Running head: MEDICATION CASE STUDY

John Smith Medication Case Study

Kortney Richardson
Schoolcraft College
Thursday, 4:00-7:30

MEDICATION CASE STUDY

2
John Smith Mediation Case Study

My patient is John Smith, admitted with chest pain. His assessment findings are as
follows: Blood pressure was 168/98; heart rate was 98 beats/min; respirations were 24
breaths/min; temperature was 98.6. He was expiring mild pain on the right side of side with a
score of 5. He was alert and oriented and knew person, place, and time. His heart rate was within
normal limits, and his heart rhythm was regular. There were diminished lung sounds in the
bilateral lower lobes of his lungs. A sputum culture was taken and came back positive for
mycobacterium pneumonia. His pulses were positive in his lower extremities. He also had a
history of smoking two packs of cigarettes a day and a history of depression. To effectively care
for John Smith in relation to pharmacologic therapy, it is necessary to identify all of his/her
medications, category, rationale for use, side effects, adverse reactions, and interactions. In
addition, all necessary assessments will be identified and completed, an appropriate plan of care
will be developed and a teaching plan included to aid in helping John Smith with resuming
medication therapy post discharge (Austin, 2010).
Medication Information
First and foremost, the nurse will identify all medications and associated
information below:
Medications
Digoxin/0.25
mgPOQD

Category
Cardiac
glycoside

Rationale/Use
Treatmentof
HF,atrial
fibrillation
Action:
inhibits
sodium
potassium
ATPase,
promoting
increased

Sideeffects
Anorexia,
nausea,
vomiting,
diarrhea,
abdominal
pain,
headache,
blurred
vision
(yellow-

AdverseRX
Bradycardia,
visual
disturbances;
life
threatening:
atrioventicualr
block,cardiac
dysrhythmias

Interactions
Drug:Increase
digoxinserum
levelwith
quinidine,
flecainide,
verapamil
Decrease
digoxin
absorptionwith
antacids,

MEDICATION CASE STUDY

Amoxicillin
500mgPO
QD

Penicillin

forceof
cardiac
contraction,
cardiacoutput,
andtissue
perfusion;
decreases
ventricular
rate

green halos),
diplopia,
photophobia,
drowsiness,
dizziness,
fatigue,
confusion

Totreat
respiratory
tractinfection,
urinarytract
infection,otitis
media,and
sinusitis

Nausea,
vomiting,
diarrhea,
rash,
stomatitis,
seizures,
pseudo
membranous
colitis,
edema,
insomnia,
dysphagia

Vaginitis,
respiratory
distress;life
threatening:
blood
dyscrasias,
thrombo
cytopenia,
neutropenia,
hemolytic
anemia,bone
marrow
depression,
SteveJohnson
syndrome

colestipol
Increaseriskfor
digoxintoxicity
withthiazide
diuretics,loop
diuretics
Lab:
hypokalemia,
hypomagnesium,
hypercalcemia
canincrease
digitalis
(digoxin)
toxicity
(Kee,Hayes,
McCuistion,
2015)
Drug:increase
effectwith
aspirin,
allopurinol,
probenecid;
increase
bleedingwith
oral
anticoagulants;
increaseeffect
ofmethotrexate;
decreaseeffect
with
tetracycline,
erythromycin
Lab:increase
serumAST,
ALT,BUN,and
creatinine;
increasePT,
INR
Food:decrease
effectwith
acidicfruitsor
juices
(Keeetal.,
2015)

MEDICATION CASE STUDY

Wellbutrin
200mgPO
QD

Anti
For
depressant depression,
seasonal
affective
disorder,and
nicotine
withdrawal
Action:itisa
weakblocker
ofneuronal
uptakeof
serotoninand
norepinephrine
andinhibits
thereuptakeof
dopamine

Sedation,
anti
cholinergic,
drymouth,
tachycardia,
agitation,
insomnia

Seizures

Nitropatch
transdermal
Anterior
chestwall
QD

Anti
anginal

Nausea,
vomiting,
headache,
blurred
vision,
dizziness,
syncope,
weakness,
diaphoresis,
flushing,
confusion,
pallor,rash,
drymouth,
palpitations

