Drug History Purpose: Identify patients reason for medication use, how it is absorbed and metabolized as well as associated

drug interactions. Describe patients ability to recognize problems attributed with his%her medications and safely ta&e them based on 'ordons functional health patterns. )xplain how patients age, gender, culture, and en"ironment influences his%her pharmacotherapy. Discuss &ey elements for patient teaching related to his%her pharmacotherapy based on best practice. )xamine the assessment data and outcomes pertinent to patients pharmacotherapy. Identify the nurses role to implement policies and procedures as well as strategies that reduce medication errors and incidents. Directions: 5sing the form below, students will gather a medication history from a patient in clinical, family member, friend, or ac6uaintance. *he indi"idual selected must ta&e 2 or more different medications. 7ne may be an herbal supplement, with the remainder being prescription medications. 3IP88 rules must be strictly adhered to. 5se initials only as name identifiers. *here will be a 19: deduction if names are used. 1. Describe nurses role in the therapeutic use of drug therapy for patients with complex health needs. !ollaborati"e #eadership$ (. )xplain pharmacological principles from a theoretical basis. *heoretical +ase for Practice$ ,. Identify special considerations for di"erse patient populations in relation to drug therapy and health care policy. 'eneralist -ursing Practice$ .. /ecognize the importance of using most current and e"idence0based resources in the determination of nursing inter"entions related to drug therapy. 1cholarship for Practice$ 2. Demonstrate the use of the nursing process in simulated situations related to drug therapy. 3ealth !are )n"ironment$ 4. Identify the legal%ethical responsibilities of the nurse in pro"iding safe drug therapy. Professionalism$

;edication history -ame: <enny ;ynhier =hy: !lass assignment =here: 1pectrum 3ealth +ig /apids 3ospital =ho: D> initials$ 49 age$ ?emale gender$ !apable of participating capable of participating@ or from chart@$ 3ow:

Introduction how did you start the Ameeting$ o D> is a cowor&er of mine, we ha"e been wor&ing together for o"er three years, I Bust as&ed her if she would be able to help me with my assignment. =e discussed her medication list, including the names, doses, fre6uencies, what they are used for and how long she has been ta&ing them. I "erbally as&ed her the 6uestions included in the concerns C barriers section.

/e"iew past medical history o 3ashimotos thyroiditis, 18D, edema, and hypo&alemia. /ecent 3istory of !0Diff, but has completed the drug regimen and now feels better.

#ist medications scheduled and Aprn: 7*!, / x, illicit, herbal, etc.$ o o o o o o Name: Wellbutrin XL Dose: 129 mg ?re6uency: 1 tablet P7 daily /eason for use: 1easonal Depression 3ow long ta&en: 12 years Pharmaco&inetics: =ell absorbed, rapidly and extensi"ely metabolized by li"er. Distribution un&nown. )xtensi"ely metabolized by the li"er into , acti"e metabolites. 1. hour half0life. Drug interactions: /is& of ad"erse reactions when used with ;87Is, amantadine, or le"odopa. Increased ris& of seizures with phenothiazines, antidepressants, theophylline, and corticosteroids. /itona"ir, lopina"ir, and efa"irenz may decrease le"els, may need to increase =ellbutrin dose. ;ay increase citalopram le"els. !arbamazepine may decrease blood le"els and effecti"eness. 5se with nicotine may cause hypertension. Increased ris& of bleeding with warfarin. =ellbutrin and one of its metabolites inhibit the !DP(D4 enzyme system and may increase le"els and ris& of toxicity from 11/I C tricyclic antidepressants, haloperidol, risperidone, thioridazine, beta bloc&ers, flecainide and propafenone. ;ay decrease le"els and efficacy of tamoxifen,

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Name: Synthroid Dose: 1.2 mcg ?re6uency: 1 tablet P7 daily /eason for use: *hyroid disorder%3ashimotos disease 3ow long ta&en: ,9 years Pharmaco&inetics: .90E9: absorbed from the 'I tract. Distributed into most body tissues, does not readily cross the placenta, minimal amounts enter breast mile. FF: protein binding. ;etabolized by the li"er and other tissues to acti"ate *,. *hyroid hormone undergoes enterohepatic recirculation and is excreted in the feces "ia bile. 40G day half0life. Drug interactions: +ile acid se6uestrants and orlistat decrease absorption of oral thyroid preparations. ;ay increase the effects of warfarin. ;ay increase re6uirement for insulin or oral hypoglycemic agents in diabetics. !oncurrent estrogen therapy may increase thyroid replacement re6uirements. Increased !H effects with adrenergics Name: Maxzide (hydrochlorthiazide + triamterene Dose: ;axzide hydrochlorthiazide 29mg I triamterene G2 mg$ ?re6uency: 1 tablet P7 daily /eason for use: =ater retention 3ow long ta&en: , years Pharmaco&inetics: hydrochlorothiazide: /apidly absorbed after oral administration. Distributed into extracellular space, crosses the placenta and enters breast mil&. )xcreted mainly unchanged by the &idneys. 4012 hour half0life. Triamterene: ,90G9: absorbed. =idely distributed. E9: is metabolized by the li"er, some excretion of unchanged drug. 1.G0(.2 hr half0life. Drug interactions: hydrochlorothiazide: 8dditi"e hypo&alemia with corticosteroids, amphotericin +, piperacillin, or ticarcillin. Decrease excretion of lithium. !holestyramine or colestipol decrease abdorption. 3ypo&alemia increases ris& of digoxin toxicity. Triamterene: Increased hypotension with acute ingestion of alcohol or other antihypertensi"e agents or nitrates. 5se with 8!) inhibitors, indomethacin, angiotensin II receptor antagonists potassium, potassium supplements, or cyclosporine increase ris& of hyper&alemia. Decreased lithium excretion. )ffecti"eness may be decreased by -18IDs. Decrease the effects of folic acid. ;ay increase ris& of toxicity from amantadine. Name: !otassium "itrate Su##lement (#rescri#tion Dose: 19E9 mg ?re6uency: 10( tablets P7 daily

