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Mrs Angela Brown is a 68 year old widow, and is back in hospital for the second time in a month. She lives alone and does not have relatives living nearby. Angela has a history of intermittent asthma, atrial fibrillation and osteoarthritis. During her current admission to hospital for a pelvic abscess she has been prescribed Metronidazole 500mg IV tds. She complains of discomfort in her buttocks and pain in the perineal area and an offensive odour from there as well. Paracetamol 1000mg qid is prescribed for pain. 

In addition to Metronidazole and Paracetamol the prescribed medication history lists the current medications of 

• Salbutamol 2 puffs pit

• Amiodarone 200mg daily

• Aspirin 300mg daily

Angela also buys Ibuprofen 200mg as an over the counter drug for when her joints ache. 

Part of the nurse's role in the discharge planning process is to ensure that Angela manages her medication safely and effectively. To commence this process you need to answer the following questions in relation to medication management:

1. What are the indications and actions of the prescribed medications?

2. What are the most common interactions of the prescribed medications? Include: drug to drug, drug to food and drug to herbal interactions? (If there are no known interactions in some areas please state this).

3. Discuss the medication management education that is required to enable Angela to manage her medications at home. 





§ Anaerobic contaminations

§ Parodontopathy (Turnbull, Lin & Matthews, 2013).

§ Anaerobic contaminations of the lower respiratory tract

§ Joined with a moment anti-infection for the treatment of blended diseases with oxygen consuming germs and for pre-agent contamination prophylaxis (Turnbull, Lin & Matthews, 2013).

Hinders nucleic acid synthesis by disturbing the DNA of microbial cells.

Capacity just happens when metronidazole is incompletely diminished

Generally little impact upon human cells or oxygen consuming microorganisms


§ Pain relieving and antipyretic properties.

§ For the treatment of torments of various types (migraines, dental agony, postoperative torment, torment regarding colds, post-traumatic muscle torment).

§ Headache cerebral pains, dysmenorrhea and joint torment (Machado et al., 2015).

Paracetamol (acetaminophen) is by and large thought to be a frail inhibitor of the blend of prostaglandins (PGs) (Machado et al., 2015).

In any case, the in vivo impacts of paracetamol are like those of the particular cyclooxygenase-2 (COX-2) inhibitors.


§ Nonsteroidal drug (NSAID).

§ Decreases hormones that cause aggravation and torment in the body.

§ To decrease fever and treat agony or irritation brought about by many conditions, for example, migraine, toothache, back torment, joint inflammation, menstrual spasms, or minor damage.

Ibuprofen is a non-specific inhibitor of a catalyst called cyclooxygenase (COX), which is required for the union of prostaglandins through the arachidonic corrosive pathway.

COX is expected to change over arachidonic corrosive to prostaglandin H2 (PGH2) in the body (Shetty et al., 2013).


§ Intense treatment of bronchospasms, regardless of the possibility that the assaults are serious.

§ Fenoterol and terbutaline have a comparable impact, while formoterol and salmeterol have longer enduring impacts.

§ Redress utilize is critical for a fruitful treatment (Devereaux et al., 2014).

§ More symptoms take after oral organization. Inward breath with a nebulizer or parenteral organization is just demonstrated if the asthma assaults are serious. In the event that there are reversible adjustments, salbutamol could likewise be useful for endless obstructive aspiratory disease.

Binding of albuterol to beta (2)- receptors in the lungs brings about the unwinding of bronchial smooth muscles. S

albutamol builds cAMP generation by enacting adenylate cyclase, and the activities of salbutamol are intervened by cAMP (Mamawag, 2012).


§ Life-threatening recurrent ventricular fibrillation or hemodynamically unstable ventricular tachycardia.

§ Amiodarone is a strong antiarrhythmic operator that is utilized to treat ventricular arrhythmias and atrial fibrillation

Additionally indicates beta blocker-like and calcium channel blocker-like activities on the SA and AV hubs

Expands the stubborn period by means of sodium-and potassium-channel impacts, and moderates intra-heart conduction of the cardiovascular activity potential


§ Aspirin is comparatively proficient as paracetamol on insignificant intense agony (e.g. migraines, dental agony, or colds).

§ Rheumatic infections (incessant polyarthritis, osteoarthritis, and so on.) and for dysmenorrhea headache medicine is not as proficient or not also endured as other prostaglandin blend inhibitors, for example, ibuprofen (Devereaux et al., 2014).

§ Serves in the aversion of thromboembolic angiopathies.

§ Utilization is all around archived as an auxiliary prophylaxis for coronary illness (after a myocardial dead tissue or a sidestep operation) (Devereaux et al., 2014).

Diminishes the creation of prostaglandins and TXA2.

Creation of prostaglandins and thromboxanes is because of its irreversible inactivation of the cyclooxygenase (COX) compound (Devereaux et al., 2014).

Cyclooxygenase is required for prostaglandin and thromboxane blend.


Interactions with foods

Interaction with other drugs

Herbal Interactions


It generally does not have any interactions, but in presence of ethanol it reacts and increases the rate of certain side effects.

It does not react with any sort of drugs as such.

· Ginger  increases the absorption and plasma half-life

· Decreases the rate of elimination constant and clearance of it


It does not react with any sort of food other than citrus ones.

 It increases the risk of liver damage in chronic alcoholics.

No such harmful interactions takes place


Food interferes with the rate of ibuprofen absorption.