Hypotension,
reflex
tachycardia,
paradoxical
bradycardia
Life
threatening:
circulatory
collapse

Tocontrol
anginapain
Action:
Decreases
myocardial
demandfor
oxygenand
decreases
preloadby
dilatingveins
whichwill
alsodecrease
theafterload;
relaxes
vascular
smoothmuscle
causinga
decreasein
venousreturn
andarterialBP

Drug:increased
riskofadverse
effectswith
levodopa,
amantadine,
fluvoxamine,
paroxetine,
cyclophosph
amide,
sertraline;
increasedriskof
toxicitywith
MAOIs;
increasedriskof
seizureswith
drugsthatlower
seizurethreshold
(thisincludes
alcohol)
(Keeetal.,
2015)
(Karch,2015)
Increasedriskof
hypertensionand
decreased
antianginal
effectwithergot
alkaloids;
increaseeffect
withalcohol,
betablockers,
calciumchannel
blockers,anti
hypertensives,
aspirin,
benzodiazepines,
vasodilators;
decreasedeffects
ofheparin;risk
ofsevere
hypotensionand
adverseCV
eventswith
avanafil,

MEDICATION CASE STUDY

Furosemide
40mgPO
QD

Loop
diuretic

Totreatfluid
retention/fluid
overloadcause
byHF,renal
dysfunction,
cirrhosis;to
treat
hypertension
andacute
pulmonary
edema
Action:
inhibits
reabsorption
ofsodiumand
waterfrom
loopofHenle
anddistal
renaltubules,
leadingto
sodiumrich
diuresis

Nausea,
diarrhea,
electrolyte
imbalances,
vertigo,
abdominal
cramping,
constipation,
rash,
headache,
weakness,
ECG
changes,
blurred
vision,
photo
sensitivity,
muscle
cramping

sildenafil,
tadalafil,
vardenafil;false
reportof
decreasedserum
cholesterolif
donebythe
ZlatkisZak
colorreaction;
hawthorn
increasesthe
nitroglycerin
levels
(Keeetal.,
2015)
(Karch,2015)
Severe
Drug:increase
dehydration,
orthostatic
orthostatic
hypotension
hypotension,
withalcohol;
hyperglycemia, increase
gout,hearing
ototoxicitywith
loss
aminoglyco
Life
sides;increase
threatening:
bleedingwith
renalfailure,
anticoagulants;
thrombocyto
increase
penia,
potassiumloss
agranulocytosi withsteroids,
s
AmphotericinB,
amiodarone;
increasedigitalis
toxicityand
cardiac
dysrhythmias
withdigoxinand
hypokalemia;
increaselithium
toxicity;increase
amphotericinB
ototoxicityand
nephrotoxicity;
decreased
absorptionof

MEDICATION CASE STUDY

Hydrochloro
thiazide50
mgPOQD

Thiazide
diuretic

Action:
inhibits
absorptionof
sodiumand
chlorideinthe
distalrenal
tubulecausing
anincreasein
thesodium,
chloride,and
water
excretionby
thekidneys;

Dizziness,
vertigo,
weakness,
nausea,
vomiting,
diarrhea,
abdominal
pain,hyper
glycemia,
constipation,
rash,photo
sensitivity,
blurred

Severe
dehydration,
hypotension,
gout
Life
threatening:
severe
potassium
depletion,
marked
hypotension,
aplastic
anemia,

furosemidewith
phenytoin;
decreased
natriureticand
anti
hypertensives
effectswith
indomethacin,
ibuprofen,other
NSAIDS;
decreasedGI
absorptionwith
charcoal
Labs:increase
BUN,
blood/urine
glucose,serum
uricacid,
ammonia;
decrease
potassium,
sodium,calcium,
magnesium,
chlorideserum
levels
Food:licorice
mayincrease
potassiumloss
(Keeetal.,
2015)
(Karch,2015)
Drug:Increase
digitalistoxicity
withdigitalisif
hypokalemiais
present;increase
renaltoxicity
withaspirin;
increase
potassiumloss
withsteroids;
decrease
antidiabetic
effect;decrease

