Medication History: Name: Katie VanderVelde Why: To gain a better understanding of the different types of medication and what

they are used for. Also to know more about drug interactions, and the pharmakinetics associated with the drug. Not to mention, recognize how the patients health history and beliefs play a part in the administration of certain drugs. In the end, I should be able to implement policies and procedures that reduce medication errors and incidents. Where: At grandmothers house Who: P.G. How: Introduction: I started the meeting by explaining why I am conducting the drug history. I let P.G. know that the information given will not be used for any other purposes than just gaining a better understanding of how drugs work. In addition, I explained that the drug history is for a school project, and an assessment, health history, and questions will be obtained. I asked her permission to conduct the history, and she agreed. Past medical history: As a child P.G. had the whooping cough, rheumatic fever, and measles. She experienced rheumatic fever three times over the course of her childhood. Twice around 10 and the other her senior year of high school, which was the most severe. She had numerous amounts of surgeries, which include open heart surgery, kidney transplant, cataract surgery, tonsils removed, and hemorrhoid surgery. P.G. also has diabetes type one, peripheral vascular disease, hyperlipidemia, hypertension, and hyperthyroidism (personal communication, June 28, 2013) Medications: -NovoLOG 70/30 31 units at 0700 and 25 units at 1700. Patient knows drug is for diabetes and to control blood sugar. Patient has taken drug for years, approximately 40 years (P.G, personal communication, June 28, 2013). NovoLOG has rapid action and is taken by injection. It is metabolized my liver, spleen, kidney, and muscle. Halflife is approximately 60-90 minutes and has a peak around 1-2 hours. ACE inhibitors, oral hypoglycemic agents, and salicylates may decrease insulin requirements (Deglin & Vallerand, 2010). -Coumadin at 1900 5mg/day. Patient understands medication is for a blood thinner. She has taken the medication for years, estimated 15 years (P.G, personal communication, June 28, 2013). The drug is well absorbed from the GI tract after oral administration. It crosses the placenta but does not enter breast milk and has 99 percent protein binding. Coumadin is also metabolized by the liver and has a half-life of 42 hours. At a constant dose its peak is 5-7 days and onset of 36-72 hours. Chronic use of acetaminophen may increase the risk of bleeding, and chronic use of alcohol may decrease the action. Also large amounts of vitamin K may reduce the effect of Coumadin (Deglin & Vallerand, 2010). -Toprol-XL twice a day at 0700 and 1700 at a dose of 25mg. Patient understands drug is used to regulate heartbeat. P.G. has taken the drug for about 10 years (P.G., personal communication, June 28, 2013). Toprol is well absorbed after oral administration. It crosses the blood-brain barrier, placenta, and small amounts enter the breasts. It is mostly metabolized by the liver and has a half-life of 3-7 hours. It has a high risk for bradycardia when used with digoxin. It may alter the effectiveness of insulin (Deglin & Vallerand, 2010). -CellCept twice a day at 0900 and 2100. Each dose is 500mg. Patient understands drug as a rejection drug for the kidney. Medication has been used for the past 8 years (P.G., personal communication, June 28, 2013). Following oral administration CellCept is rapidly hydrolyzed and afterwards extremely metabolized. Half-life occurs around 8-18 hours and peaks at 0.25-1.25 hours. CellCept may decrease the antibody response and increase the risk for adverse reactions from the live-virus vaccines; influenza vaccine may be useful. When administered with Age: 74 Gender: Female * Patient is capable of participating

food peak blood levels are significantly low. It should be administered on an empty stomach (Deglin & Vallerand, 2010). -PredniSONE taken at 0700 5mg/day. Patient understands drug as a hormone that helps with kidney rejection, and has been used for the past 8 years (P.G., personal communication, June 28, 2013). It is well absorbed after oral administration and widely distributed. Drug is converted by the liver to prednisolone, which is then metabolized by the liver. Onset can lasts for hours and the peak is unknown, but the drug lasts 1.25-1.5 days. PredniSONE may increase the requirements for insulin or oral hypoglycemic agents, and a risk for adverse GI effects with aspirin. At chronic doses that suppress adrenal function PredniSONE may decrease antibody response and increase the risk of adverse reactions from live virus vaccines (Deglin & Vallerand, 2010). -Benicar is given at 0700 20mg/day. Patient understands drug to help reduce high blood pressure. Patient has taken medication for about 10 years (P.G., personal communication, June 28, 2013). The drug is a pro-drug that is converted to olmesartan and does cross the placenta. Half of the drug is excreted unchanged in the urine and the remainder eliminated in the feces. Half-life is 13 hours and has a peak around two weeks with onset within one week. Hypotension could be related to other antihypertensives, and a higher risk of hyperkalemia with concurrent use of potassium. Higher levels of lithium and possible toxicity may occur (Deglin & Vallerand, 2010). -Synthroid at 0700 0.88mg/day. Patient understands drug is used to help with hyperthyroidism. Patient has been taken medication for the past 5 years (P.G., personal communication, June 28, 2013). Synthroid is absorbed mostly from the GI tract, and distributed into most body tissues. The drug is metabolized by the liver and other tissues to activate T3, which is then excreted in the feces. Half-life is 6-7 days and a peak at 1-3 weeks. Synthroid may increase the effects of warfarin and requirement for insulin or oral hypoglycemic agents in diabetics. It also could increase the cardiovascular effects with adrenergic (Deglin & Vallerand, 2010). Concerns or barriers: Have you had problems that can be attributed to the medications? Yes, I have had a few problems in the past with the medications. I have had to have the Benicar cut in two, because it was too much at one time and caused my BP to go too low. It also caused my heartbeat to go extremely high. I used to take 125 mg per day, but now I take 25 twice a day. Now with the dose I am taking the heart is right at pace (P.G., personal communication, June 28, 2013). Are you able to safely take medications as prescribed? Yes, I have been taking most of the medication for years and have a pill box for each day of the week. I make sure to organize the drugs in the beginning of the week and take the correct drugs and dose for each day of the week. I also have no problem with swallowing the drugs with liquid. However, there has been a few times when I have forgotten my medication when going to my daughters house. When this happened I would remember to take it right when I got home. Of course it was not at the right time, but at least I still took it on the same day. I also adjust my insulin according to how low or high my blood sugar is. If it is too high I take 31 units in the morning, and if it is too low I take 25 units. I take 25 at night no matter what my blood sugar is. I also write a sugar log for each month and send it to the doctor to make sure I have the correct amount of insulin to take (P.G., personal communication, June 28, 2013). What information or instructions were you given when the medications were first prescribed? When I first got the insulin I did not know much about it. However the doctor made me demonstrates how to draw and give insulin after practicing on a grapefruit. The doctor has my blood drawn every month for coumadin in case I need to change anything. For the tropol XL I had to go to the heart doctor and have tests, because at first I was taken too much. Cellcept I have to take one in the morning and one at night for the rest of my life. For cellcept I have blood test once a month and have to take one in the morning and night for the rest of my life. Prednisone I also have to take once a day for the rest of my life so it does not reject my kidney. The doctor said this medication makes me gain weight, which it has in the gut. At first I was instructed to take a whole benicar, but the doctor made me cut it in half. The doctor told me to take synthroid, because my thyroid was really weak

