Drug Interaction, Case Study Example

Mr. Jackson’s drug profile indicates a number of over the counter medications. There is a risk with some OTC medications when prescription medications are administered during surgical procedures or for other reasons. Therefore, it is important to evaluate his OTC usage to determine if there will be adverse effects in conjunction with the proposed surgical administration of drugs. The use of multiple vitamins and Vitamin C do not appear to have any major adverse effects if combined with other medications. However, the use of aspirin and fish oil concurrently is dangerous because it may increase the risk of bleeding in some patients. Furthermore, the combination of aspirin and flax seed oil could be dangerous because this also increases the risk of bleeding. For Mr. Jackson, this combination of OTC medications could lead to significant blood loss during the surgical procedure; therefore, these considerations should be taken seriously prior to surgery. Co-Q10 should be stopped approximately two weeks prior to any type of invasive surgery because it may cause a reduction in blood pressure (RxList, 2013). Each of these possible counterindications should be evaluated well in advance of the scheduled surgery to avoid any unnecessary complications before, during, and after surgery.

With the scheduled administration of benzodiazepine the morning of the surgery as a sedative, the administration of propofol later on the same day is likely to increase sedation even more (Rethink, 2013). Therefore, it is important to exercise caution when administering these drugs on the same day and monitor the patient’s level of sedation at all times. In addition, propofol is a highly powerful anesthetic; therefore, when the patient is administered this drug, careful monitoring should be conducted so that the patient’s heart rate and blood pressure remain stable throughout the surgery. This drug will ensure that the patient is anesthetized so that the surgery may be performed in the appropriate manner without any unforeseen complications. In addition, the administration of morphine along with propofol has been used under highly controlled settings as a means of reducing nausea and vomiting after surgery (Bree et.al, 1998). In lieu of morphine, fentanyl may be prescribed instead for effective pain management or as a supplemental anesthetic, but the physician must make the decision regarding which drug is more appropriate for this particular patient. Fentanyl is a stronger type of pain medication that requires careful monitoring and should only be used when other milder pain medications are unsuccessful in treating the pain (WebMD, 2013). Therefore, prior to surgery, it is important and necessary for the physician and other clinical staff to be fully aware of any possible complications or drug interactions and to determine how to maintain the patient’s overall health and wellbeing before, during, and after the surgery has taken place.

From a physician’s perspective, the drugs that will be prescribed must be prescribed within their allowable dosages so that the patient does not experience any unforeseen complications. For example, a typical dosage of propofol for the patient in question is 20 mg IVP every 10 seconds until onset, with 1-1.5 mg/kg after onset (Medscape, 2013). In addition, during the maintenance phase, the patient should be administered 0.05-0.1 mg/kg/min intravenously as needed (Medscape, 2013). This is the typical dosage for a man in Mr. Jackson’s age group.

Fentanyl should be administered with the intent to anesthetize at a rate of 2-20 mcg/kg, with a maintenance dosage of 25-100 mcg/kg as needed (Drugs.com, 2013). In the postoperative state, the patient should be administered Fentanyl 50-100 mcg/kg in intervals of one to two hours as necessary (Drugs.com, 2013). This administration frequency is recommended for most adult patients.

If morphine is administered as a pain medication, it may be administered intravenously at the rate of 4-15 mg every three to four hours, with slow administration over a four to five minute period (Drugs.com, 2013). This will enable the patient to respond well to the medication without excess dosing and is within the range of normal dosing for an adult male under these circumstances (Drugs.com, 2013).

It is important to prescribe the patient the correct dosage and the appropriate medications before, during, and after the surgery in order to ensure that the patient responds well to the medication and to the dosing in a manner that is consistent with existing guidelines. These efforts will ensure that the patient is protected from any and all unnecessary risks or harm throughout the course of the treatment plan. The physician in charge of the case must be fully aware of the risks associated with the medications that are prescribed and should also recognize that there are potential risks associated with his current over the counter medications. These considerations must be made prior to administering any type of prescription medication at the time of the surgical event.

It is important from a clinical perspective to maintain careful monitoring of the patient throughout the surgical process. In the preoperative state, the patient should be provided with medications which are as safe as possible and are effective for the treatment that is being sought. It is important to monitor the patient under controlled conditions and to examine his medication history prior to the surgery, including any over the counter medications, so that any possible drug interactions are eliminated as best as possible. This will also ensure that the patient is prepared for the recovery process at all levels. These efforts will enable the patient to be treated for his condition accordingly and without any unnecessary complications or drug interactions that could have been otherwise avoided. This enables the patient to be provided with a safe and effective environment before, during, and after the procedure, including the ability to make a full and uncomplicated recovery. The patient’s medication history is a key component of this process and should be carefully evaluated.

References

Bree, S.E., West, M.J., Taylor, P.A., and Kestin, I.G. (1998). Combining propofol with morphine in patient-controlled analgesia to prevent postoperative nausea and vomiting. British Journal of Anasthesia, 80, 152-154.

Drugs.com (2013). Fentanyl dosage. Retrieved from http://www.drugs.com/dosage/fentanyl.html#Usual_Adult_Dose_for_Anesthesia

Drugs.com (2013). Morphine dosage. Retrieved from http://www.drugs.com/dosage/morphine.html#Usual_Adult_Dose_for_Pain

Medscape (2013). Propofol. Retrieved from http://reference.medscape.com/drug/diprivan-propofol-343100 Rethink (2013). Interactions – benzodiazepines. Retrieved from http://www.rethink.org/living_with_mental_illness/treatment_and_therapy/medication/benzodiazepines/interactions_benzo.html

RxList (2013). Coenzyme Q-10. Retrieved from http://www.rxlist.com/coenzyme_q-10/supplements.htm

WebMD (2013). Fentanyl. Retrieved from http://www.webmd.com/pain-management/fentanyl