Medication - Quality Use of Medicine.

Running Head: MEDICATION 1
Quality Use of Medicine
Name of Student
Name of Professor
Institution Affiliation

MEDICATION 2
Date
Question 1
One of the risk factors associated with the use of the listed medicine is renal
failure. Acute renal failure is defined as sudden and temporary loss of kidney
functions. Mr. Michael is using a combination of drugs that might worsen the
functioning of his kidneys. The combined use of clarithromycin, ramipril, and
spironolactone causes renal failure. The combination of the drugs is known as triple
whammy. Tripple whammy is a situation where there is a combination of diuretics,
nonsteroidal anti-inflammatory drugs(NSAIDs), and Angiotensin converting enzyme
(ACE) inhibitors (Day, Snowden & McLachlan, 2017). The combination of these
three types of drugs is likely to result in impairment of renal functions. Spironolactone
belongs to the class of diuretics medications. These medications designed to increase
water and salt moving out of the body as urine. They are usually classified into three,
including; thiazide, loop, and potassium-sparing diuretics. Spironolactone belongs to

MEDICATION 3
the potassium-sparing category. The use of this drug, together with others, can result
in kidney problems because they might increase the amount of salt secreted from the
body and hence overworking the kidney (Hommers et al., 2019). Ramipril belongs to
the ACE class of drugs. The drug is mostly used for controlling acute as well as
chronic high blood pressure. Additionally, the drug is used for the treatment of
ventricle failure as well as the prevention of strokes. Research has proved that the use
of ACE drugs interferes with kidney functions, especially for individuals such as Mr.
Michael, who have renal artery stenosis.
The use of ramipril helps in preserving the urinary functions, but they result in to
decrease in glomerular filtration and hence to cause vasodilation of the renal arteriole
(Fanelli, Ghisi, Aprile & Lapi, 2017). The NSAIDs usually aim at cyclooxygenase 2
(COX-2) enzymes. The COX-2 enzymes produce prostaglandins(PG), which are vital
in the regulation of homeostasis in kidneys. PG helps in the control of sodium,
chloride as well as water transportation in the kidney. Therefore, when NSAIDs are
used, they result in the retention of sodium and potassium in the kidney and hence
leading to renal impairment. Additionally, the interaction of NSAIDs with diuretics
results in blocking of COX-2 enzyme and therefore preventing synthesis of
prostacyclin, which causes artery vasoconstriction and hence disrupting renal
functions.
Mr. Michael is also at risk of digoxin toxicity. This happens due to the use of
spironolactone, which is a diuretic drug. Spironolactone results in low levels of
potassium in the body. The drugs act by eliminating excess fluids from the body and
hence resulting in loss of potassium. The combination of the medicines which Mr.
Michael is using could also cause digoxin toxicity since they lead to irregular heart