I enjoyed the medication reconciliation assignment. It allowed me to learn more about medications and how I am going to have to assess the capability of my client taking them. I was fortunate with my client because they did not pose any difficulties or safety concerns that I should be concerned about. The client understands why he is on each of his medications and the what the therapeutic effect of them is as well. Along with this, he understands what the drug does to his body and knows what adverse affects to look out for. It is important that he knows and understands this to ensure that he is taking the medication as safely as possible. His medications were used to control different diagnoses, so they did not have a similar effect. This process was very interesting, it was good practice for the clinical field in regards to thinking through medications.
Med Rec Paper is posted below
Client Name: NA Date of Review 11/1/2020
Allergies: None
Storage of Medication: Medication stored on bedroom shelf, in the original container
Keeps Medication in original container? Yes
No issue noted in regard to medication
How many providers do this client use? One
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 UnderstandingYes or No |
| Fluoxetine | Prozac | 40 mg | CVS | Daily, in morning | Depression / Anxiety | Same as intended | Yes |
| Guanfacine | Intuniv | 1 mg | CVS | Daily, at night | ADHD | Same as intended | Yes |
| Men’s Multivitamin | Multivitamin | 2 gummies | CVS | Daily, in morning | Vitamin / mineral supplement | Same as intended | Yes |
| Ibuprofen | Advil | 600 mg | CVS | PRN related to pain | Pain relief | Patellar Tendonitis | Yes |
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.
My client is routinely using 2 medications, 1 over the counter medication as needed for pain and 1 over the counter vitamin supplement. Fluoxetine and guanfacine are prescribed by his provider. The men’s multivitamin and ibuprofen are bought over the counter. The difference between the over the counter medications is that the multivitamin is not approved by the FDA, but ibuprofen is. Each medication poses concerns for potential side effects or adverse reactions and drug to drug interactions between each other. My client reported occasional alcohol use as well, which can have effects with each of these medications.
Fluoxetine is a strong antidepressant and is prescribed to the client. 20 mg has been seen to alleviate most types of depression (Pary, R., et al.). It can have reverse reactions than its intended purpose, including anxiety and nervousness (Fluoxetine, 2020). My client demonstrates a strong understanding on the importance of taking this drug in the morning, to reduce insomnia at nighttime. It is important that the client knows to be cautious when using fluoxetine with ibuprofen because it can increase risk of bleeding. If bleeding is seen in the urine, vomit, stool, gums, etc. it is important that the client contact his provider immediately. Nausea and vomiting are also common side effects of this medication as they are seen in over 10% of clients with this prescription (Prozac, 2020). With fluoxetine, alcohol can increase the risk of CNS depression, so it is vital that he understands to be extremely cautious regarding alcohol intake (Fluoxetine, 2020). Throughout my assessment, I noted that my client expresses knowledge towards fluoxetine and how to appropriately take it.
Guanfacine is another medication that my client is prescribed. He is prescribed this drug to maintain attention deficit hyperactive disorder, also known as ADHD. Guanfacine’s most common side effect is low heart rate, also known as bradycardia, which can be extremely dangerous if not properly assessed. Syncope, the loss of consciousness due to drop in blood pressure, is also a common side effect of this drug and can be directly related to bradycardia (Guanfacine, 2019). With syncope, I am concerned about my client’s risk for falls, but he states understanding of going from sitting to standing slowly. Another common side effect is lack of or trouble keeping an erection. If my client were to experience any of these side effects, he understands the importance of contacting his provider immediately (Guanfacine, 2019). Alcohol use must also be considered when taking guanfacine because the interaction can cause increased sedation (Guanfacine, 2019). Each side effect and risk speak to the importance of taking this medication as prescribed and the client has expressed an adequate understanding of that.
Ibuprofen is taken over the counter by this patient as PRN for pain related to patellar tendonitis secondary to post ACL reconstruction. Ibuprofen use must be closely monitored when being taken with prescribed medications. As mentioned early, ibuprofen has an interaction with fluoxetine related to increased bleeding due to its antiplatelet agent and should be monitored closely (Advil, 2020). Also, when using ibuprofen, alcohol can cause adverse reactions in the gastrointestinal system (Ibuprofen, 2020). The client exhibits understanding to not use this medication long term because that is when severe adverse effects occur most often.
Lastly, my client takes a men’s multivitamin daily to supply minerals and vitamins to the body. Vitamin A and Vitamin E are avoided due to their risk of potentially serious adverse effects. These side effects include increased risk of cancer, heart disease and death (Vitamin Supplement, 2020). Alcohol does not have direct adverse effects regarding multivitamins, but its use can inhibit their absorption. Men’s multivitamin’s have shown to play a role in the prevention of cancer in men (Gaziano, J.M., et al.).
My client exhibits strong understanding regarding the use and side effects of each medication. I am concerned about the bleeding risk associated with fluoxetine and the bradycardia/fall risk associated with guanfacine. My priority concern with this specific client is alcohol consumption and its dangerous adverse effects. Alcohol directly affects three of four medications on my client’s regimen, so I have given thorough education on alcohol intake to ensure that the client does not put himself at risk for these 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.
Safe medication administration and delivery is extremely important regarding a client’s plan of care. Each medication has its own mechanism of action to ensure that the therapeutic effect is being done correctly. The only way to ensure of this is to properly take each medication as prescribed and directed by one’s provider. Also, non-pharmacological agents can be involved in and aid with treatment. Medication administration is done most safely when the client understands the therapeutic use and how to appropriately take each of the medications that they are on.
