anemia, Celiac disease, Thalassemia and other diseases. Genetics can lead to certain disease like for instance Bloom’s syndrome which are very a common disease around the Ashkenazi Jews population.

There is a high probability that in the case of Mr. JP his diagnosis of type 2 diabetes was cause by his bad habit of eating or genetics.
The diabetes association’s mentions: “If you have type 2 diabetes, the risk of your child getting diabetes before age 50 is 1 in 7 and if you were diagnosed after the age of 50 is 1 in 13. Some scientists believe that a child's risk is greater when the parent with type 2 diabetes is the mother. If both you and your partner have type 2 diabetes, your child's risk is about 1 in 2” (Association, n.d.). Being diagnose with type II diabetes Mr. JP has the need to use drugs to help him control his glucose; glargine (Lantus). We can also add that besides his diabetes type II, his hypertension could be cause by genetics and ending in the use of Lisinopril (prinivil).
Even though Mr. JP does not have any allergy, health beliefs or alternative therapies/herbal supplements that can affect his medications, this factors are very important to assess when prescribing medication to a patient. For instance taking Ambien with certain herbal products may have an interaction which can lead to increase of dose leading to excessive drowsiness and risk of falling. Also it is very important to ask if the client is allergic to any medication since the patient can have an allergy reaction that could lead to complications. For example many patients are allergic to antibiotics like Rifampin (Rifadin) here are some of the reactions that a patient can present: difficulty breathing, swelling of your face, lips, tongue, or throat which this could lead to respiratory depression and death.
In conclusion, there are many variables in relation to medications that should be analyze before prescribing a medication. For this reason is very important for health providers to have a complete assessment and have all the data necessary before prescribing a medications to avoid any harm to the client and their families.

Nursing Diagnoses. 1. Risk for complications related to lower plasma glucose levels such as mental disorders, behavioral disorders, autonomic nerve function disorders and hypoglycemic coma.
2. Risk for cardiac dysrhythmia related to hyperkalemia or hypokalemia related to furosemide (Lasix) and Lisinopril (Provinil) treatment.
3. Risk for Suicidal thoughts related to the side effects cause by Zolpidem (Ambien).
Nursing Implications. Before administering any type of medication, the nurse should assess the patient’s knowledge about the disease and recommended treatment. A complete head-to-toe physical assessment, labs, medication history, allergies, herbal and supplements should be taken in consideration.
Antidiabetic drugs such as Glargline (Lantus) a throughough medication history includes a list of the patient’s current medications, including over the counter drugs, herbal and supplements. Review laboratory test results like fasting blood glucose level and A1C level to have a baseline and compared when there is an abnormal result. Assess the prescriber’s order for correct drug, route, type of insulin and dosage to prevent any mistake. Assess blood glucose level before administration to avoid hypoglycemia.
Glargline (lantus) is a long acting insulin which is injected into subcutaneous tissue, it forms microprecipitates that are slowly absorbed over the 24 hours. It is usually dosed once daily, but the drug may be dosed every 12 hours, depending on the patient’s glycemic response. One of the major complication and adverse effect is hypoglycemia resulting from excessive insulin which can lead to brain damage, shock and possible death. Other adverse effect are weight gain,

lipodystrophy and allergic reaction. For better outcome of treatment it is recommended adhere to a healthy diet, take medication as scheduled and monitor blood glucose level.
Administration of antibiotics requires a critical assessment for any history of or current symptoms indicative of hypersensitivity or allergic reactions. Conduct a nursing physical examination that include GI, neurologic, and a baseline vital sign values. Diagnostics and laboratory studies such as AST, ALT to assess liver function; urinalysis, BUN and serum creatinine level for assessing renal function, also cardiac function testing is important like ECG, echocardiography, ultrasonography, and cardiac enzyme level and lastly, the most important a Culture and sensitivity of infected tissue and complete blood count for baseline.
Rimfadin (Rifadin), is the first of the rifamycin class of synthetic macrocyclic antibiotics. Rimfadin is well absorbed (PO), completely absorb (IV), It is widely distributed, crosses placenta, metabolism liver-extensively, excreted in feces and has a 3 hour half-life. The drug is a potent enzyme inducer and is associated with many drug interaction like Amprevanir, buspirone, clofibrate, cyclosporine, dapsone, delavirdine, disopyramide, doxycline, fluconazole, phenytoin, zolpidem, efavirenz, saquinavir, quinidine, and nevirapine. Advese effects are hepatitis, hematologic disorders, and red-orange-brown discoloration of tears, sweat, and sputum. All antibiotics need to be taken as ordered by physician and at the same time every day to minimize the chances of resistance to the drug therapy. For better absorption it is recommended to decrease high-fat foods.
Before giving an antihypertensive drug, Lisinopril (Prinivil) it is important to measure and document blood pressure, pulse rate, respirations, and pulse oximetry readings. Monitor labs test including: WBC with differential, platelets, BUN, Creatinine, serum sodium, potassium,

