Quality Use of Medicines Assignment: A Case Study

Running Head: QUALITY USE OF MEDICINES ASSIGNMENT: A CASE STUDY.
QUALITY USE OF MEDICINES ASSIGNMENT: A CASE STUDY.
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QUALITY USE OF MEDICINES ASSIGNMENT: A CASE STUDY.
Q1. Assess Ms Tong’s medication chart and identify and explain two (2) significant risks
that may be associated with the use of these medicines.
From the medication chart, Ms. Tong’s doctor has prescribed clarithromycin, esomeprazole, and
amoxicillin, to be taken as a regular medication. Besides, the doctor prescribed Metoclopramide,
to be taken as a “pro re nata” (PRN) medication. Clarithromycin and amoxicillin are antibiotics
administered to counter bacterial infections. On the other hand, esomeprazole (a proton-pump
inhibitor), is administered to reduce the amount of acid produced in the stomach. A combination
of these three drugs is administered to treat stomach ulcers that are caused by the
bacterium, Helicobacter pylori.
Metoclopramide interacts with an antidepressant such as sertraline. Antidepressants target the
serotonin transporter, resulting in either serotonin syndrome-like events, or dystonia. The
interaction causes the overstimulation of both the central and peripheral serotonin receptors
(Diaz et al., 2018). Serotonin is a hormone produced in the body that helps with sleeping,
digestion, and regulation of mood. Serotonin syndrome results from an increase in the production
of serotonin, and inhibition of the hormone’s reuptake and metabolism. Serotonin syndrome is
characterized by the rapid development of hyperthermia, high blood pressure, a change in the
mental status, for instance, one becomes delirious, autonomic instability, stiffness, vomiting,
diarrhea, nausea stomach cramp, and muscle twitches.
Metoclopramide has also been associated with mental depression in patients with and those
without any previous history of depression (Igata et al., 2016). Patients on Metoclopramide have
demonstrated depression symptoms, ranging from mild to severe, such as continuous sadness,
feelings of hopelessness, and helplessness, feelings of guilt, irritation and a lack of tolerance to

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QUALITY USE OF MEDICINES ASSIGNMENT: A CASE STUDY.
other people, having no interest in the occurrences around them, increase in anxiety, developing
thoughts of self-harm, and even attempting to commit suicide. Ms. Tong is on treatments for
depression. Administration of Metoclopramide to this patient will lead to her developing a severe
form of depression. Ms. Tong, as a consequence, has an increased likelihood of developing
bipolar disorder. The extreme shifts in mood and variations in the levels of energy and normal
functioning of the body may be detrimental to her health, which may lead to the deterioration of
her health (Harada et al., 2017). Fluctuations in the mood that is associated with bipolar will
adversely affect Ms. Tong’s response to the medication. It will delay the rate of elimination of H.
pylori. It will also cause the progression of her ulcers, leading to extreme discomfort
Q2. Describe the strategies a nurse may implement to prevent/manage the risks identified
in Question 1.
The development of serotonin syndrome can be recognized and prevented before it develops to
extreme levels. A nurse can apply several strategies to ensure that serotonin syndrome does not
develop during Ms. Tong’s treatment. The nurse can minimize the amount of Metoclopramide
being administered to the patient. Metoclopramide is usually prescribed to relieve the feelings of
nausea, vomiting, heartburn, loss of appetite, and the feeling being full after eating. A lower dose
of Metoclopramide will reduce the chances of drug-drug interactions with any antidepressant
medication available in Ms. Tong’s bloodstream. The nurse can also discontinue the
administration of Metoclopramide. While the patient patient’s comfort will have been greatly
affected, the chances of developing serotonin syndrome will have been avoided entirely, “since
many cases of the syndrome are self-limiting if medications are stopped early.” (Christopher
Frank, 2008).