and was not functioning. I had a thyroid test and was prescribed a high dose of synthroid. Since then the medication has been lowered and no side effects have been present (P.G., personal communication, June 28, 2013). Do you think the medications are doing what they were prescribed to do? Yes, I have more energy and I sleep better. The heart medication makes my heart beat better so I can rest better. If my heart is fluttering I cant relax as well. My thyroid made me weak and tired. The thyroid medication has given me energy so I am not weak and feel like I can accomplish more (P.G., personal communication, June 28, 2013). Does anyone else help take your medications? No, I take all my medications on my own. I also organize them in the beginning of the week on my own. I do not need help taking my medications and am able to take care of myself. A nurse does not come to my home or any type of assistance (P.G., personal communication, June 28, 2013). According to Gordons Functional Health Patterns P.G. is accurately following the right steps to a healthy lifestyle. Relating to perception and health management my client adheres to preventive health practices. If she was concerned with her medication she would let the doctor know, and perhaps change the dosage of the drug. P.G. also follows her daily requirements of medication. However, her cognitive-perceptual patterns may be declining. There have been a few times when she has forgotten to bring her medication when she visits her daughter. She remembers to take it when she gets home, but it is still of concern. She also has cataract surgery and still has problems with vision. However, she can still drive and is able to see for the most part. As of her sleep and rest, with the re-adjustment to her toprol-XL she has slept better at night. Not to mention, her thyroid medications has helped her feel more energized. In addition her role and relationship in her current life situation is on track. Her responsibility as of now is making sure she takes her medication and takes care of herself. She makes sure to take her medication at the right dose and time and has a pill box to help organize the pills. Also, her coping and stress tolerance is on the right track according to Gordons functional health patterns. She does not need much family help with taking care of herself. P.G. organizes her pills on her own and does not have a nurse or caregiver help her. She copes with her problems well and asks the doctor if she has a concern with the medication. Her values and beliefs are more on the naturalistic side. She does not take any medication to help her with sleep nor with anxiety. Growing up she was influenced by her parents to follow every aspect of the Holy Gospel. She believes that God will take care of her and medication should not be used to solve psychological problems. The only medication she uses in for physical concerns. Overall P.G. is functioning and taking care of herself very well. She only has a few physical barriers, but cognitively for the most part on track (Taylor, Lillis, Lemone, & Pamela, 2011). I told P.G. to continue organizing her medication and taking it at the correct time. I also encouraged her to call a health professional if she has any questions or concerns.

Reflection: Overall taking a drug history of P.G. was very informational and interesting. Many of the questions asked about the problems with some of the medications helped me understand how certain drugs work. If I knew more about the medication I would have asked if there were any problems in the past with synthroid and PredsiSONE. After looking these two drugs up I realized they may increase the requirements of insulin. P.G. helped me understand more about the drugs rather than me teaching her about the drugs. For example, she was telling me that the amount of insulin she takes in the morning depends on her blood sugar level. She also explained to me the side effects of some of the medications rather than me teaching her. For example, benicar was slowing her heart down too much so the doctor told her to limit the drug to half a pill each day. Also, some

medications can greatly affect the heart, like synthroid and Toprol. Having known this before taking the drug history would have been beneficial for the patient. In order to reduce medication error I would advise when organizing the medication box each week to check it over a couple times with glasses on. Knowing her cataract history in both eyes could bring about medication error when organizing the pill box. Some aspects I would change in a future drug history would be to ask more questions about changes that have occurred with the medications. It was not a question that I asked but P.G. seemed to want to talk about how she had to reduce her dosages on many of her medications. Information regarding changes in medication can greatly affect the patient physically and mentally. If I knew more about the medication I could have been able to explain to P.G. why she is only taking a certain dosage. In addition, the changes that could have been made to help reduce side effects.

References Deglin, J. H., & Vallerand, A. H. (2010). Daviss Drug Guide for Nurses (12th ed.) *Mobile application software]. Retrieved from http://www.skyscape.com/estore/productdetail.aspx?productid=219 Taylor C.R., Lillis C., Lemone P., & Pamela L. (2011). Fundamentals of Nursing: The Art and Science of Nursing Care (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.