Fluoxetine has a few rules to ensure it is giving off the intended therapeutic effect and not adverse ones. It is important to take this medication as prescribed and in the morning. Taking this medication at night greatly increases the risk of insomnia. When taking the fluoxetine at nighttime, 10-33% of clients report symptoms of insomnia (Prozac, 2020). Taking this around the same time each day will reduce the risk of possible side effects related to the drug. If you miss taking this in the morning and it is close to the time off your normal dose, it is okay to take it. Never double dose to catch up on a missed one (Fluoxetine, 2020). The purpose of this drug is to help with depression and anxiety, over weeks the client should be feeling better. It is important to understand that even if one begins to feel better, do not stop taking this. Stopping this medication abruptly or without being advised by your provider can worsen your condition (Prozac, 2020). It is important to administer this as prescribed to avoid possible adverse effects and assure that the client is getting the full therapeutic effect. Some non-pharmacological agents that can help increase mood include exercise, self-care, and eating healthy. These lifestyle habits can be helpful in conjunction to this medication. Learning new habits can have various positive effects, helping the client feel even better.
Guanfacine, the other medication that is prescribed to my client, also has a few rules that are important to follow. This medication can cause drowsiness, so it is to be taken at nighttime. Avoid taking this medication with high-fat meals because it can slow down or reduce the rate of absorption (Intuniv, 2020). My client takes this drug to help treat ADHD, so it should make him feel better. It is vital that my client understands to not suddenly stop this medication as it can cause rebound hypertension. If the client realized that he missed a dose, he can take it as soon as it is thought of. If that time is closer to the next administration than the missed one, skip that dose and wait until the next one. The client must understand to not take a double dosage to catch up on a missed dose. This can cause severe bradycardia and syncope (Guanfacine, 2019). If you miss two or more dosages, contact your provider to create a plan to restart the medication. Do not store guanfacine in the bathroom, store it somewhere dry. Do not crush, chew, or break the capsule to avoid rushing the absorption rate of the medication (Intuniv, 2020). Taking this medication as prescribed is very important as it can correlate with heart function. Some non-pharmacological means that can be used in regard to ADHD include behavioral education and learning therapies/trainings to help with symptoms.
Ibuprofen is taken over the counter by my client, it is a complicated medication because it is oftenused with more ease than caution. My client uses it to decrease pain related to patellar tendonitis. It commonly causes GI irritation when taken incorrectly. This OTC drug must be taken with either a meal or a large glass of water to decrease irritation. Never chew, crush, or break this medication because it can affect the rate of absorption in the body. This drug should be placed in a room that is dry and is at room temperature (Ibuprofen, 2020). Ibuprofen should be taken as soon as pain is felt, do not wait for the pain to worsen or try to tough it out (Advil, 2020). Do not take ibuprofen long term, unless instructed to do so by your provider. This medication is closely monitored with a lot of prescription medication, so it is important to take this as recommended and consult the provider before taking it. Pain can also be managed with non-pharmacological agents such as ice packs, acupuncture, massage, or meditation. These have shown to reduce pain, like ibuprofen may but they do not have a direct pharmacological reaction with the body (MacMillan, 2017).
Multivitamins are also taken over the counter by my client. It is important to store multivitamins at room temperature and away from sunlight/in the heat (Vitamin Supplement, 2020). Putting them in the sunlight increases the risk of them melting because they are gummies. When they are melted together it alters the recommended dosage.
Overall, my client understands how to appropriately use his medications. I have educated him on the therapeutic effect of each medication that he is on and how to appropriately administer them. Using these medications correctly can reduce the risk of severe side effects such as increased bleeding risk with fluoxetine or severe bradycardia with guanfacine. I spoke with the client about non-pharmacological agents that can be involved in treatment of (in the client’s case) major depressive disorder, ADHD and pain. I have discussed with the client to reduce alcohol intake on these medications because it can worsen depression and increase sedation. Throughout my assessment, my client expressed understanding of his medication regimen and what he can do to ensure safety during administration.
Work Cited
Advil, Motrin,… (ibuprofen) dosing, indications, interaction, adverse effects, and more. (2020). Retrieved November 01, 2020 from https://reference.medscape.com/drug/advil-motrin-ibuprofen-343289
Fluoxetine. (2020, June 08). Retrieved November 01, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=25&did=942135
Gaziano, J. M., Sesso, H. D., Christen, W. G., Bubes, V., Smith, J. P., MacFadyen, J., Schvartz, M., Manson, J. E., Glynn, R. J., & Buring, J. E. (2012). Multivitamins in the prevention of cancer in men: The Physicians’ Health Study II randomized controlled trial. JAMA, 308(18), 1871–1880. https://doi-org.une.idm.oclc.org/10.1001/jama.2012.14641
Guanfacine. (2019, June 17). Retrieved November 01, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=25
Ibuprofen. (2020, January 01). Retrieved November 01, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=25&did=942339
Intuniv, Tenex (guanfacine) dosing, indications, interactions, adverse effects, and more. (2020). Retrieved November 01, 2020 from https://reference.medscape.com/drug/intuniv-tenex-guanfacine-342384#92
MacMillan, A. (2017, May 17). Before you take Ibuprofen, try this. TIME.
Pary, R., Tobias, C., & Lippmann, S. (1989). Fluoxetine: prescribing guidelines for the newest antidepressant. Southern medical journal, 82(8), 1005–1009.
Prozac, Sarafem (fluoxetine) dosing, indications, interactions, adverse effects, and more. (2020, May 04). Retrieved November 01, 2020, from https://reference.medscape.com/drug/prozac-sarafem-fluoxetine-342955
Vitamin Supplement. (2020, July 29). Retrieved November 01, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=19&did=979523&searchTerm=multivitamin&hits=multivitamin,multivitamins
