Coronary Artery Case Study: Analysis of Medications and Mechanisms

This report presents a comprehensive analysis of medications prescribed to James Murphy, a 57-year-old patient who underwent coronary artery bypass surgery and developed a graft wound infection. The assignment fulfills a case study brief requiring the student to analyze each medication's use, side effects, interactions, and nursing implications based on the provided medication chart. The report covers a range of medications, including Warfarin, Aspirin, Metoprolol, Metformin XR, Ramipril, Potassium Chloride, Pantoprazole, Atorvastatin, Oxycodone/Naloxone, Cefazolin, and Furosemide. Furthermore, the report delves into the detailed mechanisms of action for Aspirin and Furosemide, explaining how these drugs work to manage the patient's conditions. The analysis includes references to relevant research and clinical guidelines, providing a thorough understanding of the medications and their impact on patient care. The document adheres to the specified format and style, including a template for medication analysis and a separate section for the mechanism of action of selected drugs.

Running head: CORONARY ARTERY CASE STUDY 1
Coronary Artery Case Study
Student’s Name
University

CORONARY ARTERY CASE STUDY 2
Coronary Artery Case Study
Name: Warfarin
Use- This drug is coumarone anticoagulant, a long term prophylaxis drug used for atrial
fibrillation.
Side effects
Can lead to inappropriate bleeding which is manifested in bruising, haematuria, blood in stool
and joint pain.
Interactions
Diet rich in vitamin K foods and metformin can help reduce the anticoagulant effect. Interaction
with other drugs like aspirin, cefazolin, enoxaparin and magnesium pantoprazole can increase
bleeding (Adams, 2016).
Nursing implications
Individual daily dosage is to be determined by a qualified professional while testing through
urinalysis is done to determine the side effects (Broyles, 2017).
Name: Aspirin
Use:
Aspirin is used to inhibit platelets in the bloodstream to reduce clotting. It works faster when
chewed and reduces the blood concentrations b 50%
Side Effects:
Common side effects include upset stomach, heartburn drowsiness and mild headache. Severe
side effects include nausea, vomiting, rapid breathing, bloody stools, swelling and sometimes
pain lasting more than three days.
Interactions:

CORONARY ARTERY CASE STUDY 3
When interacted with warfarin and heparin it can increase the additive anticoagulant effect which
will increase bleeding. When used with ibuprofen it decreases the antiplatelet effect (Serhan &
Chiang, 2013). This drug also leads to increased risk of GI bleeding with alcohol,
glucocorticoids or NSAIDS.
Nursing Implications:
The patient needs to be assessed for signs of bleeding through checking the stool, bleeding gums,
petechial and ecchymosis. The drug needs to be discontinued if severe effects are witnessed by
the patient.
Name: Metriprolol
Use: used for blocking adrenergic receptors on the myocardium. The onset of the drug is within
fifteen minutes of taking (Lehne, 2010).
Side Effects:
Palpitation, cold extremities, intermittent claudication and heart failure. Slight effects include
heart burn, fatigue, dizziness, nausea, and headache.
Interactions:
Combination with calcium channel blockers can result in heart failure and hypertension. Use of
barbiturates and rifampin can inhibit the effects of metoprolol (Lehne, 2010).
Nursing Implications:
The need to monitor blood pressure and apical pulse before administration. Patients with
metoprolol IV boluses need to be put on a cardiac monitor.
Name: Metformin XR
Use:

CORONARY ARTERY CASE STUDY 4
This drug is a biguanide and is used to lower high blood glucose levels by improving body
sensitivity through reducing glucose produced in the body and the amount of glucose the
intestine absorbs thus reducing the intensity of heartbeat (Derosa, D’Angelo, Romano, &
Maffioli, 2017).
Side effects:
Long-term use can lead to heart disease, blindness, kidney damage, and poor circulation.
Interactions
The drug should not be taken by patients on metformin medication since it leads to allergic
reactions like shortness of breath, wheezing and swelling of the face. This drug also reacts with
most high blood pressure medications and diuretics (Derosa, D’Angelo, Romano, & Maffioli,
2017).
Nursing implications
Type 1and 2 diabetes patients should not take the drug since it can lead to accumulation ketone
bodies in blood. The nurse needs to ask the patient if he/she has kidney or liver problems.
Alcohol dependence, dehydration, pancreatis, thyroid problems and heart problems.
Name: Ramipril
Use
Used to treat high blood pressure through reducing the risk of a heart attack by working as an
angiotensin-converting enzyme (ACE) inhibitor. The drug relaxes the blood vessels in the body
thus reducing stress on the heart and lowering blood pressure (Thomsen, Rasmussen, & Linnet,
2014).
Side effects

