Answers of Health Care 2022

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

1HEALTH CARE
Answer 1
Two significant risk associated Ms. Tong’s medication:
Ms. Candice Tong, a 56 year old female who was admitted to hospital with symptoms of
upper abdominal pain, nausea and vomiting. She has been found to have two peptic ulcers due to
infection with Helicobacter pylori bacteria. To promote healing of her peptic ulcer, she has been
prescribed warfarin, clarithromycin, esomeprazole and amoxicillin. Apart from warfarin, the
other three medications need to be taken twice daily each month.. The medicines that she had
been taking before hospital admission include ramipril, felodipine, atorvastatin and citalopram.
On assessing the medication chart and assessing the side-effects, drug-drug interaction of each
drug, the following two risks have been identified for Ms. Tong:
 All the three drugs clarithromycin, esomeprazole and amoxicillin have been given to Ms.
Tong for treatment of bacterial infection and peptic ulcer and preventing symptom of
abdominal pain and vomiting. However, there is risk for Ms. Tong in taking citalopram
and esomeprazole together. This is because taking these two drugs together can increase
the concentration of citalopram in the blood and this could lead to serious side effects
such as irregular heart rhythm which can turn out to life threatening for the patient too.
The main reason behind this is that both the drugs has been metabolised by cytochrome
P450 (CYP)2C19. Co-administration often results in 50% increase in plasma levels of
citalopram. Bot the drugs individually also have the side effects of causing hyponatremia
and risk of this side-effect can also increase (Tsuchimine et al., 2018). Esomeprazole is a
proton pump inhibitor (PPIs) and Gjestad et al. (2015) supports that PPIs often inhibit
selective serotonic reuptake inhibitors like citalopram.

2HEALTH CARE
 Another risk identified through medication chart includes interaction between
atorvastatin and the two drugs namely clarithromycin and esomeprazole. Clarithromycin
has been prescribed to patient to treat bacterial infection and to treat stomach ulcer caused
by Helicobacter pylori. In addition, Ms. Tong has been taking atorvastatin to maintain
and reduce cholesterol level in blood because of history of hyperlipidemia. However,
serious interaction between atorvastatin and clarithromycin is a risk factor that can affect
health outcome of patient. The risk associated with use of atorvastatin and clarithromycin
together is that it can cause harmful effects because of increase in blood level of
atorvastatin and impact of toxicity on patient. This can lead to serious side effects such as
liver damage (Olmos-Martínez et al., 2019). In addition, atorvastatin has interaction with
proton pump inhibitor (PPI) esomeprazole. Barkas et al. (2015) explains that PPI
significantly interfere with cholesterol mechanism. Therefore, there is a high likelihood
that PPI drug will interact with atorvastatin because as both drugs are metabolized by
same P450 cytochromes. This again can increase toxic effects or dose related adverse
effect on patients.
Answer 2
To reduce the risk of increase in plasma concentration of citalopram due to interaction
between citalopram and esomeprazole and decrease the possibility of irregular heart rhythm, it is
necessary to consider the dose of the two drugs. To minimize inhibitory effects of PPI on SSRIs,
the key action that can be taken is decrease the dose of the drugs by 50%. This action is
necessary to enhance the pharmacokinetic effects of both the drugs and minimize inhibitory
effects of PPI on drugs like citalopram. In case dose adjustment is not possible, then it will be
extremely critical for the doctors to regularly monitor patients regarding changes in vital signs.