Pharmacology Case Description Question 1

PharmacologyCase Description


Themedication order prescribed to Lilian Tudor is sufficient based onthe conditions she faces on a regular basis like blood pressure,arthritis, diabetes, and kidney leakage. However, there is criticalinformation that is missing. The patient is aged over 80 years andshe has 10 different medications she is expected to undertake. As aphysician, it would be important to lower the number of drugsprescribed to the patient. Her body is aging and it may not have theability to synthesize and optimize the ingested drugs. Thisinformation is missing although all the drugs [10 of them] may affectthe overall health of the patient.

Animportant consideration for nurses administering tramadol is thatthey should pay close attention to the side effects. Headache,vomiting, nausea, constipation, dizziness, and drowsiness maypotentially affect the patient (Columbus, 2004). This is soparticularly to the elderly.

Thereason Lilian is taking tramadol is based on her joint pains andswellings. More clearly, the patient suffers from intense arthritisand therefore the need to administer tramadol for pain-relief. Othercommon reasons are to minimize other conditions of arthritisrheumatoid arthritis, osteoarthritis, septic arthritis, andinfectious arthritis.

Thereis no specific interaction between Tramadol and the drugs Lilian istaking. However, it is important to take into consideration thattramadol is a pain-relief drug and it may not argue well with otherpain-relief medications (Scott and Galloway, 2015). It may result tooverdosing when different drugs treating similar conditions areprescribed.


Garlicis a highly effective supplement when it comes to dealing withillnesses and disease. More than 300 different drugs are known tointeract with Garlic since its supplements do not present majorhealth problems to patients. Garlic is mainly known to contain arange of active ingredients the primary one being alliumsativum.There are no reported health hazards or implications in mixingtramadol with Garlic since the two falls into separate class of drugs– and that Garlic is by itself an effective drug. This studytherefore supports that Lilian will not face any challenges whenmixing Tramadol [and related medications] with Garlic supplements.According to Collins-Bride, Saxe, Duderstadt, and Kaplan (2016), itis important for the patient to seek medical attention andrecommendations on which supplements to consume alongside her currentprescriptions. While garlic may not pose immediate implications whenmixed with the drugs Lilian is taking, it may have other unknowneffects which may occur at a later stage.


Assessingpain when dealing with patients require open communication betweenthe practitioner and the patient (Wuhrman et al. 2011). It is,therefore, important for the nurse to develop rapport with Lilian indetermining periodic pain, whenever it occurs.

Zolpidemworks by acting on brain receptors responsible for releasing theGABA-A receptors (ASHS, 2015). The drug later causes the release ofneurotransmitters in the brain that act as chemical messengers in thenerve cells. Zolpidem also treats insomnia and it belongs to a classof drugs called sedative-hypnotics. The drug may act 1-2 hours afteradministration by slowing down the brain activity to make it possibleto induce sleep.

Safetyprecautions for the drug is that patients taking 6.25 – 12.5 mg ofextended-release ambiens should not drive, operate machinery orengage in activities that demand a high level of mental alertness.The Food and Drug Administration (2013) warns the levels of zolpidemmay remain high during the next day and impair the mental alertnessof patients (FDA, 2013).

Thereasons for Lilian falling are diverse. She suffers from arthritisand pain, shock, or failure of the joins may prompt her to fall.Suppository may also cause vaginal burning and irritation causingfemale patients to fall down due to pain.


Albuterolis an inhalation that relaxes the muscles of the airways andtherefore increasing the blood flow into the lungs (Rose, 2015). Thedrug belongs to the adrenergic bronchodilators class of medicationsince it is a quick-relief medicine. The drug-response time isusually 10-15 minutes although the time may vary depending on thehealth and the age of the patient. It works faster in youngerpatients as opposed to elder victims.

Patientsare required to inform physicians before undertaking Albuterol ifthey have any of the following conditions heart disorder, lowpotassium levels in the blood, congestive heart failure, HBP, or aseizure such as epilepsy (Rose, 2015).

Bothprescriptions ipratropium and albuterol may be scheduled at the sametime. However, the nurse/physician may change the dose or schedule toensure they do not occur at the same time. It is recommendable tochange the doses or how often they are used for one patient.