chloride, and magnesium and calcium levels. Assess also for conditions, factors, or variables that may be underlying causes of a patient’s hypertension.
Lisinopril (Prinivil) has a variable absorption, unknown distribution, not metabolized, excreted in kidneys and 12 hour half-life. It has an interaction with alcohol, probenecid, allopurinol, aspirin, cyclosporine, indomethacin and lithium. The adverse effect are Stroke, headache, dizziness, hypotension, hepatic failure, hepatic necrosis, proteinuria, agranulocytosis, hyperkalemia, angioedema, anaphylaxis and toxic epidermal necrolysis. The client should avoid high-potassium diet to avoid hyperkalemia.
Furosemide (Lasix) a loop diuretic, needs to asset patient for hearing lost, hypokalemia, monitor for CV, GI, neurologic and respiratory. In patients with CHF asset fluid volume and status by recording input and output, weight crackles in lungs, peripheral pitting edema and dehydration symptoms. For labs it is important to monitor sodium, potassium and magnesium, also including BUN, blood PH, ABGS, uric acid, CBC and blood glucose. Nurse should monitor BP before and during therapy, lying, standing and sitting because orthostatic hypotension can occur rapidly.
The pharmacokinetics for Furosemide (Lasix) are Absorption in the GI tract, metabolize by the liver, excreted in urine and feces, and it has a ½ to 1 hour half-life. This drug can interact with vancomycin, digoxin, lithium, and probenecid. Some of the adverse effect that patient may experience are headache, loss of hearing, chest pain, circulatory collapse, hypokalemia, hyperglycemia, nausea, diarrhea, dry mouth, vomiting, renal failure, thrombocytopenia, agrunlocytosis, anemia and toxic epidermal necrolysis.
For patient education is important to teach the patient to take the medicine early in the morning to prevent nocturia, also to take his medication with food to reduce the symptoms of nausea,

also caution the patient that this product reduces potassium and a rich potassium diet should be added it, do not combine with any OTC or any medications without the physician’s approve, advise patient to keep taking the medication even if feeling better, patient should monitor his BP and pulse every day.
Before administering Zolpidem (ambien) is important to assess mental status, mood sensorium, anxiety, affect, sleeping pattern, drowsiness, suicidal tendencies for indications of increasing tolerance and abuse; also monitor B/P, pulse and I&O ration for renal dysfunction.
The absorption of Zolpidem (ambien) is rapidly, the metabolism of this medication is by the liver, the excretion is by the kidneys, and the half-life is 2 ½ hour but since Mr. JP is an older adult the half-life is increased.
Zolpidem (ambien) should not be consume with alcohol, CNS depressants, CYP3A4 inhibitors as the action of both products may occur. Instruct the patient not to discontinue medication abruptly after a long term use, do not crush ext rel tablets, prime the spray before using, do not double or skip doses, avoid driving and activities that require alertness because drowsiness may occur.
Adverse complications may occur such as headache, lethargy, drowsiness, suicidal ideation. Leukopenia, granulocytopenia, angioedema, anaphylaxis also instruct the patient to not use more than 3 months unless directed by prescriber, caution patient to avoid OTC preparations unless approved by prescriber, advise patient that complex sleep-related behavior may occur.