When one is healthy there is hardly a need to visit the doctors, or a need to consistently refill medications. However, when one has an illness, especially an illness that does not have a cure, then one is obligated to go for monthly check-ups, monthly blood draws, and monthly pharmacy visits. Such is the case for Nirmal, a 52-year-old female, who has had rheumatoid arthritis for five years and hypertension since her early thirties. Rheumatoid arthritis is a chronic inflammatory disease, considered an “autoimmune disease,” and is characterized by “joint swelling, joint tenderness,” and destruction of “synovial joints” (Charles, Britt, & Pan, 2013, p. 765). She currently takes a myriad of medications which control her rheumatoid arthritis and hypertension, but the five medications that will be analyzed are: prednisone, gabapentin, methotrexate, metoprolol, and tramadol. …show more content…
Prednisone, which also goes by the trade name Deltasone, is one of the first line of medications that is offered when one has rheumatoid arthritis, because it’s primary indication involves being an “anti-inflammatory glucocorticoid” (Frey & Frey, 1990, p.
127). Thus, prednisone can be utilized for an array of illnesses that involve inflammation. Prednisone is administered orally or intravenously, ranging from one milligram to fifty milligrams; however, Nirmal takes this medicine orally, once every day, in 5 milligram dosages. Prednisone is easily absorbed in the gastrointestinal tract and extensively binds to plasma proteins, such as serum albumin; however, because prednisone is “biologically inert,” it must be converted to the active metabolite prednisolone, which is then metabolized mainly in the liver and utilizes cytochrome P450 enzymes (Frey & Frey, 1990, p. 129). The half-life of prednisone is two to three hours, and is excreted in the urine as “sulfate and glucuronide conjugates” (Frey & Frey, 1990, p.
129). Furthermore, prednisone is a “glucocorticoid receptor agonist” (Frey & Frey, 1990, p. 128). However, because it is first metabolized into prednisolone, it is prednisolone that crosses cell membranes and binds with high affinity to certain cytoplasmic receptors. This causes an inhibition of leukocytes at the sites of inflammation, suppression of “humoral immune responses,” and interference in the synthesis and function of inflammation mediators, such as leukotrienes and prostaglandins (Bergmann, Barraclough, Lee, & Staatz, 2012, p. 720). This demonstrates that the therapeutic relief in prednisone is caused by inhibition and interference in cells that cause inflammation. Additionally, prednisone is very potent when compared to commonly prescribed steroids. For example, five milligrams of prednisone is equivalent to twenty milligrams of hydrocortisone, which is equivalent to twenty-five milligrams of cortisone (Bergmann, Barraclough, Lee, & Staatz, 2012). This illustrates that prednisone is four times more potent than hydrocortisone and five times more potent than cortisone. In terms of effectiveness, there is not a substantial amount of research that analyzes prednisone’s effectiveness in rheumatoid arthritis; however, the data that is available demonstrates that prednisone is more effective than either placebo or “active drug controls” in improving rheumatoid arthritis (Saag, Criswell, Sems, Nenleman, & Kolluri, 1996, p. 1824). Although, Saag and colleagues (1996) note that one must be taking prednisone for relatively six months to observe therapeutic relief. Moreover, one must take into consideration the safety and toxicity of prednisone, because long-term use of steroids, such as prednisone, may lead to osteoporosis. Osteoporosis occurs because prednisone depletes the calcium in bones. This paradox is alarming, because individuals who take prednisone do so to relieve the inflammation; however, prednisone may concurrently cause another illness. Even though this paradox occurs, Saag and colleagues affirm that only individuals who have been taking prednisone for a long time will develop this condition, although they fail to mention what constitutes a long time (1996). In terms of toxicity, prednisone may cause low birth weight or birth defects if a woman takes the medicine during her first trimester. In addition, prednisone can pass into breast milk and harm a baby; in fact, it may affect the growth of a child (Saag, Criswell, Sems, Nenleman, & Kolluri, 1996).
Furosemide is available in tablets, sublingual tablets, oral suspension, and intravenously. (2) The recommended schedule dose for adults for an initial dose is 20 to 80mg. (3) The same dose as well as higher doses may be administered 6 to 8 hours following the previous dose if needed. (2) When titrating doses it may be raised by 20 to 40mg but not within 6 to 8 hours after the initial dose, and this may continue until the desi...
Patients with SLE have an increased risk for renal failure and heart failure and thus need to be monitored closely (Robinson, Sheets Cook, & Currie, 2011). A referral to a rheumatologist should be made upon suspicion of SLE (Weinstein, 2011).
Today he chooses to have a healthy life and control his diabetes. He takes one medication orally for his diabetes, Metformin. JR has a good, healthy diet as well as exercise habits like taking walks with his dog. JR takes seven medication on the daily with three being for his heart, one for his high blood pressure, one for his cholesterol, one for his diabetes and another one to prevent blood clots. After making sure there was no drug to drug interaction between any of this medications, I informed my patient that his medication can not cure diabetes and high blood pressure but control
Rheumatoid arthritis is a chronic inflammatory and an autoimmune disease that occurs when the immune system mistakenly attacks the body’s tissue (Rheumatoid arthritis, 2017). This disease affects the entire body, which is called a systemic (means entire body) disease. Arthritis is derived from the word part arthr-, which means “joint,” and -itis, which means “inflammation,” so altogether it means “inflammation of the joints.” It creates inflammation that causes the tissue that lines the inside of joints (synovium) to thicken. About 1.5 million people in the U.S. are affected. It affects all races, but it affects three times as many women than men (What is Rheumatoid Arthritis, n.d.). Overtime, rheumatoid arthritis causes painful swelling that can potentially result in bone erosion or joint deformity, which leads up to physical disabilities. RA can affect more than just your joints, but can spread to body systems, skin, eyes, lungs, heart, blood vessels, e.t.c (Rheumatoid arthritis, 2017).