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/eason for use: 3ypo&alemia 3ow long ta&en: , years Pharmaco&inetics: =ell absorbed following oral administration. )nters )!?J then is acti"ely transported into cells. )xcreted by the &idneys. 5n&nown half0life. Drug interactions: 5se with potassium0 sparing diuretics or 8!) inhibitors or angiotensin II receptor agonists may lead to hyper&alemia. 8nticholinergics may increase 'I mucosal lesions in patients ta&ing wax0matric potassium chloride preparations. Name: !ro$era Dose: (.2 mg ?re6uency: 1 tablet P7 daily /eason for use: ;edroxy0 progesterone supplement to control hot flashes and night sweats 3ow long ta&en: . years Pharmaco&inetics: 9.4019: absorbed after oral administration. Distribution includes drug entering the breast mil&. ;etabolized by the li"er. 3alf0life: 1 st phase0 2( mins, (nd phase0 (,9 min, biological0 1..2 hr Drug interactions: ;ay decrease effecti"eness of bromocriptine when used concurrently for galactorrhea or amenorrhea. !ontracepti"e effecti"eness may be decreased by carbamazepine, phenobarbital, phenytoin, rifampin, or rifabutin. 8minoglutethimide may decrease oral absorption.

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Identify concerns or barriers use 'ordons functional health patterns$ o 3a"e you had problems that can be attributed to the medications@ 'i"e example s$. =hen D.>. was first put on the ;axzide, she experienced chest pains and leg cramps due to depleted potassium%hypo&alemia. *hat is the reason the client is now on the potassium citrate supplement. 8re you able to safely ta&e medications as prescribed@ 'i"e example s$.'ordons 3ealth Perception%3ealth ;anagement pattern can apply to D.>.s compliance and ability to safely ta&e her medications. 1he is a 49 year old female, she wor&s full time. 1he seems to understand her medications, why she is on them, and when to ta&e them. =hat information or instructions were you gi"en when the medications were first prescribed@ D.>. states that the main things she remembers from when the medications were first prescribed were to always ta&e the medications at the same time each day and do not s&ip medications, e"en if condition impro"es. 'ordons !ogniti"e0Perceptual pattern can be related to her compliance with her medication as she has the understanding of the medications to &now when and how much to ta&e each day, and she also understands the conse6uences of not ta&ing her medications.

Do you thin& the medications are doing what they were prescribed to do@ 'i"e example s$. Des. 1he states that her =ellbutrin is for seasonal affecti"e disorder, and seems to help. *he synthroid is to ma&e up for the lac& of thyroid function. 1he used to ha"e a lot of swelling, especially in her feet and an&les, and the ;axzide has ta&en care of that, and the potassium helps to pre"ent the symptoms she was ha"ing of hypo&alemia. *he Pro"era is helping with her symptoms of menopause. Does anyone else help you ta&e your medications@ D.>. states that she does not need help ta&ing her medications, but sometimes her husband does remind her to ta&e them.

=rap up:

/eflection K,99 words$ o Identify 6uestions that could ha"e been as&ed as well as patient teaching that could ha"e been conducted if you had more &nowledge about the medications. Identify strategies you would offer to reduce medication errors or incidents. Identify aspects of a medication history you would change in the future gather more or less information$. Identify what you learned doing this assignment.

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/eflection: 7"erall I feel that the patient was "ery &nowledgeable about her meds. 8s she has been on each medication for at least , years and all the way up to ,9 years, she is pretty well informed about each medication. 1he was for the most part spot on about what each drug is used for. 1he wasnt 6uite sure on all of the dosages for each one, so we did ha"e to double chec& what she actually ta&es, but she carries a list with her in her purse that contains all of that information. 3ad I &nown more information about the ;axzide during the inter"iew, I would ha"e as&ed the client what exactly she is on it for. It is a diuretic, and she told me it was for water retention, but I did not thin& to as& why she is retaining water in the first place. 8ccording to the Da"iss Drug 'uide, she could ha"e edema for a number of reasons including heart failure, renal dysfunction, cirrhosis, glucocorticoid therapy, or estrogen therapy. I dont thin& there are many strategies I would be able to use in this case to reduce medication errors or incidents because as I said before, she has been on all of her medications for so long, and already &nows so much about

them. 3ad this not been the case, I definitely thin& it would be important to ma&e sure the patient &nows the importance of when to ta&e their medications, what side effects they may experience, and which side effects would be most important to report to the doctor. ;any drugs should be ta&en with or without food or at a certain time of day, so these things would be important to &now as well. It is especially important in most cases not to stop the medications or change the amount without first consulting their physician. I thin& I got most of the information that I needed from the client and from Da"iss drug guide, but if I were to do it again, I would get a more detailed medical history. I learned the most about the ;axzide, I had ne"er heard of it before, so it was interesting to learn more information about it, and to see that it caused the hypo&alemia.