MEDICATION CASE STUDY

decreases
vision
preloadand
cardiacoutput
anddecreases
BPbycausing
vasodilation
onthe
arterioles
Uses:to
increaseurine
outputandto
treatHTN,
edemafrom
HF,hepatic
cirrhosis,renal
dysfunction
Colace100
mgprnPO
BID

Lipitor10
mgPOQD

Laxative: Forprevention
emollients of
constipation;a
stoolsoftener;
actsonthe
smalland
large
intestines.
Emollients
lowersurface
tensionand
promotethe
accumulation
ofwaterinthe
intestinesas
wellasthe
stools.
Anti
InhibitsHMG
hyper
CoA
lipidemic reductase,
whichcausesa
decreasein
serum
cholesterol,
serumLDLs,
andincreases

hemolytic
anemia,
thrombocyte
penia,
agranulo
cytosis,renal
failure

thiazide
absorptionand
effectswith
NSAIDs,
cholestyramine,
andcolestipol
Labs:increase
serumcalcium,
glucose,uric
acid;decrease
serum
potassium,
sodium,
magnesium
(Keeetal.,
2015)
(Karch,2015)
Nointeractions

Nausea,
vomiting,
diarrhea,and
abdominal
cramping

Contra
indications:
inflammatory
disordersofthe
GItract,
(Keeetal.,
pregnancy,
2015)
spasticcolon,
orbowel
obstruction

Headache,
flatulence,
abdominal
pain,
cramps,
constipation,
nausea

Liverfailure,
rhabdo
myolysiswith
acuterenal
failure

Drug:myopathy
or
rhabdomyolysis
with
erythromycin,
cyclosporine,
nefazodone,
tacrolimus,
niacin,fibric

MEDICATION CASE STUDY

serumHDLs;
italso
increases
hepaticLDL
recapturesites,
which
enhancesthe
reuptakeand
catabolismor
LDL.Italso
lowers
triglycerides
levels

Protonix40

Proton
pump

Forgastricand Headache,
duodenal
dizziness,

Contra
indicatedwith

acidderivatives,
azole
antifungals,
clarithromycin,
diltiazem,
cimetidine,
protease
inhibitors,other
HMGCoA
reductase
inhibitors;dose
shouldnotbe
greaterthan10
mg/daywith
cyclosporineand
20mg/daywith
clarithromycin
orprotease
inhibitors;
increased
digoxinlevels
withpossible
toxicitywhen
takentogether;
increased
estrogenlevels
withhormonal
contraceptives;
decreased
absorptionof
atorvastatinif
takenwith
antacidsand
shouldbe
separatedby2hr
Food:decreased
metabolismand
riskoftoxic
effectswhen
combinedwith
grapefruitjuice
(Karch,2015)
Possible
decreasedserum

MEDICATION CASE STUDY

mgPOQAM

inhibitor

ulcersand
GERD
Action:
suppresses
gastricacid
secretionsby
inhibiting
ATPase

9
diarrhea,
abdominal
pain,nausea,
vomiting,
URI
symptoms

hyper
sensitivityto
PPIsand
shouldbeused
cautiously
becauseof
increasedrisk
ofC.difficle
infection

levelsof
atazanavirand
nelfinavirwhen
takenwiththis
drug;possible
increased
methotrexate
leveland
warfarinlevel;
possible
decreased
clopidogrel
(Karch,2015)
(Keeetal.,
2015)

