This paper addresses a pharmacological management plan for Mr. NX, including consideration of possible contraindications to CAMs, prescriptive and non-prescriptive recommendations for treatment of acute pain, and other ongoing disease processes followed by evaluation strategies.
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Pharmacological Management Plan
CAMs Contraindicated with Current Prescriptions
There is a contraindication to take Creatine together with Lisinopril. If patient takes these two drugs together, a risk to suffer from nephrotoxicity for him/her increases (Epocrates, 2015a). As the case presents, Kava Kava can cause elevated levels of HDL, reduced platelet count, hypertension, as well as, severe hepatitis. Consequently, it would not be advisable for a patient to use Kava Kava supplements continuously. Therefore, the medicine contraindicates to take the latter with Lisinopril since such combination could result in liver damage due to the chemicals. Additionally, there is a contraindication to combine Coenzyme Q-10 with Coumadin. This is due to the potential effect of reduced effectiveness of the drug, and it can result in the pro-coagulation impact as well (Epocrates, 2015b). Additionally, when taken with Coumadin, garlic is also contraindicated. The combination of these two products could lead to an increase in bleeding. Coumadin is a blood-thinning medication, and its combination with garlic can prove to be dangerous for a patient, and thus a patient should not take them unless under a close supervision of a doctor (Epocrates, 2015b).
CAMs Contraindicated with Diagnoses
For any patient who has a history of DVT there is contraindication with Coenzyme Q-10. Therefore, such a case poses a risk of an increase in the coagulation effect. Consequently, the patient in the case has a history of recurrent DVT, and as such, there is contraindication since he also takes garlic in order to lower the pressure of his blood. Furthermore, for a patient who suffers from diabetes there is also contraindication for combination with garlic resulting in the extended bleeding, as well as, lowering of the blood sugar. It has an effect on sugar levels in the blood, as well as, clotting, which could have dire effects on an individual.
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Prescription for Back Pain
The case indicates that Mr. NX has had back pains for the past decade, and factors contributing to the pain have been unknown. As a result, he has probably taken various over the counter medicines with the aim of reducing or alleviating the pain. Notably, one of the factors that could lead to the back pains is the inflammation of the liver. Additionally, Kava Kava does interfere with the Lisinopril as its metabolism occurs in the liver. It would be advisable for the patient to explore other supplements, which represent an alternative to Kava Kava. There is a recommendation for the patient to take first line prescription drugs to replace Kava Kava. As advised by Wynne & LaPorte (2012), the patient can take Acetaminophen 1000mg for the pain every 6 hours, but keeping the daily dose maximum 4000mg. Acetaminophen is ideal for Mr. NX since it does not have an anti-inflammatory impact, and it does work properly as a pain reliever as it works mainly in the brain by switching off the pain perceptions. The medication is also ideal because it does not cause heart problems or stomach upset like most of the other over the counter pain relievers. It is important for the patient to take the medication according to the prescription because in case of incorrect dose, it can be harmful causing liver damage.
Whenever an individual is suffering from chronic pain, he/she should consider a multidisciplinary approach as a remedy. As Wynne & LaPorte (2012) state, it is an approach that should involve a change in the patient’s lifestyle in order to manage the symptoms and consequently relieve the pain. The patient gets a recommendation to continue with his/her exercise routine so that he/she can improve the strength of the muscles, which can assist in the reduction of some of the back pain.
Changes in Prescribed Drugs
After analyzing the case study, it would be ideal to encourage Mr. NX to take a break on the CAM therapies and to continue with the prescription drugs. In addition, he should stop taking Coumadin and start Xarelto therapy. He should take 20 mg of Xarelto by mouth per day for thirty days. Generic medications can be a treatment, but there should not be any refills. It is a change that would be ideal for the customer because the medication does reduce the risk of the recurrence of DVT, which has been affecting Mr. NX for a while (RxList, 2015). As shown in the case, that the patient is suffering from recurrent DVT, it means that Coumadin has not been effective. In order to control the high blood pressure, taking ACE Inhibitors in low doses is an ideal approach. When taken in low doses, the effects on the lipid profiles, functions of the kidneys, and the metabolism of glucose is lower. The ACE Inhibitors are ideal since they have demonstrated to have a reduction effect on the risk of diabetic neuropathy (Wynne & LaPorte, 2012). Mr. NX should also stops taking Kava Kava, creatine, and the garlic supplements until further analysis to ensure that they are safe for him and do not contraindicate. Another recommendation for the patient also is to undergo further evaluations in order to identify the reason why the patient is suffering from anxiety. After such analysis, a doctor should prescribe proper medication with consideration of the other ailments and medications that the patient is taking.
There should be a follow up in 30 days in order to evaluate whether Xalerto is effective or not. When dealing with chronic pain, the goal is usually to get into a mutual agreement for the reduction of the pain, as well as, the improvement of the activities of daily living of the patient. The period of 30 days is ideal and sufficient for Mr. NX to come up with a routine that is agreeable to the doctor’s plan, and the one that will enhance his recovery. If the patient follows the original plan and this is the case during the assessment after 30 days, a doctor should give additional prescriptions, and another follow up should take place after 60 days. It will be important in order to keep checking the management of the pain. However, if any problems arise prior to the date of the next monitoring, the patient should be aware on how to raise concerns, and he/she should do this as soon as any problem arises.
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Strategies for Evaluating Side/Adverse Effects
It is worth noting that there could be adverse effects resulting from the medications that the patient takes per prescription. Therefore, there should be strategies aimed at evaluation of the adverse effects and based on both the objective and subjective data collected from the patient. It is necessary to take various samples for the lab analysis and these include blood glucose levels, Chem 8, CBC, as well as, HgbA1C. However, HgbA1C should take place only if it has not been done within the six months preceding the evaluation. In addition, it is crucial to analyze the cholesterol levels PT/PTT and the functions of the liver and kidneys as well (Fischbach & Dunning, 2015). The evaluation should also emphasize on the back pain that Mr. NX has been experiencing, and if the patient indicates that the pain has been reducing, the current medication plan should continue. Additionally, there should be another follow up after four months. However, if the patient indicates that there are no improvements in the back pain, it is important to order an x-ray of the patient’s back. In addition, the chronic pain management algorithm should prevail in order to assist the patient to reduce the pain levels that he/she experiences. Additionally, there should also be an evaluation of the progress in lifestyle modifications. It is necessary to educate the patient how he/she can maintain daily records on the levels of blood glucose, pressure, and pain scale per day. As they make their visits to the doctor, the latter should look them through, as they are critical in understanding the progress.
Strategies for Evaluating Effectiveness
In order to assess the effectiveness, the same strategies as those used in the evaluation of the adverse effects should be applied. However, there should be an emphasis on the subjective report of the patient and the records that he/she keeps for daily tests. It is also of high importance to take all the lab tests and properly assess the results. This will indicate whether the approach used has been effective.