- Based on your review of the above individual’s medications, what do you feel are actual or potential safety concerns surrounding medication administration and why
One potential safety concern for this patient is the combination of a few of her medications. For example, taking an antiviral like acyclovir frequently can decrease the effectiveness of her birth control pill. It is an important education point that not many people are made aware of. Furthermore, taking birth control has many specific monitoring instructions to ensure safety. Due to the varying quantity of hormones on different weeks, it is vital that the pills are taken in order, and at the same time every day. This patient has a past medical history significant for IBS and persistent nausea. Both vomiting and diarrhea can decrease the effectiveness of birth control, so it is important to use a second form of birth control at those times. Taking the pill at night can help to mitigate gastrointestinal side effects which is what this patient has chosen to do.
Spironolactone is a diuretic, although it has off-label use for treating hormonal acne. Diuretics, or “water pills” are classically used to eliminate excess water from the body, often for patients with hypertension or heart failure. Therefore, it lowers the blood pressure in high doses. It is important for this patient to monitor her heart rate, especially because spironolactone is a potassium-sparing diuretic, and an increased serum potassium can become life threatening. In the same vein, it is important for this patient to watch her intake of high potassium foods.
Benadryl is the only over the counter medication that this patient is taking. She is also utilizing an off-label application of the drug, as it is classically used to combat allergies. However, since the medication has sedating effects, it can be used for sleep occasionally. Fortunately, she does not take it very often, and only uses it when she works overnight shifts at work. Some studies have indicated an increased risk of Alzheimer’s in people who use Benadryl long-term.
While these four medications do not have dangerous interactions with each other, none of them should be taken with alcohol, as it can either intensify or dampen a medication’s effects. It is also important for this patient to remain hydrated constantly, as it will decrease the chances that she experiences any adverse reactions or side effects.
- Considering concepts of safe medication administration and delivery, how would you approach a teaching plan with this individual to improve the safety of their medication delivery? Consider health care literacy as well as cultural considerations.
I think a very important aspect of successful medication administration and delivery for this patient is hydration. If the patient is unable to stay hydrated, her electrolyte levels may shift and become dangerous, potentially impacting her heart and brain. This has the potential to be very serious considering she also has a history of vomiting and diarrhea, making her more likely to become dehydrated. Dehydration also impacts blood volume, as it causes hypovolemia, which can decrease blood pressure dramatically. Considering that both spironolactone and Benadryl decrease her heart rate, monitoring fluid intake and output is very important for this patient. This patient should be educated about activities and circumstances that can lead to dehydration, such as exercise and increased sweating, and what these symptoms manifest as before they become dangerous.
Other important administration tips include how the patient should be timing her doses of some of her medications. She should understand that spironolactone and her birth control work together to combat hormonal acne and should be taken together for best effects. Additionally, it is best that they be taken at night, as spironolactone can cause drowsiness and birth control can cause stomach upset, which may not be felt during the night.
One larger overarching theme is the fact that with the exception of Benadryl, none of her medications should be taken if she becomes pregnant. It is important that she knows the risks associated with taking these medications while pregnant, and in the case that she does become pregnant, she should contact her providers immediately and discontinue her medications.
I don’t anticipate health literacy as being a problem for this patient, as she does work in a healthcare setting, however, we cannot assume that medical professionals will be perfect patients.
Student Name/Semester: Evan Carrell
Client Name (initials only) AC Date of Review/Interview: 7/15/2021
Allergies: (if stated, list effects/response) NONE
Storage of Medication (How and where does client store medication?): In kitchen cupboard
Keeps medications in original container? Yes or No. If no, please explain:
Access issues (in obtaining meds, trouble opening, reading labels, comprehension, functional issues – i.e. arthritis, hearing deficit, glasses)? Glasses/contacts
How many providers does this client use? 2 providers
Where do they get their medications? Mail Order vs. Pharmacy
List all medications (prescribed, over-the-counter, herbal, supplements) that client takes.
| Drug (generic) | Trade Name | Dose | Where client obtains meds from? | Frequency | Intended Use | Patient Use (if different) | Demonstrates Understanding Yes or No |
| Ex: Ibuprofen | Advil | 200 mg | i.e. Rite Aid, CVS, Mail Order | BID prn (usually 2-3x/week (a) | Pain relief (b) | “arthritis” | Yes (c) |
| Acyclovir | Zovirax | 400mg | Walgreens | 2 tabs TID for 2D PRN (twice a year) | Cold sores | “ | Yes |
| Spironolactone | Aldactone | 50mg | Walgreens | 3 tabs at bedtime | Hormonal acne | “acne” | Yes |
| Norgestimate and ethinyl estradiol | Tri-Lo-Sprintec | 0.18mg/ 0.025mg | Walgreens | 1 tab at bedtime | Contraception | “birth control” | Yes |
| Diphenhydramine | Benadryl | 25mg | Walgreens | 2 tabs at bedtime PRN (once/twice a month) | Sleep | Yes |
References
Lexicomp. (n.d.). Lexicomp. Retrieved July 16, 2021, from https://login.une.idm.oclc.org/login?qurl=https://online.lexi.com%2flco%2faction%2fhome%3fsiteid%3d1%26
