Quiz 10: Pharmacotherapy of the Geriatric Patient


The case study presents an 88-year-old patient with a history of diabetes and hypertension. The patient is independent and lives in an assisted living facility and was prescribed with drugs to control diabetes and hypertension. The patient's daughter observes that the patient's blood sugar and pressure levels were fluctuating, indicating a non-conformation to the prescribed drugs. The patient's daughter seeks nursing intervention to treat the patient. The priority nursing assessment would include both objective and subjective data collections. These will include obtaining the patient's version regarding her taking the prescribed drugs regularly and also physical and laboratory examination to assess the situation. The assessment should include monitoring the blood pressure, fluid volume, blood sugar levels, cognitive abilities, motor skills and for possible adverse effects of the prescribed drugs.

Drugs are used for therapeutic purposes either alone or in combinations as required by the health condition of a patient. Drug interactions can occur between two or more drugs and the net effect of such interactions differ. The major net effects of drug interactions can lead to additive, synergistic, or antagonistic results. The salient points and differences among these effects are presented as follows: Additive effects: such effects will lead to the production of a net effect which is much more that the sum of the effects of the individual drugs involved. Synergistic effects: such effects will lead to an enhancement of the net effect, while each of the drugs in combination augmenting or complementing the effect(s) of other drug(s) involved. Antagonistic effects: such effects will lead to the inhibition or inducing an opposite effect by a drug on another drug when administered in combination.

The case study presents an 80-year-old patient who is undergoing treatment with a diuretic, antihypertensive, and multivitamins on a daily basis. The patient is depressed on knowing about the loss of a dear one and is now being treated with intravenous saline infusion and oxygen by mask. Her vital signs indicate elevated body temperature, low blood pressure while her apical pulse rate and respiratory rate are near normal. The patient also manifests signs of dehydration with quite and slurred speech. A major predisposing factor for the patient to the observed condition is the combined effect of the drugs hydrochlorothiazide (diuretic) and atenolol (antihypertensive). The drug interactions will induce excessive fluid loss and tiredness/dizziness, leading to the condition as observed in the patient presented in the given case study. The adverse effects of the drug interactions are augmented by the lack of proper nutrient/diet intake by the patient.

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