Week 8 Nurs 676B

Week 8 Nurs 676B

 

Week 8 Nurs 676B

The case study depicts Samuel, an 82-year-old male type II diabetes patient with complaints of low blood sugar. His antidiabetic therapy includes glyburide and diet. He recently had a suspected staph infection treated with sulfamethoxazole and trimethoprim. Samuel is also on Lisinopril, Flomax, Lipitor, Paxil, Coenzyme Q10, and a multivitamin. In addition, his daughter found old prescriptions for atenolol, alprazolam, and terazosin in his drug cabinet.

Glyburide has the potential for causing hypoglycemia and should be used in caution in elderly patients such as Samuel since hypoglycemia is especially dangerous.   The patient’s hypoglycemia can be attributed to drug-drug interactions with glyburide which increase the glucose-lowering effect of glyburide, resulting in low blood sugar (Hardin & Jacobs, 2021). For instance, Lisinopril increases the glyburide effects through pharmacological synergism resulting in low blood sugar. Beta-blockers also increase the pharmacodynamic effect of glyburide, causing low blood sugar (Hardin & Jacobs, 2021). Thus, the patient’s hypoglycemia can be due to drug-to-drug interaction of glyburide with Atenolol (beta-blocker).

The clinician should ask the patient and his daughter questions to establish the safety of his medication management. The clinician should ask the patient about his current medical conditions and the drugs for each condition. This will help identify the unnecessary drugs that the patient is taking (Saljoughian, 2019). In this case, the patient has drugs for anxiety (alprazolam)   and depression (Paxil), which could be unnecessary if the patient has no depressive or anxiety disorders. In addition, the clinician should enquire about the physician-prescribed drugs and OTC drugs to establish if the OTC drugs are causing polypharmacy (Saljoughian, 2019). Furthermore, the clinician should ask about drug side effects and establish the medication causing the mentioned side effect. The patient should be probed on drug allergies to prevent adverse drug reactions.

Samuel and his family should be educated about each drug’s indication and the potential side effects. He should be advised to label his drugs in different drug containers with the dose and frequency to avoid taking one drug twice. Furthermore, the patient should be educated about the dangers of polypharmacy to understand that a drug can be stopped if it is causing harm or is no longer beneficial (Saljoughian, 2019). Lastly, the patient and his family should be educated that stopping unnecessary drugs and adhering to effective medications can lower costs.

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References

Hardin, M. D., & Jacobs, T. F. (2021). Glyburide. In StatPearls. StatPearls Publishing.

Saljoughian, M. (2019). Polypharmacy and drug adherence in elderly patients. US Pharm, 44(7), 33-36.

Week 8 Nurs 676B
US pharmacist .com article
www. Avoiding Drug-Induced Hypoglycemia in the Older Adult (uspharmacist.com)ding Drug-Induced Hypoglycemia in the Older Adult (uspharmacist.com)
Samuel is an 82-year-old male brought in by his daughter for complaints of low blood sugar. Samuel has a history of type II diabetes well-controlled with glyburide and diet. He was treated last week at an urgent care for a suspected staph infection to his arm with sulfamethoxazole and trimethoprim. He also takes lisinopril, Lipitor, Flomax, Paxil, Coenzyme Q10, and a multivitamin. His daughter also found old prescriptions for alprazolam, atenolol, and terazosin in his medicine cabinet. With what you know about drug-drug interaction in older adults, what could be the cause of his hypoglycemia? What questions do you need to ask the patient and his daughter about safe medication management? What education should be offered to this patient and his family?

US Pharm. 2019;44(10)4-8.
There is much to be learned from those who have examined the unintended effects of medication therapy. As this knowledge base increases, it is important to seek systematic reviews and meta-analyses of these effects and to rely on the evidence these studies provide in order to better serve patients through appropriate medication monitoring and other medication-therapy management (MTM) services. In light of the fact that advancing age is a risk factor for drug-induced (DI) hypoglycemia (TABLE 1) in the article US pharmacist, this brief discussion will provide nuanced guidance and additional resources to help pharmacists better individualize pharmaceutical care to this vulnerable patient population.