18 Oct Impact of Drug Interactions and Adverse Events on Therapeutic

Impact of Drug Interactions and Adverse Events on Therapeutic

A 60-year-old Caucasian woman with newly diagnosed peptic ulcer disease, generalized anxiety disorder, and iron deficiency anemia. She also has a long history of asthma and depression. She is a strong believer of herbal medicine. She takes St. John’s wort for her depression, iron pills for her anemia, and alprazolam (Xanax) as needed for her anxiety. During her asthma exacerbation, she is instructed to take prednisone for at least 5 days. She also takes esomeprazole (Nexium) for her peptic ulcer disease. Three months later, she experienced severe fatigue, shortness of breath, dizziness, and swelling/soreness in the tongue. Her asthma is well controlled with the occasional use of albuterol (Proventil) inhaler. During her physical exam, her physician suspected that she had bacterial vaginosis and gave her a prescription for a 1-week course of metronidazole (Flagyl). She drinks at least two to three cans of beer per day.

Diagnosis: Drug–Drug Interactions

St. John’s wort is known to inhibit which of her medication that is known to be metabolized by cytochrome P-450 (CYP3A4) and could potentially cause her to experience significant fatigue?

Which of her medication could interfere with the absorption of her iron pills?

Which of her medication could potentially cause her to develop vitamin B12 deficiency?

How does metronidazole interfere with alcohol?

If she was given a prescription for ketoconazole, which of her medication could interfere with its absorption?

DQ2 Prescription Writing

Overview

A prescription is an order from a physician, a nurse practitioner, or physician assistant to a pharmacist that indicates the medication that a patient is to take. If the prescription is poorly written, this can lead to medication error. Here are some statistics:

Medication errors occur in approximately 1 in every 5 doses given in hospitals.

One error occurs per patient per day.

Approximately 1.3 million injuries and 7,000 deaths occur each year in the U.S. from medication-related errors.

Drug-related morbidity and mortality are estimated to cost $177 billion in the U.S.

These are estimates from various sources and studies and provide shocking evidence about prescriptions. It is no wonder why malpractice insurance is so expensive.

Initial Post

Please review your course materials and research to evaluate the proper ways to write prescriptions.

For your initial post, share one piece of knowledge that you have found along with the resource information. Practice writing a prescription and submit that along with your post for your peers to evaluate.