Her BMI is 28 in the overweight zone. She had 4 episodes of DVT within 2 years. Her previous medical history includes osteoporosis which lead to poor mobility due to pain. She is currently waiting for Total Knee Replacement. After a Total Knee Replacement , patient is more likely to suffer from pain and being immobile for a period of time before commence physiotherapy. That greatly increase the chance of developing DVT(Brown, Edwards, Seaton&Buckley, 2014) .Patient education relating to physical activity includes encouraging early ambulation. First of all, administering medication oxycodone as patient request. Oxycodone is a opioid analgesics, belong to schedule 8 drug addition. It has to be prescribed by doctors to relieve moderate
PICO Question: Among the elderly patients receiving care at Cary Medical Center on Med/Surg, who are currently taking multiple medications due to comorbidities, would reviewing medications at each provider visit reduce polypharmacy and its associated adverse reactions?
Arthritis affects people of all age groups. More than 100 types of arthritis are known. Among these osteoarthritis and rheumatoid arthritis having the highest incidence. One of the major causes of chronic debilitation in industrialized nations is Osteoarthritis which results from damage to the joints, which may be due to trauma, infection, or age-related wear. Rheumatoid arthritis is encountered less frequently than osteoarthritis and is estimated to affect around one per cent of the world’s population. Amongst patients of Rheumatoid arthritis, women are three times more likely to be affected by this condition than men. This condition is caused by an inflammatory process where the body starts attacking itself. Rheumatoid arthritis also affects several joints, with inflammation sometimes seen in and around the lungs, the heart, the eyes and the skin. The most commonly reported complaint by arthritis patients is pain. The pain might be from the joint itself and be a result of inflammation, damage from the disease, or through daily wear and tear. Muscle pain is also common and is caused by having to force movements against stiff and painful joints. Although range of movement in the affected joint may be limited and uncomfortable, physical exercise has been shown to benefit those with arthritis. Physical therapy has been shown to significantly improve function, decrease pain in the long term and delay the need for surgery in advanced cases. The majority of arthritis cases occur among theelderly, however the disease can occur in children as well. Over 70% of the population that get affected by arthritis in North America are over the age of 65 (4). The disease occurs more commonly in females than males in all races, age groups, and ethn...
PICO Question: Among the elderly patients receiving care at Cary Medical Center on Med/Surg, who are currently taking multiple medications due to comorbidities, would reviewing medications at each provider visit reduce polypharmacy and its associated adverse reactions?
Acetaminophen is ingested orally and is rapidly and completely absorbed into the gastrointestinal tract. It works in about one hour. The liver detoxifies 90% of it by mixing it with sulfuric acid, and another 3-5% is catabolized by enzyme reactions to the acid. The metabolites are excreted in the urine.
Bibliography: Arthritis Foundation, Understanding Arthritis (1986); Kelley, William N., et al., eds., Textbook of Rheumatology, 2d ed., (1985); McCarty, Daniel F., ed., Arthritis and Allied Conditions, 11th ed. (1988); Moll, J. M. H., Rheumatology in Clinical Practice (1987).
Rheumatoid Arthritis is when the joints are chronically inflamed, which happens because it is an autoimmune disease which means that the immune system attacks the body tissues. Although Rheumatoid Arthritis mainly affects the joints, it can also affect other organs.
What prompted me to research about the various pain pathways was my grandmother's arthritis. She has suffered for many years with severe joint pain and in the past, has been treated with corticosteroids. Currently, she is taking Celebrex, (COX-2 inhibitor) which is a relatively new drug in the family of 'superaspirins'. What impressed...
“Always remember to be an internist, my dear.” This was an invaluable piece of feedback I received on a rheumatology rotation in my first year of internal medicine residency. Truly, I have never learned so much about medicine as I did during this first rotation in rheumatology. I became fascinated by the subtle presentations and cases that posed a diagnostic challenge to multiple subspecialties. I have been inspired by rheumatology as a field where multisystem disease is encountered on a daily basis and rheumatologists must use both general medicine and subspecialty skillsets to diagnose and treat patients. The academic challenges in rheumatology initially attracted me to the field however my subsequent experiences with patients, mentors, and research have made me passionate about pursuing rheumatology as my specialty.
Oliver, S. (2006). Benefits of patient pathways in rheumatoid arthritis care. Nursing Times. 102 (16), 28-33. Retrieved from http://www.nursingtimes.net/nursing-practice-clinical-research/benefits-of-patient-pathways-in-rheumatoid-arthritis-care/203268.article
As we age, the use of medication is often increased in an effort to treat illness and disease. In older adults this frequently results in the administration of multiple medications, both appropriately and inappropriately, at the same time. This is known as polypharmacy. While polypharmacy can exist with any age demographic, it is much more prevalent in older adults where the risk of multiple health conditions is greater. It is not uncommon, for example, for a patient to be treated with multiple therapeutic drug combinations in order to manage disease such as diabetes, heart failure and chronic obstructive pulmonary disease (Kaufman, 2011, p. 49). Polypharmacy is associated as a major factor placing older adults at risk for an adverse drug event. As the number of medications increase, the need for monitoring becomes much more crucial. When there is a breakdown in proper monitoring, the older adult is significantly placed at a higher risk for negative health outcomes due to serious side effects, poor adherence, adverse drug reactions and adverse drug interactions.