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POLYPHARMACY Patient case study, Patient Profile, 2013001182 - Coggle…

- - - - 2g of cefazolin is reconstituted with sterile water for injection (Medsafe, n.d). Obese patients with a high BMI may be given 3g of cefazolin reconstituted with sterile water for injection (Medsafe, n.d). These doses can be administered 6-8 hourly; max 6g daily (Bryant & Knights, 2015).
    - - Common: GI upset, DRESS (drug rash with eosinophilia and systemic symptoms) - discontinue immediately, hypersensitivity including fever and anaphylaxis, super infection, vaginitis and neuropathy (MIMS, 2017).
      - Rare: Elevated LFTs, hepatitis, interstitial nephritis and jaundice (MIMS, 2017).
    - - Treatment and surgical prophylaxis of infections in the skin, bone, joint, respiratory tract, ear, nose, throat and gynaecological procedures, urinary tract infections and septicaemia (MIMS, 2017).
    - - Intravenous or intramuscular (Medsafe, n.d). The patient recieved a intravenous dose.
    - - Hypersensitivity to cephalosporins (MIMS, 2017).
    - - Warfarin, typhoid vaccine (within 24 hours), probenecid and aminoglycosides (MIMS, 2017).
    - - Cefazolin inhibits cell wall biosynthesis by binding to penicillin binding proteins which stops peptidoglycan synthesis (Medsafe, n.d).
  - - - Bradycardia, intolerance to opioids, asthma, head injury, coma, respiratory depression susceptibility and children under 2 years (MIMS, 2017).
    - - Fentanyl's mechanism of action is similar to that of morphine as it mimics the actions of endogenous enkephalins and endorphins at opioid receptors (Bryant & Knights, 2015).
    - - Selective serotonin reuptake inhibitors, central nervous system depressants, other opiates, general anaesthetic, muscle relaxants, alcohol, beta-blockers, Ca channel blockers, midazolam and naltrexone (MIMS, 2017).
    - - The normal dose range for fentanyl in combination with local anaesthetic for spinal anaesthetic varies between patients. The recommended dose for a patient of this age and weight is 12-28mcg/hour (Medsafe, n.d).
    - - Common: Dizziness, insomnia, GI upset, tremor, convulsions, rash, anaphylaxis and hypersensitivity, depression, anxiety, confusion, hallucination, urinary retention, respiratory depression, bradycardia, tachycardia, hypo or hypertension, euphoria, cyanosis, serotonin toxicity, withdrawal symptoms, dependence, post-op agitation, cardiac arrest, hypothermia, delirium, laryngospasm and suppressed cough reflex (MIMS, 2017).
    - - Analgesia in anaesthesia for pre-medication, induction and maintenance, post-op analgesia, analgesia in regional general anaesthesia, management of chronic pain and chronic cancer pain, epidural and spinal anaesthesia in combination with bupivacaine or ropivacaine (Bryant & Knights, 2015).
    - - Injection, oral, intranasal, transdermal patch or infusion (Bryant & Knights, 2015).
  - - - Hypersensitivity to amide local anaesthetics, acute active disease of the cerebrospinal system including meningitis, cranial haemorrhage and tumors, recent trauma in the vertebral column, inflammation to the desired injection site, hypotension, arthritis of the vertebral column, hypovolaemic shock and pernicious anaemia (Medsafe, n.d).
    - - Bupivacaine binds to the intracellular part of voltage-gated sodium channels and blocks sodium stream into nerve cells, preventing depolarization. Without depolarization no conduction or initiation of a pain signal can occur (Medsafe, n.d).
    - - Some antiarrhythmics including lignocaine, class III antiarrhythmics and anticoagulants (MIMS, 2017).
    - - 1.5-4ml injected into the L3-L4 interspace, patients are kept in a sitting position for 2 minutes before being placed into a supine position, the blockage then spreads to the T7-T10 segment (Medsafe, n.d).
