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Constant chest pain was the primary reason why George made a decision to make an appointment with a doctor. After being diagnosed with coronary artery disease, the patient underwent surgery. Medical history demonstrates that this person had blockages in 3 coronary arteries, which is why immediate treatment was required. In turn, George has also developed an infection in the post-operative period. The combination of these health issues with type 2 diabetes has significantly affected the overall health status of this person. As a result, a mix of different medications was prescribed to the patient in order to improve George’s well-being.
Based on the medication chart, the patient should take pain relievers, such as aspirin, medications lowering blood sugar levels, such as metformin, and medications treating heart failure, such as ramipril. In this case, it is essential to avoid the drug interaction, as it can result in a considerable increase in side effects and worsening of the quality of the whole treatment. However, if medications are combined in an appropriate manner, George is expected to recover in a short time. Consequently, the analysis of a medication chart provides comprehensive information regarding the quality of the entire treatment plan.
Analysis of Medications
Aspirin
Indications
As one of the most common painkillers, aspirin can be included in the treatment of a variety of health issues. Most frequently, healthcare providers prescribe this medication to patients suffering from headaches, period pain, and toothache. Moreover, it is used to treat colds and “flu-like” symptoms (1). However, in the case of a 57-year-old George, aspirin can be considered an effective analgesic for post-operative pain. At the present time, this medication plays an essential role in facilitating a patient’s recovery to normal function.
Side effects
If the person uses appropriate doses of aspirin, side effects are unlikely to be noticed. Nevertheless, some people still experience nausea, indigestion, as well as stomach or gut irritation due to specific features of personal health. In addition, there are less common side effects of using aspirin, including vomiting, bruising, stomach bleeding, and worsening asthma symptoms. In some rare cases, the use of this medication is associated with bleeding in the brain and kidney failure. If the patient takes aspirin on a regular basis, there is a high likelihood of being affected by a hemorrhagic stroke.
Mechanism of Action
Even though this medication has been widely used since the beginning of the past century, its real mode of action became known in the 1970s. In fact, non-steroid anti-inflammatory drugs, such as aspirin, significantly affect the activity of cyclooxygenase that causes inflammation, swelling, pain, and fever (2). As a result, this medication exhibits a vast number of pharmacologic activities, including analgesic, antipyretic, and antiplatelet properties.
Interactions
Taking into consideration that integration of some drugs can considerably lower the quality of treatment, it is essential to identify drugs that are likely to interact with aspirin. For instance, it is not recommended to combine the use of aspirin with anti-inflammatory painkillers, such as diclofenac, ibuprofen, and naproxen. The combination of these medications can result in stomach bleeding and issues associated with heart and blood vessels. Furthermore, aspirin should not be taken with antidepressants, warfarin, and methotrexate, as this mix can cause bleeding and the creation of toxic elements.
Nursing Implications
Firstly, all nurses are required to take into account the manufacturer’s summary of product characteristics and appropriate local guidelines before administering aspirin. Secondly, it is crucial to remember that a patient’s pain should be assessed one hour before or after medication. Apart from this, nurses should monitor the renal and liver function of patients who regularly take aspirin. Finally, nursing practitioners are required to identify other medications for possible interactions.
Metformin
Indications
Metformin is the medication that is usually prescribed for patients who suffer from type 2 diabetes or prediabetes. Considering that George is diagnosed with this health issue, metformin should be an integral part of his treatment plan. Currently, this drug is perceived as an effective tool to lower blood sugar levels by improving the way the body handles insulin (3). For the best outcomes, it is recommended to combine this drug with healthy nutrition and regular exercise.
Side Effects
Despite the fact that this medication is safe for the health, it still can contribute to the development of some side effects. For example, people taking this drug can face physical weakness, diarrhea, hypoglycemia, and muscle pain. Also, some patients suffer from nausea, vomiting, and dizziness caused by metformin. It is essential to note that people can experience different side effects, which is why it is important to contact the healthcare provider in case of any health issues.
Mechanism of Action
Even though this medication is tremendously effective in the context of glucose metabolism, its mechanism of action has not been clearly identified yet. It is assumed that the alteration of the energy metabolism of the cell is the main principle offering metformin the opportunity to regulate blood glucose levels (4). As a metabolic inhibitor, this drug reduces the amount of sugar by inhibiting hepatic gluconeogenesis.
Interactions
From the perspective of interactions, metformin has no severe drug interactions. However, in order to avoid negative effects on the body, it is not recommended to combine this medication with anticancer drugs, such as vandetanib, antimicrobial drugs, such as cephalexin, as well as alcohol and certain HIV medications. In fact, the medications listed above are likely to increase the body’s levels of lactic acid when taken with metformin. Therefore, it is crucial to discuss these drug interactions with a doctor to ensure they are not harmful to the overall health.
