This paper addresses a pharmacological management plan for Mr. NX, including consideration of possible contraindications for CAMs, prescriptive and non-prescriptive recommendations for management of acute pain and other ongoing disease processes, followed by evaluation strategies.
Pharmacological Management Plan
CAMs Contraindicated with Current Prescriptions
The order of Mr. NX include drugs such Glyburide 3 mg daily with breakfast, Lisinopril 20 mg daily and Coumadin 5 mg daily. Glyburide is an oral anti-diabetic drug (mainly for diabetes type 2). Glyburide causes lactic acidosis and. Therefore, anything that may increase the risk of this side effect is contraindicated like in this case the use of creatinine. Creatinine enhances the rate of metabolism which in turn improves the speed of glucose breakdown increasing lactic acid in the body. There is an increased risk of lactic acidosis which is an adverse outcome of glyburide. Lisinopril is an effective antihypertensive drug with a long lasting action. Mr. NX takes garlic which is contraindicated in a person taking Lisinopril because of its ability to lower the blood pressure further. Coumadin is a drug that prevents coagulation of blood mainly taken to prevent deep vein thrombosis. It is also a blood thinner just like garlic. Therefore, garlic is contraindicated to avoid risks of bleeding as it may increase blood thinning effect. Coenzyme q10 also inhibits the effects of Coumadin rendering it ineffective and hence contraindicated.
CAMs Contraindicated with Diagnoses
Creatinine supplement should be minimized or eliminated in diabetes. Creatinine increases the rate of glucose breakdown, and this may increase the levels of glucose in the blood. In diabetes type 2 where the insulin synthesis is effective but the receptors are not active, the sugar levels may be too high complicating the condition. Deep vein thrombosis is a cardiovascular disease where there are blood clots in the veins called thrombus. It may lead to a fatal disease called pulmonary embolism when the embolus travels to the lungs. In DVT coenzyme, q10 is contraindicated because it increases blood viscosity thereby increasing the risk of deep vein thrombosis. Coenzyme q10 also inhibits the actions of warfarin making management of DVT with it ineffective as evidenced by HM Government (2010).
Prescription for Back Pain
Back pain is very common, and its management requires the employment of various techniques. The most important step is determining the cause. Mr. NX had a chronic back pain with no injury, no weakness nor numbness of the lower extremities and with no effects on the bladder a. The pain was constant dull and weak. With these descriptions, it is clear that the pain is not neuropathic i.e. not originating from nerves. According to Rahele and Shobha (2008), such pain is described as deep somatic pain. The new prescription may include use Naprosyn 275mg twice daily.
Changes in Prescribed Drugs
New order is necessary if there is a need for continuation of the use of complementary and alternative drugs. The change would involve using diuretics such as Aldactone 25mg times daily which works efficiently for diabetic patients. It also contains potassium-sparing which helps in preventing other cardiovascular diseases such as deep vein thrombosis. Therefore, use of Aldactone will be more beneficial as it will be managing two conditions at a time and also safe for the patient who is diabetic. Drugs such Coumadin should also be stopped because of the use of garlic which besides being a blood thinner and, therefore, useful for prevention of deep vein thrombosis can also be used to manage hypertension. Garlic can, therefore, be used not as a complementary drug but as an alternative to managing mild hypertension. With Aldactone, there is no need for the use of kava kava as an alternative medicine in controlling anxiety because Aldactone by itself can be used to manage hypertension effectively but kava kava cannot be used as an alternative hence should be stopped.
Follow-Up Evaluations
Time-Frame
Strategies for Evaluating Side/Adverse Effects
All medicinal products have side effects also called adverse reactions whose quick identification is needed as soon as they occurred and managed properly to avoid complications. According to Medicines and Healthcare Products Regulatory Agency (n.d), drug side effects are the unwanted reactions caused by administration of a drug. Most drugs have serious side effects such as death, making people prefer more natural substance used as drugs i.e. complementary medicine. Owing to this Federal and Drug Administration (FDA) and Health Canada came up with strategies for evaluating adverse effects. They include:
Reporting system by patients on prescribed drugs; this requires patients to report any adverse effects to the nearest health facility. Through that many side effects, identification has been possible and more precaution taken.
Adverse effects in children; therapeutic orphans: the side effects in pediatric has not been thoroughly established. Therefore reporting all forms of unwanted events in pediatrics can help in determining the many unknown effects in children. Children are usually at more risk and affected more than adults though the cause is unknown. Therefore, more is required to be done in pediatrics to control the adverse effects.
Strategies for Evaluating Effectiveness
The effectiveness of a drug must be evaluated to know the advantages it may have over the others, and this is done by weighing the risks and benefits. Strategies for assessing drug effectiveness include:
Blind evaluation: this involves starting a medication without telling the patient its effect the observing the patient after a given period. If the patient has notable improvements with little or no adverse effects, then the drug can be said to be effective.
The effectiveness of a drug can also be evaluated by determining its tolerability. If a drug does not make the patient feel sicker than he/she was, then effectiveness is high. Compliance is also high on such drugs.
Conclusion
Complementary and alternative medicines are commonly used these days mainly because of the adverse effects associated with other medications. It, therefore, calls for medical practitioners as well as scientists to come up with ways of incorporating it into the western medicine. Many people find themselves using different drugs for the same reason. The level of the drug in the body, therefore, increases to a level that cannot be controlled causing complications. A complete medication history on the admission of a patient to any health facility should be taken to prevent drug interactions.
References
HM Government, (2010). Drug Strategy 2010 Evaluation Framework-Evaluating costs and benefits. Retrieved from https://www.gov.uk//Drug_Strategy_Evaluation_Fram
Medicines and Healthcare Products Regulatory Agency, (n.d). Guidance on adverse drug reactions. Retrieved from https://www.gov.uk//Guidance_on_adverse_drug_rea
Rahele, M. & Shobha, R. (2008). Diabetes mellitus, follow up type 2. Retrieved from http://library.utsouthwestern.edu/portals/fammed/coreTopics/diabetesFollowup.pdf
