Nursing Question Answer 2022

Running head: CASE STUDY: NURSING
CASE STUDY: NURSING
Name of Student:
Name of University:
Author’s Note:

CASE STUDY: NURSING
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Answer number 1.
The significant risk that is linked with the medication for Mr Tong:
The patient, MS Canadice Tong, is of 56 years old who was admitted to the hospital for
complaint of upper abdominal pain, vomiting and nausea. On assessment, she was diagnosed
with the peptic ulcer, which was infected by the Helicobacter pylori bacteria. As the mean of
treatment, she was given pharmacology intervention and prescribed medicine was Citalopram for
the depression, Atorvastatin for high cholesterol, Ramipril and Felodipine for high blood
pressure. Further, for treating ulcer, she was advised with clarithromycin, and esomeprazole and
amoxicillin medicine. From the review of the medication chart, and evaluating the side effect of
the drugs given, drug-drug interaction was noticed which is the primary reason for the side
effects, the two main risk that has been recognized for Ms Tong are as follow:
1. It is evident from the medication chart that Citalopram, Atorvastatin, Ramipril and
Felodipine are needed to be taken daily where they may interact with the antibiotic,
halting their action. For the treatment of ulcer the antibiotic amoxicillin, and
esomeprazole is prescribed, which have a negative impact on the patient because she is
also taking Ramipril. Atorvastatin is HMG CoA reductase inhibitors, which is interrupted
in its action by antibiotic along with the action of Ramipril (Nayan et al., 2017). It is
evident from the study of Surichan et al. (2018) that Atorvastatin action is altered by
inhibiting the activity of the cytochrome P450 due to which it loses its function of
clotting blood. It is also evident from the study of Psaty and Cooper (2018) that drugs for
hypertension and anticoagulant medicine along with antibiotic may cause harmful
consequence to the patient. As an impact of such, Ms Tong may have internal bleeding

CASE STUDY: NURSING
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which Ramipril drugs can worsen, and there is the risk of myocardial complications too.
Hence, the interaction of such a drug can slow the healing process of the peptic ulcer and
even give rise to kidney complications.
2. Another risk that Ms Tong may face can be viewed by the interaction of Felodipine with
clarithromycin and esomeprazole. The patient is taking Felodipine for high blood
pressure issue, and clarithromycin was prescribed to lower the bacterial infection. As the
patient is having low blood pressure, therefore by consuming feleodipine and ramipril,
Patient can have adverse effect on the health. It can slow the blood circulation and may
cause respiratory depression and cardiovascular complication. It is also evident from the
study of Sarkeshikian et al. (2019) that drugs for high blood pressure often interact with
the antibacterial drug in their mechanism of action. The antibacterial drug work by
transporting hydrogen ion via proton pump (PP) and kills the bacteria by creating an
imbalanced gradient. The Felodipine is known to interrupt the action by blocking calcium
channel due to which the concentration of hydrogen and calcium ion increase in the
blood, which gives rise to reactive oxygen and causes toxicity. The primary reason for
such consequence can be visualized by reviewing the study Zhang (2015) where it is
described that P450 Cytochrome metabolizes these three drugs. Thus, the patient is a
considerable risk of toxicity, which can impair the function of the liver.
Answer number 2.
In order to prevent and manage the potential risk of drug interaction, initially, the nurse
needs to assess the dose and time period until which the drug is required to be taken by the
patient. The interaction of antibiotic and Ramipril leads to internal bleedings, and the nurse can
consult with a physician to prescribe low-risk profile antibiotic such as cephalexin (Kim &