Nursing Implications
Nurse practitioners should be aware that it is vital to regulate doses of this medication for each unique patient with the purpose of lowering blood sugar levels. In case the patient takes an inappropriate dose of metformin, there is a high likelihood of facing gastrointestinal complaints. In addition, this drug should be stored in a tight container in a cold place. By the way, patients diagnosed with renal problems are likely to experience lactic acidosis when taking this drug, which is why they should be prescribed other medication.
Ramipril
Indications
This medication is usually prescribed to patients who suffer from hypertension and heart failure. In fact, ramipril makes it easier for the heart to pump blood around the body. Hence, taking into consideration that George was diagnosed with coronary artery disease, he should take this drug on a regular basis. Moreover, ramipril is beneficial for the prevention of strokes, heart attacks, and kidney problems.
Side Effects
This medication is unlikely to cause unwanted effects, although there are some cases when the use of ramipril results in side effects. Most frequently, patients experience blurred vision, confusion, dizziness, and sweating. Furthermore, some patients suffer from chest tightness, shortness of breath, and unexplained bleeding. In this case, it is extremely important to discuss the symptoms with a healthcare provider who would be able to offer appropriate medical help.
Mechanism of Action
As an angiotensin-converting enzyme inhibitor, this medication has a considerable impact on the conversion of angiotensin I to angiotensin II. In other words, this drug contributes to the decrease in aldosterone-induced congestion (5). Accordingly, sodium and water reabsorption reduces, thereby resulting in a significant lowering of blood pressure. In this way, the chances of facing heart failure decrease as well. Subsequently, ramipril serves two essential functions when it comes to improving a health condition.
Interactions
Ramipril is widely known to interact with some medications, which can result in an increase of side effects or a worsened quality of the way the drug works. For example, it is not recommended to combine ramipril with potassium supplements, water pills, mood stabilizer drugs, and pain relievers (6). In case this recommendation is ignored, the patient is likely to struggle with nausea, vomiting, and an increase in the levels of lithium. At the same time, the positive effect of ramipril is expected to be minimized.
Nursing Implications
Nurse practitioners are advised to monitor the patient’s blood pressure 3-6 hours after taking this medication, as it is considered the period of peak effectiveness. Simultaneously, the nurse is required to educate patients on the role of this kind of drug. In fact, it is not allowed to breastfeed while taking ramipril. Additionally, patients should be aware that it is important to maintain adequate fluid intake in order to minimize the chances of experiencing side effects.
Patient Fact Sheet About Metoprolol
At the present time, heart disease is considered one of the main causes of a significant increase in mortality and morbidity rates across the whole world. In fact, nearly 25% of all deaths in the US are caused by this health disease (7). In turn, coronary artery disease (CAD) is the most common type of this health issue, which can lead to heart failure. Most frequently, CAD develops when the blood supply reduces, thereby resulting in the lack of appropriate oxygen and fewer nutrients. At the same time, there is a variety of other types of heart disease, including congenital heart defects, arrhythmia, dilated cardiomyopathy, and myocardial infarction (8). Each disease should be treated with the help of high-quality medications in combination with healthy nutrition and exercise. When it comes to medication, there are numerous options that can be prescribed by the healthcare provider based on specific features of the patient’s health. For instance, as a beta-blocker, metoprolol is widely used with the purpose of increasing the survival of patients diagnosed with various types of heart disease, including CAD.
Role of Metoprolol
Even though metoprolol is usually used to treat high blood pressure, this medication is also effective when it comes to the treatment of CAD. In fact, it improves the well-being of patients by relaxing blood vessels and slowing heart rate (9). Presently, this drug comes as a traditional tablet and an extended-release tablet. The majority of physicians recommend taking this medication while consuming food. At the same time, there is still a likelihood that side effects might occur due to metoprolol. For instance, some patients taking this medication highlight that they experience dizziness, tiredness, nausea, vomiting, and runny nose (10). In this case, it is essential to contact a doctor who would be able to offer alternative medication options.
It is recommended to talk to the medical worker before taking this medication in order to identify if the person might be allergic to the components of this drug. Moreover, it is important to share the entire medical history with the physician to offer this person the opportunity to assess the advantages and disadvantages of prescribing metoprolol. It is not advisable to combine this medication with fingolimod, lumefantrine, and propafenone, as these drug interactions are likely to lower the quality of the whole treatment. If CAD is ignored, it can result in a considerable heart muscle weakness that can also lead to heart failure (11). Therefore, treatment of CAD should be based on a mix of lifestyle interventions, medications, and regular counseling that is beneficial for relieving stress and improving mental health.