Ibuprofen antagonises the effects of furosemide & thiazides. It is a compelling anti-inflammatory with analgesic and antipyretic action. Ibuprofen increases the risk of toxicity of methotrexate & lithium toxicity. Its effects on analgesic and antipyretic are further opposed to by paracetamol.

Gingko has a blood-thinning effect and therefore increases the risk of bleeding when taken in combination with drugs that thin the blood.


It generally does not react with any types of foods.

There are a few types of medications that associate contrarily with salbutamol (likewise called albuterol), so they ought not be taken in the meantime unless endorsed together by a specialist. Salbutamol influences the sensory system in an indistinguishable path from monoamine oxidase (MAO) inhibitors and tricyclic antidepressants do, which can build the seriousness of cardiovascular symptoms. A few sorts of diuretics can bring down potassium levels in the blood, which is likewise a symptom of salbutamol. Salbutamol actuates beta receptors, so beta-blocking medications may render it incapable. Individuals taking digoxin ought to realize that salbutamol could diminish its expected impacts. Different medications that ought not be taken in the meantime as salbutamol are furazolidone, linezolid, and procarbazine (Hostrup et al., 2016).

· It reacts with caffeine, interact with Ephedra,  Licorice and Ginseng for over-stimulating the cardiovascular system.


Grapefruits and juice of grapes must be avoided while taking Amiodarone. Otherwise no side-effects takin this drug do not have any side effect.

The pharmacokinetics of various medications, including numerous that are ordinarily regulated by people with coronary illness, are influenced by amiodarone.

It enhances the activity of warfarin through repressing the leeway of both (S) and (R) warfarin.

Amiodarone represses the activity of the cytochrome P450 isozyme family.

· Grapefruit juice blocks the breakdown of amiodarone in the intestine.

· Tobacco can also create such disturbance in the health body (Gehring et al., 2014)


They are restricted for consumption with alcohols.

Aspirin is a drug that belongs from a class of generally utilized medications, both remedy and over the counter, called nonsteroidal mitigating drugs (NSAIDs, for example, ibuprofen, naproxen, and indomethacin.

Have common interactions with Gingko

Angela will need a proper medication guideline by the nurses. The medicine management helps in improving the quality by utilizing the medicine with the help of reduction of poly-pharmacy as well as burdening of medicines. A good medicine management is possible when the below four steps are been followed:

Step1- Assessing the patient, Angela must be analyzed by the nurse : It includes the following steps

  • Reviewing the medicines that ios provided by the medical practitioner to Angela, co-morbidities as well as condition

Step 2- Checking the medicines of her

  • Matching the medicines on the goals of treatment
  • Identifying the discrepancies in between the medicines taken as well as prescribed

Step 3- Optimizing the medicines that has been prescribed to Angela

  • Evaluating the signs as well as symptoms of the medicinal issues
  • Considering the adjustments of dose (Raskin et al., 2014)

Step 4- Following up the action taken for angela on the ground of managing the medicine

  • Monitoring or communicating with the alterations of medicine
  • Anticipating adverse outcomes


Allen, N. M., Hacohen, Y., Palace, J., Beeson, D., Vincent, A., & Jungbluth, H. (2016). Salbutamol-responsive fetal acetylcholine receptor inactivation syndrome. Neurology, 86(7), 692-694.

Devereaux, P. J., Mrkobrada, M., Sessler, D. I., Leslie, K., Alonso-Coello, P., Kurz, A., ... & Parlow, J. L. (2014). Aspirin in patients undergoing noncardiac surgery. New England Journal of Medicine, 370(16), 1494-1503.

Gehring, G., Rohrmann, K., Atenchong, N., Mittler, E., Becker, S., Dahlmann, F., ... & Ciesek, S. (2014). The clinically approved drugs amiodarone, dronedarone and verapamil inhibit filovirus cell entry. Journal of Antimicrobial Chemotherapy, 69(8), 2123-2131.

Hostrup, M., Kalsen, A., Auchenberg, M., Bangsbo, J., & Backer, V. (2016). Effects of acute and 2?week administration of oral salbutamol on exercise performance and muscle strength in athletes. Scandinavian journal of medicine & science in sports, 26(1), 8-16.

Machado, G. C., Maher, C. G., Ferreira, P. H., Pinheiro, M. B., Lin, C. W. C., Day, R. O., ... & Ferreira, M. L. (2015). Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. bmj, 350, h1225.

Mamawag, E. M. T. (2012). Metronizadole-induced Encephalopathy in a 64-year-old Female: a Case Report. Philippine Journal of Microbiology and Infectious Diseases, 39(1).

Raskin, S. A., Maye, J., Rogers, A., Correll, D., Zamroziewicz, M., & Kurtz, M. (2014). Prospective memory in schizophrenia: Relationship to medication management skills, neurocognition, and symptoms in individuals with schizophrenia. Neuropsychology, 28(3), 359.

Shetty, N., Patil, A. K., Ganeshkar, S. V., & Hegde, S. (2013). Comparison of the effects of ibuprofen and acetaminophen on PGE 2 levels in the GCF during orthodontic tooth movement: a human study. Progress in orthodontics, 14(1), 6.

Turnbull, A.M.J., Lin, Z. & Matthews, B.N. (2013). Severe bilateral anterior uveitis secondary to giardiasis, initially misdiagnosed as a side effect of metronidazole. Eye, 27(10), p.1225.

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