Concerns About Drug Regimen
Polypharmacy and Potential Drug Interactions:
What concerns me a lot is Aubre R.’s drug plan, which is Polypharmacy and Potential Drug Interactions. Overall, seven medications prescribed have an increased probability of negative consequences, less efficacy, and drug-drug interactions. For instance, it is very alarming that people who are using these agents are taking them together, such as alprazolam, zolpidem, and hydrocodone. The synergistic effect of these agents, with possible growth of depressive symptoms, cognitive impairment, and sleepiness, may cause dangerous adverse effects in an elderly patient like Aubre R. Moreover, metoclopramide and amitriptyline may cause serotonin syndrome, a life-threatening condition characterized by confusion, agitation, hyperthermia, and autonomic instability (Sheikh-Taha & Asmar, 2021). The clinical use of bethanechol in combination with dicyclomine may entail pharmacodynamic antagonism that may exacerbate Aubre R.’s symptoms of irritable bowel syndrome (IBS) and create problems regarding treatment effectiveness.
Adverse Effects and Inadequate Symptom Management
My second concern about Aubre R.’s medicinal plan is that the side effects may be intense, and the symptoms may not be well managed. Such side effects of bethanechol, metoclopramide, and dicyclomine, such as gastrointestinal disorders, drug interaction, hypertension, and tachycardia, may put Aubre R. at risk of deterioration in her existing condition or add new complications. The possible side effects of bethanechol, an agent prescribed for urinary retention, include gastrointestinal disturbances, which, in some cases, may cause cramping and diarrhea and further aggravate the symptoms of IBS (Goriacko & Veltri, 2021). Much like metoclopramide, a drug for gastric motility, it can cause extrapyramidal symptoms like dystonia, tardive dyskinesia, and parkinsonism in older people, in particular. These adverse effects not only have a negative impact on Aubre R’s health but also reveal possible insufficiencies in controlling her unmanaged symptoms.
Lack of Holistic Approach and Alternative Treatment Options
My last concern about the drug regimen of Aubre R. is due to the fact that it reveals a lack of account, holistic options, and alternative treatment. However, a holistic approach, which involves not only pharmacological treatment but also lifestyle modification, dietary changes, and psychological interventions, may be needed more, especially if there is a background of domestic violence, anxiety disorder, and insomnia, as in Aubre R.’s case. Combining psychotherapy like cognitive-behavioral therapy, mindful practices, and physical exercise could, alongside pharmacological treatment, create a customized and efficacious treatment plan for Aubre R. Furthermore, searching for different drugs with fewer side effects and drug interactions, including SSRIs or non-opioids painkillers, may give Aubre R. more high-quality treatments while reducing the negative effects of what she is currently using.
Recommendations for the Patient
To provide Aubre R. with adequate healthcare, I will develop a strategy, and this strategy will focus on improving her medication plan, addressing her medical problems, and enhancing her overall well-being. As a first step, I propose doing all medication review steps as this will be the answer to decrease the negative effects of polypharmacy and reduce drug numbers. Hence, it covers getting rid of ineffective and harmful medications observed among the elderly, like benzodiazepines such as alprazolam. Benzodiazepines often induce dependence and cognitive dysfunction (Ettcheto et al., 2020). Rather than advocate for the prescription of pharmacological in the fight against productivity and insomnia, I propose the establishment of non-pharmacological techniques that can be effective in encouraging better sleeping habits and mental wellness.
Upon reviewing other treatments that can be solely manufactured to cater to Aubre R.’s unique needs and medical condition, I propose another approach. For IBS symptoms, dietary modifications such as a low-FODMAP diet and probiotics work. A low-FODMAP diet and probiotics help alleviate gastrointestinal problems and allow normal bowel movements (Bellini et al., 2020). In addition, I would recommend the additional treatment of some other medications that have beneficial side effect profiles than TCA, such as nortriptyline or SSRIs in certain neuralgic pain and anxiety conditions.
References
Bellini, M., Tonarelli, S., Nagy, A. G., Pancetti, A., Costa, F., Ricchiuti, A., … & Rossi, A. (2020). Low FODMAP diet: evidence, doubts, and hopes. Nutrients, 12(1), 148.
Ettcheto, M., Olloquequi, J., Sanchez-Lopez, E., Busquets, O., Cano, A., Manzine, P. R., … & Camins, A. (2020). Benzodiazepines and related drugs as a risk factor in Alzheimer’s disease dementia. Frontiers in aging neuroscience, 11, 344.
Goriacko, P., & Veltri, K. T. (2021). Adverse Drug Effects Involving the Gastrointestinal System (Pharmacist Perspective). Geriatric Gastroenterology, 297-339.
Sheikh-Taha, M., & Asmar, M. (2021). Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States. BMC geriatrics, pp. 21, 1–6.
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