Thenurse will inform Lilian that the combination of both inhalers ishighly effective when treating wheezing, coughing, chest tightness,and difficulties in breathing. She would inform Lilian thecombination of Albuterol and Ipratropium is significant and effectivewhen dealing with multiple cases of Chronic Obtrusive PulmonaryDisorders – as opposed to just using one inhaler.

3B[1] – Rationale for the Cardiologist

Bothheparin and warfarin are anticoagulation medications that takedifferent reaction times. Heparin will react almost immediately totreat the clot before warfarin begins reaction after a day or two.More clearly, Warfarin takes 24 – 48 hours before it attains thecorrect levels (Rose, 2015). So heparin is usually administeredsimultaneously with warfarin to help treat the clot before the otherstarts its activity. Immediately the INC is in the correct rangeafter 48 hours, heparin can be stopped.

Question3B [2] – Nursing Implications

Thereare selected nursing implications when administering or prescribingdigoxin. These include:

  • A ½ of the loading dose is given immediately PO or IV.

  • A ¼ of the loading drug is given 8 – 12 hours of PO or IV.

  • The remaining ¼ of the dose is given after 8 to 12 hours IV or PO.

  • Administer a slow push of IV after 5-10 minutes.

  • It is important for nurses to assess for toxicity. This can be achieved by obtaining an ECG after 6 hours of digitizing (Alabsi, 2011).

Theabove can be achieved as follows:



Lilianshould know that the Hormonal Replacement Therapy [HRT] is done toreplace the hormones the body does not produce after menopause (MayoClinic, 2016). The patient should also realize the process is knownto minimize symptoms of menopause, counters hot flashes, and managesmenopause symptoms Hormonal therapy has long-term benefits oftreating dementia and heart disease. Part of the knowledge is forLilian to discover that aging patients may suffer from lack ofhormones due to failure in the menopause. She should therefore bemade to understand that replacement therapy serves to ensure thatpatients are able to attend various biological needs and are able tomaintain the overall health through external hormones.


Prescriptionrecommendations for the therapy include:

  • Systemic Oestrogen – Eases the virginal symptoms of itching, dryness, discomfort and burning. The medication comes in various forms including spray, cream, gel, skin patch and pill (Mayo Clinic, 2016).

  • The low-dose vaginal drugs – These come in pill form, ring, tablets, and cream. They relieve virginal pains, itching, and urinary symptoms. The above medication does not, however, help in night sweats, hot flashes, and osteoporosis.

  • Another current recommendation is the progestin and progesterone medication. This drug is balanced by oestrogen since oestrogen alone can cause growth of a lining in the uterus often causing uterine cancer. It is recommendable to mix it with progestin.


Alabsi,S. (2011). Guidelines for use of Digoxin. The Guidelines for Use ofDigoxin. The Kelly Cunningham, Phar.

AmericanSociety of Health-System Pharmacists. (2015). Zolpidem.The American Institute of Health Official. Retrieved from

Collins-Bride,G.M., Saxe, J.M., Duderstadt, K.G, and Kaplan, R. (2016). ClinicalGuidelines for Advanced Practice Nursing. Jones &amp BartlettPublishers.

Columbus,F. H. (2004). Arthritisresearch: Treatment and management.New York: Nova Science Publishers.

ElsaWuhrman,&nbspMaureen F. Cooney.&nbsp(2011). Acute Pain: Assessmentand Treatment.&nbspMedscape.The Medscape Official.

MayoClinic. (2016). HormoneTherapy: Is it Right for You?The Mayo Clinic Official Website. Retrieved from

Rose,A. (2015). Anticoagulationmanagement: A guidebook for pharmacists.

Scott,I. C., Galloway, J. B., &amp Scott, D. L. (2015). Inflammatoryarthritis in clinical practice.

TheFood and Drug Administration [FDA]. DrugSafety Communication: FDA approves new label changes and dosing forzolpidem products and a recommendation to avoid driving the day afterusing Ambien CR.The FDA Official. Retrieved from