Nursing Case Study: Polypharmacy

Mrs. A is a 71-year-old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother 's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:

* Furosemide 40 mg daily in the morning
* Digoxin 250 micrograms daily
* Paracetamol

Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
- Furosemide (Lasix) 40 mg daily in the morning: Loop diuretic used to treat edema associated with congestive heart failure (CHF).
- Digoxin (Lanoxin) 250 mcg daily: In heart failure, increases contractility by inhibiting sodium/potassium ATPase pump in myocardial cells promoting calcium influx via sodium –calcium exchange pump ("Digoxin," 2015, p. 6).
- Paracetamol (Acetaminophen) 500 mg, 1-2 tablets 4 hourly PRN: Analgesic with limited anti-inflammatory activity (Woo & Wynne, 2011, p. 887). Used to reduce the pain of

2).
- Digoxin (Lanoxin): Increases serum potassium along with Piroxicam, interaction is possible.
- Paracetamol (Acetaminophen): “Decreased effectiveness of diuretic (Furosemide) because acetaminophen may decrease renal prostaglandin excretion and decrease plasma renin activity”(Woo & Wynne, 2011, p. 891).
- Piroxicam (Feldene): Combining with diuretic (Furosemide) in elderly patients, volume-depleted, or with poor kidney function can result in reduced kidney function and lead to kidney failure (Ogbru, 2015, p. 3). Decreases the effectiveness of diuretics (Furosemide).
- Mylanta Suspension (Magnesium hydroxide): Minor interaction when taken with digoxin since “digoxin decreases the levels of magnesium hydroxide by increasing renal clearance”("Magnesium," 2015, p. 2). This has the greatest ability to absorb or bind to the surface of other drugs, resulting in decreased bioavailability.
- Coloxyl (Docusate Sodium): No none interactions. However, their “detergent properties may facilitate the absorption of other substances in the GI tract, including prescription drugs”(Woo & Wynne, 2011, p. 158).

Discuss potential side effects of the drugs indicated in the