Assessments
In addition to attaining knowledge related to current prescribed drugs, it is required for a
nurse to complete all necessary assessments prior to giving each individual drug, during
administration of drugs, and after giving the drugs (Austin, 2010).
Digoxin
The assessment should begin with obtaining a complete drug history for him. This should
also include any herbal remedies that he may be taking. Any possible drug interactions should be
noted. This is especially important if the patient is taking a potassium-wasting diuretic as this
could lead to hypokalemia and cause digoxin toxicity. Also his serum potassium levels should be
taken because low levels will enhance the action of digoxin. To avoid hypokalemia from taking
the thiazide diuretic hydrochlorothiazide along with the digoxin a potassium supplement should
be taken. His apical pulse should also be taken; in order to take digoxin his heart rate should be
greater than 60 beats/min (Kee et al., 2015).
Amoxicillin

MEDICATION CASE STUDY

10

Before starting with amoxicillin, an assessment of allergies to penicillin or cephalosporins

should be done. Liver enzymes should also be evaluated since the liver, as well as the kidneys, are
responsible for the metabolism and the excretion of antibacterial drugs and thus could cause
damage to these organs. Urine output also needs to be assessed. Normal urine output is about 30
mL/hr. If urine output is lower than 30 mL/hr, the drug dosage may need to be decreased (Kee et
al., 2015).
Wellbutrin
To begin the assessment, baseline vital signs should be obtained as well as a their current
weight. To assess renal and liver function the following labs should also be evaluated: BUN,
serum creatinine, and liver enzymes; urine output should be assessed and should be greater than
1500 mL/d. His mental status should also be evaluated and should include a history of any
episodes of depression and any thoughts of suicide. A complete drug history also needs to be
obtained including any herbs or alcohol (Kee et al., 2015).
Nitropatch
Baselines vitals should be obtained as well as a drug and health history (Kee et al., 2015).
The health history should include an assessment of the following: allergy to nitrates, severe
anemia, acute myocardial infarction, head trauma, cerebral hemorrhage, hypertrophic
cardiomyopathy, hepatic or renal disease, xerostania, hypotension or hypovolemia, increased
intracranial pressure, constrictive pericarditis, pericardial tamponade, low ventricular filling
pressure or low PCWP (Karch, 2015). Because hypotension is a common side effect with
antianginal mediations, monitoring vital signs, especially his blood pressure, is an important part
of the physical assessment. Any chest pain he may be experiencing needs to be noted because if
any chest pain continues he may have developed a tolerance to the medication (Kee et al., 2015).

MEDICATION CASE STUDY

11

Before applying the patch, a complete skin assessment needs to be done. Check to make sure no
other patches are still on his and check the site where the patch is to be applied for any
discoloration, irritation, or breaks in the skin (Karch, 2015).
Furosemide
First obtain a drug history paying attention to any drugs that have possible interactions
with loop diuretics. Also it should be noted if he is taking any highly-protein bond drugs. Since
furosemide is a highly-protein drug, taking it with other highly-protein bond drugs would cause
the drugs to compete for the receptor site causing the drugs to displace each other and not be
effective. As part of the physical assessment his vital signs and weight should be evaluated and
his urine output and serum electrolyte levels. Checking his urine output would show whether his
has gained or lost body fluid. His urine output should be about 30 mL/hr. If urine output has not
increased since taking this medication, this could indicate a possible renal disorder. Weigh is
another indicator for fluid loss or retention. For every 2.2 lbs lost, there is a fluid loss of 1 L (Kee
et al., 2015). Also check for edema; this would also indicate whether this is fluid retention (Karch,
2015). Monitor for any drop in his blood pressure since hypotension is an adverse reaction. One
contraindication for this drug is hypersensitivity to sulfonamides and furosemide should not be
taken if this sensitivity is present. Checking his serum potassium is very important since he is also
taking digoxin because digoxin toxicity can occur is hypokalemia occurs (Kee et al., 2015).
Hydrochlorothiazide
The assessment for hydrochlorothiazide is the same for furosemide. When assessing the
vital signs pay attention to BP as hypotension is a side effect of this medication. Also check for
edema and assess his urine output; a decrease in urine output would indicate fluid retention and an
increase would indicate fluid loss. Also a decrease in weight would indicate fluid retention; for