How is it Abused?
At the present time, metoprolol can be abused intravenously or orally in the form of tablets with the following strengths: 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg (12). depends on the purpose of treatment and specific features of the patient’s health. Most frequently, patients are recommended to take from 100 to 450 mg of this medication orally per day. In turn, doses above 450 mg are likely to cause side effects.
What is its Effect on the Mind?
In cases recommended doses are not increased, no effect on the qualitative functions of the brain is expected to be noticed. However, if this medication is overused, the person can suffer from the decreased initiative, a depressed frame of mind, and disturbed sleep. Moreover, this drug has a considerable impact on the development of depression, mental confusion, and short-term memory loss (13). Therefore, it is crucial to follow all recommendations provided by the healthcare provider when it comes to doses of metoprolol.
What is its Effect on the Body?
It is essential to note that metoprolol has a significant impact on the response to nerve impulses. In order words, this medication makes the heart beats slower and decreases blood pressure. Nevertheless, in addition to the positive impact of this drug on the body, there are some negative effects as well. The majority of patients taking metoprolol experience drowsiness and dizziness, which is why it is not recommended to drive while taking this medication.
What are its Overdose Effects?
In case the person takes a high amount of metoprolol, they can overdose. Usually, the main symptoms of overdosing by this drug are slow heartbeats, shortness of breath, bluish-colored fingernails, and fainting (14). There is no clear information regarding the amount of medication that should be taken to overdose, as it depends on specific features of each person’s health. If the symptoms listed above are noticed, it is important to ask for medical help.
What is its Legal Status in the United States?
In the United States, this medication is classified as a prescription-only drug in the beta-blocker class, which can be taken by individuals who suffer from hypertension and heart disease (15). Discovered in 1969, metoprolol is considered an effective FDA-approved drug.
References
- Nudy M, Cooper J, Ghahramani M, Ruzieh M, Mandrola J, Foy A. Aspirin for primary atherosclerotic cardiovascular disease prevention as baseline risk increases: a meta-regression analysis. The American Journal of Medicine. 2020;133(9):1056-1064.
- Zheng S, Roddick A. Association of aspirin use for primary prevention with cardiovascular events and bleeding events. JAMA. 2019;321(3):277.
- Crouse A, Grimes T, Li P, Might M, Ovalle F, Shalev A. Metformin use is associated with reduced mortality in a diverse population with COVID-19 and diabetes. Frontiers in Endocrinology. 2021;11(1):1-15.
- Gedawy A, Al-Salami H, Dass C. Role of metformin in various pathologies: state-of-the-art microcapsules for improving its pharmacokinetics. Therapeutic Delivery. 2020;11(11):733-753.
- Sirenko Y, Rekovets O. Ramipril in patients with arterial hypertension as monotherapy or in combination with hydrochlorothiazide. Hypertension. 2017;51(1):81-91.
- Bondeva T, Schindler K, Schindler C, Wolf G. Ramipril pretreatment worsened renal injury and survival despite a reduction in renal inflammation in experimentally induced sepsis in mice. Journal of the Renin-Angiotensin-Aldosterone System. 2020;21(2):14-27.
- Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: a review of contemporary guidance and literature. JRSM Cardiovascular Disease. 2017;6(2):20-48.
- Quertermous T, Ingelsson E. Coronary artery disease and its risk factors. Circulation Research. 2016;118(1):14-16.
- Malakar A, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology. 2019;234(10):1681-1686.
- Hajar R. Risk factors for coronary artery disease: historical perspectives. Heart Views. 2017;18(3):109.
- Cagle S, Cooperstein N. Coronary Artery Disease. Primary Care: Clinics in Office Practice. 2018;45(1):45-61.
- Kandaswamy E, Zuo L. Recent Advances in Treatment of Coronary Artery Disease: Role of Science and Technology. International Journal of Molecular Sciences. 2018;19(2):424.
- Clemente-Moragón A, Gómez M, Villena-Gutiérrez R, Lalama D, García-Prieto J, Martínez F et al. Metoprolol exerts a non-class effect against ischaemia–reperfusion injury by abrogating exacerbated inflammation. European Heart Journal. 2020;41(46):4425-4440.
- Bussey C, Babakr A, Iremonger R, Hout I, Wilkins G, Lamberts R et al. Carvedilol and metoprolol are both able to preserve myocardial function in type 2 diabetes. Physiological Reports. 2020;8(5):1.
- Liu X, Lou X, Cheng X, Meng Y. Impact of metoprolol treatment on mental status of chronic heart failure patients with neuropsychiatric disorders. Drug Design, Development and Therapy. 2017;11(2):305-312.
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