CORONARY ARTERY CASE STUDY 5
Coughing, dizziness, chest pain, nausea, vomiting, diarrhea and weakness or tiredness. Serious
side effects include low blood pressure, hypersensitivity, liver problems and swelling.
Interactions
Ramipril interacts with potassium supplements, water pills, mood stabilizers by increasing the
lithium level in the body and gold products. Blood pressure drugs can also lower blood pressure
and affect the kidney function.
Nursing implications
The dosage is determined by the doctor based on the age, severity of the condition and other
medications. There is need to monitor the patient for the early symptoms to test how the patient
reacts with the first dose.
Name: Potassium chloride
Use
The drug is used to prevent or treat low blood vessels of potassium which arise from taking
certain medicines with prolonged illness (Preidt, 2019).
Side effects
Less serious effects include nausea, occasional diarrhoea and appearance of potassium chloride
tablets in stool. Severe effects include confusion, uneven heartbeat, muscle weakness, severe
stomach pain, coughing up blood.
Interactions
This drug is affected by other drugs like eplerenone, digoxin, quinidine, bronchodilators, ace
inhibitors and diuretic pills.
Nursing implications

CORONARY ARTERY CASE STUDY 6
A special diet is important in ensuring that the patient takes potassium rich foods. Regular testing
needs to be done to determine the effects of the drug to the body.
Name: Pantoprazole
Use
The drug works by decreasing the amount of acid the stomach makes thus relieving symptoms
like heartburn, difficulty swallowing and persistent cough (Lázaro, et al., 2017).
Side effects
Headache, diarrhoea, irregular heartbeat, seizures and signs of lupus.
Interactions
This drug interacts with methotrexate, it may also interfere with certain laboratory tests.
Nursing implications
The nurse/doctor needs to know the medications that the patient is using including non-
prescription drugs, vitamins and herbal supplements which affect how other medicines work and
at the same time how this drug works.
Name: Atorvastatin
Use
The medicine is prescribed to lower cholesterol to decrease the risk of heart disease thus
preventing stroke and heart attacks.
Interactions
The drug needs to be administered 2-4 hours before or after administering bile acid sequestrate.
Avoid co-administration of the drug with tipranavir plus, cyclosporine, and telaprevir which can
lead to increased risk of rhabdomyolysis (Correale, et al., 2013).
Side effects

CORONARY ARTERY CASE STUDY 7
Joint pain, insomnia, nausea, loss of appetite, indigestion symptoms and increased transaminases
Nurse implications
The medication is used along with proper diet to lower cholesterol and fats. The doctor needs to
now all the medications that the patient is taking to determine whether the drug needs to be
administered or not.
Oxycodone / naloxone
Use
Oxycodone is an opioid for moderate severe pain while naloxone is used as an opioid blocker for
preventing abuse or misuse of opioid medications.
Side effects
Constipation, excessive sweating, delirium, balance problems and cognitive impairment.
Interactions
This drug does not interact with buprenorphine and anaesthesia drugs since this can decrease its
effect. Other drugs like benzodiazepines, Monoamine oxidase inhibitors, Antidepressants,
Muscle relaxants, Hypnotics, Antipsychotic drugs and anticholinergic drugs can increase the side
effects of the drug (Tanaka, et al., 2018).
Nurse implications
The dosage depends on the age, the condition being treated, its severity, the medical conditions
of the patient and the reaction within the first dose. This means that the nurse needs to monitor
the patient after the first dose to determine any side effects of the drug. Caution needs to be taken
when stopping the dose and when switching to another opioid combination.
Name: Cefazolin
Use

CORONARY ARTERY CASE STUDY 8
This is an antibiotic used before and after surgery to prevent infections. Being a cephalosporin it
works by stopping the growth of bacteria.
Side Effects:
Common side effects are allergic reactions, confusion, diarrhoea, drowsiness, fainting, headache,
loss of appetite, nausea, low platelet count, seizure, stomach crumps and hives.
Interactions:
The drug has no severe interaction with other drugs but moderate interactions include
bazedoxifene/conjugated, dienogest, estradiol, ethinylestradiol (Andreas, et al., 2014).
Nursing Implications:
The nurse needs to consider the allergic reactions of the patient especially those that react to
cefazolin. The dose needs to be adjusted in severe renal insufficiency, super infections and
promotion of non-susceptible organisms may occur with prolonged use or repeated use
(Gonzalez-Estrada & Radojicic, 2015).
Name: furosemide
Use
The drug is used to reduce extra fluids in the body that arise from conditions like heart failure
and kidney diseases. This leads to lessening the symptoms like swelling and shortness of breath.
Being a water pill it increases urine passage thus helping the body to get rid of water and salt.
Side effects
Dizziness, headache, blurred vision and light-headedness. It also leads to dehydration, muscle
cramps, confusion, severe dizziness, fainting, nausea, unusual dry mouth and vomiting.
Interactions

