Quality Use of Medicines Answer Question 2022

Running head: QUALITY USE OF MEDICINES
QUALITY USE OF MEDICINES
Name of the Student
Name of the University
Author’s Note:

1QUALITY USE OF MEDICINES
Answer to Question Number 1:
In this scenario, two issues related to the quality use of medicines have been identified
and they are 'Hypotension' and 'Contraindication’. Hence, these two issues will be discussed
in the following sections.
Hypotension:
One of the significant risks for Ms Tong is Hypotension. Ms Tong is taking
'Clarithromycin', 'Ramipril', 'Felodipine', and 'Atorvastatin'. All of these drugs have a side
effect of hypotension. Ms Tong had a history of hypertension, and at present, her blood
pressure (BP) is 100/60 and therefore, administration of multiple anti-hypertensive medicines
poses a significant risk of hypotension. Investigators have discovered Clarithromycin to be
related to the increasing danger of hypotension or shock (Henneman & Thornby, 2012).
Additionally, ‘Ramipril’, and 'Felodipine' also increase the risk of hypotension. Statins are
both less systolic and more diastolic and have an impact on pre-hypertension patients, normal
blood pressure, and people not reducing BP (You et al., 2017). Some tiny trials have explored
the anti-hypertensive impacts of statins on BP in patients, which indicate comparatively tiny
but clinically significant decelerating impacts. In a meta-analysis of Briasoulis et al. (2013)
proposed the decrease in systolic BP in patients receiving statins to be minor but statistically
important.
Adverse drug reaction or Contraindication:
Contraindication is referred to as a particular situation in which a procedure, surgery,
or drug should not be used because of the adverse health reaction it presents (Fugate &
Rabinstein, 2015). Contraindication can be divided in to two subcategory which are relative
and absolute Contraindication. Relative Contraindication is the situation when caution should
be taken while prescribing or administering two or more drugs. On the other hand, absolute

2QUALITY USE OF MEDICINES
Contraindication can be referring to the case when a substance or event has a life-threatening
implication (Fugate & Rabinstein, 2015). Ms Tong has a significant risk of suffering from
relative Contraindication. Ms Tong has been prescribed with both 'Clarithromycin' and
'Atorvastatin'. Studies have reported that the co-administration of Clarithromycin with statins
(HMG-CoA reductase inhibitors) (Hirota & Ieiri, 2015) have the adverse side effects of
muscle disease like myopathy and muscle tissue destruction (Li et al., 2015). Thus, Ms Tong
has a significant risk of relative Contraindication.
In addition to this, Ms Tong was also prescribed with 'Esomeprazole'. It has been
reported that certain drugs raise the side effects of the esomeprazole. Clarithromycin is one of
those drugs and it raises the side effects of esomeprazole (Eljaaly, Alshehri, Bhattacharjee,
Al-Tawfiq, & Patanwala, 2019). In this case, Ms Tong also might suffer from the case study
of relative Contraindication.
Answer to Question Number 2:
Strategies for the prevention of 'Hypotension’:
 Evaluate the ABCDE strategy for patients. Monitor essential signs, full EWS charts in
accordance with local procedures and make sure that senior assistance is called if
necessary. The frequency of EWS findings should be modified according to local
protocols for each patient (Ren et al., 2017).
 Regular monitoring of vital signs of the patient’s average blood pressure level. It
should be greater than 100 mm Hg of systolic blood pressure (Thomopoulos, Parati &
Zanchetti, 2017).

3QUALITY USE OF MEDICINES
 Make sure the patient is clear and able to breathe; use a mask with a non – rebreathing
bag and elevated flow of oxygen at high concentrations of oxygen (Figueroa, Basford
& Low, 2010).
 Take care of the patients by raising their legs by tilting their bed may be useful to
boost cerebral perfusion (de la Torre, 2016).
 Ms Tong will be advised to partake in daily physical activity or exercise to increase
her BP. She will also be advised to change her position slowly at home as she might
feel dizzy while standing up quickly from sitting position. She will also be advised
drinking an adequate amount of liquid in the morning before a meal as it will help to
raise her BP (Ricci, De Caterina & Fedorowski, 2015).
Strategies for the prevention of 'Contraindication':
Many adverse drug reactions do not endanger life but interfere with everyday life, e.g.
back pain or joint pain. Instead of retaining data, it is suggested that patients are frequently
monitored using structured profiles by their nurses for any possible adverse drug reactions.
Then suitable professionals can address the problems identified (O’connor et al., 2016).
Nurses should always assure that institutional policies relating to the transcription of
medicinal drugs are followed. Transcription of medication as prescribed is not sufficient, but
the right dosage, right pathway, and time to the right medicines are prescribed for the proper
patient. Institutions must have medication reconciliation processes in place when a patient is
transferred from one organization to another or from one unit to another in the same
organization (Saw et al., 2016). The nurse should check each medicine for the right patient;
right drugs; proper dosages; right routes; and the right time as mention in prescription. The
health care providers should compare it to the Medication Administration Record (MAR). It
involves the correct labelling of medicinal products, readable documents or the accurate
recording of medicines. Any medicines not properly documented can lead to a mistake.