    - - Common: Hypotension, GI upset, bradycardia, postdural puncture, dizziness, headache, hypertension, incontinence, urinary retention.
      - Uncommon: Convulsions, unconsciousness, muscle weakness, back pain, visual disturbances, tinnitus.
      - Rare: Cardiac arrest, anaphylaxis, paralysis, unintentional total spinal block, neuropathy, respiratory depression, excitation and confusion (MIMS, 2017).
    - - Intrathecal (spinal, subarachnoid) anaesthesia for surgical and obstetrical procedures, abdominal surgeries and lower limb and hip surgery, lasting 1-4 hours where muscle relaxation is desired (Medsafe, n.d).
    - - Intrathecal (Medsafe, n.d).
  - - - CNS depressants including alcohol, centrally acting hypertensives, inhalation anaesthetics and drugs that inhibit CYP3A4 can inhibit the metabolism of midazolam and prolong the therapeutic and adverse effects for several hours; this includes medications such as St John's wort, clarithromycin and erythromycin (Bryant & Knights, 2015).
    - - Sever renal impairment, severe respiratory impairment, sleep apnoea, hypersensitivity to benzodiazepines, pregnancy, childbirth and breastfeeding (MIMS, 2017). Midazolam is also contraindicated in use for children and the elderly (Bryant & Knights, 2015).
    - - Midazolam binds to and potentiates GABA receptors (Medsafe, n.d).
    - - For conscious sedation carried out under local and spinal anaesthesia, the initial dose should not exceed 2.5mg IV. Further doses of 1mg can be administered as required. A total dose higher than 5mg is not usually necessary to reach desired level of sedation (Medsafe, n.d).
    - - Common: GI upset, drowsiness, dry mouth, euphoria, confusion, headache, hallucination, dizziness, falls, altered libido, psychosis, hostility, tolerance, dependence, withdrawal symptoms, hypotension, tachycardia, vasodilation, rash, thrombosis, sleep walking and sleep eating (MIMS, 2017).
      - Rare: Respiratory depression, cardiac arrest and laryngospasm (MIMS, 2017).
    - - Premedication for surgery, conscious sedation, induction of general anaesthesia, severe insomnia andlong-term sedation in ICU (MIMS, 2017).
    - - Intravenous, intramuscular, rectal, intranasal and oral (Medsafe, n.d). The patient had intravenous doses.
  - - - Common: GI upset, fatigue, cough, postop haemorrhage, hyperglycaemia, hypokalaemia, chest pain and hypotonia (MIMS, 2017).
      - Rare and very rare: Pancreatitis, nephrotoxicity, anaphylaxis, rash, bronchospasm, shock, renal failure, coma, severe skin reactions, thromboctopenia, neurological disorder and angioedema (MIMS, 2017).
      - Unknown frequency: Hepatic necrosis or failure and tachycardia (MIMS, 2017).
    - - There are few drug interactions which can occur when taking paracetamol. Paracetamol is a substrate for CYP1A2, which means in may interact with drugs which enduce this same enzyme such as tobacco or inhibitors such as warfarin and amitriptyline. Because of this, paracetamol may prolong bleeding in patients who have already been stabilized on warfarin (Bryant & Knights, 2015).
    - - Intravenous, rectal and oral (MIMS, 2017). The patient had an oral dose.
    - - Hepatic failure, decompensated active hepatic disease and severe hepatocellular insufficiency (MIMS, 2017).
    - - Oral administration: Maximum of 4 doses of 1g over 24 hours - not exceeding 4g per day (MIMS, 2017).
    - - The exact mechanism of action for paracetamol is unknown. However, it is believed to include inhibition of prostaglandin synthesis, within the central nervous system (Medsafe, n.d).
    - - -Analgesic relief of pain associated with headache, teething, muscle aches, cold and flu, arthritis, backache and dental pain.
        -Reduction of fever (MIMS, 2017).