CORONARY ARTERY CASE STUDY 9
This drug interacts with desmopressin, lithium and ethcrynic acid. Patients allergic to sulfa drugs
needs to be treated cautiously when using this drug. The doctor needs to examine the patient in
case of changing exercise routine, quitting smoking, reducing stress and even changing the diet
which will all interfere with the dosage.
Nurse implications
Periodic tests on the kidneys and blood minerals are essential in monitoring the drug and
checking the side effects. This drug also affects some lab tests like diabetes and thus the need to
adjust the lifestyle of the patient based on the condition (Bayat, Faritous, Aghdaei, & Dabbagh,
2015). A complete medical history of the patient is essential in deciding the right drug.
Aspirin mechanism of action
Most heart attacks that people experience arise as a result of blocked or reduced blood
supply to the heart. In most cases, this is a result of atherosclerosis which forms a plaque in the
arteries. These plaques reduce blood flow and can even lead to damage which leads to heart
attacks or stroke (Bavry, Gong, Handberg, Cooper-DeHoff, & Pepine, 2015). This means that
people with this condition need to take medications that reducing clotting of blood thus
increasing blood flow and reducing the formation of platelets. This is the reason why aspirin has
been widely used as an anti-inflammatory drug.
Aspirin is a common pain reliever and an anti-inflammatory drug that is used to make the
blood thinner. The drug prevents blood clots by interfering with the clotting action. Mekaj, Daci,
& Mekaj (2015) states that the role of platelets in the body is to form plugs as a result of many
factors. People with coronary arteries have blood clots within their arteries which prevent the
circulation of blood. This leads to the narrowing of blood vessels due to atherosclerosis which
can burst and thus lead to clotting that reduces blood flow. This leads to a heart attack due to the

CORONARY ARTERY CASE STUDY 10
clumping of the platelets. Aspirin works by inhibiting the activation of platelets and aggregation
thus preventing the synthesis of prostaglandins. This process plays an important role in the onset
of acute occlusive vascular events (Dai & Ge, 2012). This means that the drug blocks the
formation of cyclooxygenase-dependent vasoconstrictors leading to endothelial dysfunction
which increases vasodilation and inhibits the progression of atherosclerosis. Aspirin also eases
inflammation through blocking cyclooxygenase thus reducing the ability of the body to produce
chemicals that cause inflammation.
Mancia, et al. (2013) adds that aspirin has also been regarded as the best drug for
preventing death especially for people with heart diseases. This drug is good for people with
coronary artery disease since it hardens the arteries thus reducing the effects of the disease which
also reduces the damaging of the heart. When taken regularly it reduces the risk of heart disease
since it controls blood flow which reduces the risk of attacks. This is the reason why aspirin
therapy has been recommended for people with heart problems. Aspirin therapy has been widely
advised for patients based on the clinical indications that exist. This drug is important to Murphy
since it reduces inflammation thus reducing the risk of a heart attack.
Furosemide mechanism of action
Furosemide is a diuretic drug that is used in coronary and heart failure patients. Patients
with heart-related conditions require medications that reduce the functioning of the heart so that
the symptoms of the condition can be reduced. This means that it is important for the patient to
reduce the level of fluids in the body so that the heart can have little pressure in pumping blood
and keep the body (Shah, Anjum, & Littler, 2017). Furosemides or water pills are used to help
the kidney to get rid of unneeded water and salt in the body thus reducing the pressure of the
heart to pump. This drug is used as a first-line treatment for mild-moderate hypertension and at

CORONARY ARTERY CASE STUDY 11
the same time managing the symptoms of heart failure. Since blood pressure leads to other
complications like swelling and water build can increase the risk of heart disease and lead to
difficulties breathing. According to Schartum-Hansen, et al. (2015) suggests that fluid retention
is a challenge in all acute heart failure patients manifested in pulmonary and peripheral edema
leading to impairment of the transportation of oxygen, nutrients and even wastes which can lead
to organ failure
Being a loop diuretic, this drug inhibits the luminal NA-K-CI co-transporter by binding to
the chloride transport channel which causes sodium chloride loss in urine. This means that the
drug abolished the corticomedullary osmotic gradient and blocks negative and also free water
clearance. This action increases diuresis to reduce edema. When the fluids are excreted in the
body, the blood flow is reduced making it easy for the heart to pump faster when the fluids in the
body are excreted through urine (Miles, et al., 2019). Patients with heart-related problems benefit
from this drug making it easy for them to manage hypertension through the increased urine
output in the kidney. When water is removed from renal tubes and urine output is increased and
also inhibits water reabsorption by blocking sodium-potassium-chloride cotransporter (NKCC2).
This drug is important to the case of Murphy since it reduces other complications of the coronary
artery disease of the patient. By increasing urine excretion, the patient avoids edema and at the
same time reduces the pressure of the heart making it easy for the patient to manage the
condition.

CORONARY ARTERY CASE STUDY 12
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CORONARY ARTERY CASE STUDY 13
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