MEDICATION CASE STUDY

12

every 2.2lbs lost, 1 L of fluid is lost. Check for signs and symptoms of hypokalemia like muscle
weakness or cardiac dysrhythmias. If hypokalemia does occur, this could cause digoxin toxicity;
this makes monitoring for hypokalemia very important. Potassium, glucose, uric acid, and
cholesterol levels should be obtained as well as a complete drug history (Kee et al., 2015).
Colace
When assessing for laxatives, it needs to be determined that there is no intestinal
obstruction; if there is an intestinal obstruction laxatives must be avoided. Abdominal pain should
also be assessed because severe pain could indicate other conditions like appendicitis, ulcerative
colitis, or diverticulitis (Kee et al., 2015).
Lipitor
One of the major things that needs to be assessed when taking an antihyperlipdemic is
liver function. Antihyperlipidemics are contraindicated with liver disorders. Because GI upset
including abdominal pain and abnormal stools are side effects of Lipitor, signs and symptoms of
GI upset should be evaluated. Some labs that should as be obtained include cholesterol,
triglycerides, AST, ALT, and CPK (Kee et al., 2015).
Protonix
When taking a proton pump inhibitor, liver enzymes should be monitored. Also asses for
common symptoms that are associated with taking proton pump inhibitor; these symptoms
include headache, diarrhea, dizziness, rash and abdominal pain (Kee et al., 2015). Assess for any
allergies or sensitivity to proton pump inhibitors as this would be a contraindication for taking
Protonix. As part of the physical assessment an abdominal examination should be obtained
(Karch, 2015).
Goal Statement

MEDICATION CASE STUDY

13

In order to ensure safe drug administration in the home environment, the nurse will
implement a goal for the client and specific interventions to help teach the client about his
medication therapy (Austin, 2010). It is important that Mr. Smith understands why he is taking
any of these medications as well as possible side effects and adverse reactions to look out for.
Also he should understand the importance of compliance to his medication therapy and why it is
impairative to follow his drug regime. These goals should be met by the time of discharge.
Interventions
In order to help the client meet their goal, the nurse will implement specific interventions.
The nurse is responsible for providing information to the client about his medication therapy. Mr.
Smith should be taught what side effects to look out for while taking these medications and what
to do if the side effects were to occur. He should be taught what drugs to avoid and what drugs
may interact with certain medications he may be taking. The nurse should also explain why he is
taking each medication and what the desired effects of those medications are. The nurse should
also implement a medication therapy schedule so help Mr. Smith stick to his medication regime.
Also, Mr. Smith needs to be taught the importance of not skipping a dose and why it is important
to follow his medication schedule (Ackley and Ladwig, 2014).
Teaching Strategies
Teaching strategies that may be helpful for this client include: giving the client a list of all
his medications with the times they are to be taken, providing a list of any possible drug or food
interactions, and using a pill container to divide his medications by days. This will help ensure
that he takes his medications daily and at the appropriate times. Also before discharge have him
demonstrate how to monitor his vital signs so he knows what to look out for, and have him state

MEDICATION CASE STUDY

14

what signs and symptoms could result and have him state what to do if any side effects do occur
(Ackley and Ladwig, 2014).
Conclusion
By identifying information about John Smiths medication therapy, implementing
appropriate assessment techniques, and developing a teaching plan specific for this client, one
can assure that safe medication administration will occur both in the acute care and in the
hospital settings (Austin, 2010). Implementing any of the teaching strategies will help John
Smith stick to his medication therapy and will help him know about the medications he is taking
as well as know that signs and symptoms to look out for.

MEDICATION CASE STUDY

15

References
Ackley, B. J., & Ladwig, G. B. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide
to Planning Care (10th ed.). Maryland Heights, MO: Mosby Elsevier
Austin,H.(2010,October28).RN,MSN,AssistantProfessorofNursing.
(KortneyRichardson,Interviewer)
Karch, A. M. (2015). Lippincotts Nursing Drug Guide. Philadelphia, PA:
Kluwer Health.
Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2014). Pharmacology: A Patient-Centered
Nursing Process Approach (8thth ed.). Toronto, Canada: Elsevier Saunders.

MEDICATION CASE STUDY

16