Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

Case Study: MN553 Advanced Pharmacology Unit 9 Case Study

This paper addresses a pharmacological management plan for Mr. NX, including consideration of possible contraindications for CAMs, prescriptive, and non-prescriptive recommendations for management of acute pain and other ongoing disease processes, followed by evaluation strategies.

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Pharmacological Management Plan CAMs Contraindicated with Current Prescriptions

Some of the current complementary and alternative medications that would be contraindicated for Mr. NX would be creatine, Coenzyme Q10, and garlic. Creatine is contraindicated when taking Lisinopril. Creatine can cause nephrotoxic effects when taken in combination with Lisinopril. Coenzyme Q10 when taken in conjunction with Glyburide can actually decrease the levels of Coenzyme Q10 (McPherson, 2016). Taking Coenzyme Q10 and Coumadin at the same time decreases Coumadin’s blood-thinning properties which can be life threatening. When taking Garlic supplements or consuming large amounts of garlic in food while taking Coumadin increases the risk of anti-coagulation when taken together, as each are blood thinners individually (Olson, Kent 2018).

CAMs Contraindicated with Diagnoses

There are some complementary and alternative medications that should be avoided when you have certain diagnoses. When you have Diabetes, you should avoid Creatine and Coenzyme Q10 as it puts you at a greater risk of developing hypoglycemia. Creatine is also contraindicated when you have a diagnosis of hypertension because it actually poses the risk of increasing your blood pressure (McPherson, 2016). Creatine, Coenzyme Q10, and garlic are all contraindicated when a person has a diagnosis of DVTs. This can put a person at risk of developing pulmonary or cerebellar emboli and anticoagulation (Olson, 2018). There is a risk of hypotension when taking Coenzyme Q10 or garlic when you have a diagnosis of hypertension (McPherson, 2016).

Prescription for Back Pain

It is always best start with over the counter (OTC) medications first to relieve pain before jumping into prescription pain medications. It would be best to start with an OTC such as acetaminophen or Alieve by taking it as directed. Mr. NX could also try glucosamine since it is known to have anti-inflammatory and cartilage repairing abilities. Message may also be beneficial in his case of back pain since he has not suffered from any specific back injury or have any neurological issues related to the pain (McPherson, 2016).

Changes in Prescribed Drugs

Since Mr. NX is taking Coumadin 5mg daily in-addition to garlic supplements and Coenzyme Q10, he would need to cautioned on those two supplements. Garlic can potentiate the effects of Coumadin increasing the risk of bleeding, while Coenzyme Q10 can put him at risk of developing an embolism. Coenzyme Q10 can help treat his hypertension that is being treated with Lisinopril. Mr. NX should then use caution when taking supplements with his prescribed medications. Garlic may cause an increase in hypertensive effects when combined with Lisinopril. If his blood pressure beings to run too low, it would be important to lower his Lisinopril dosage (McPherson, 2016).

Follow-Up Evaluations

Time-Frame

Mr. NX would need to follow-up at least monthly to begin with due to his current medication, supplement use, and diagnoses’. This can help to determine the effects of his supplement use with his prescribed medications before it becomes harmful to his overall health (Olson, 2018).

Strategies for Evaluating Side/Adverse Effects

Mr. NX should be encouraged to report any increase in bruising or bleeding after starting garlic supplements. Any change could warrant a reason to lower either his Coumadin dosage or amount of garlic supplement he is to take (Olson, 2018). With acetaminophen, Mr. NX would need to be sure not to exceed 4000mg in a 24hr period to avoid potential liver damage. He should also be advised to check his blood pressure at least daily to monitor for hypotension since that could occur when taking garlic, Coenzyme Q10, and Lisinopril. He should report any lightheadedness or dizziness as this can also be effects of garlic and Coenzyme Q10 when taken with Lisinopril (McPherson, 2016). Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

Strategies for Evaluating Effectiveness

The effectiveness of these supplements can be evaluated by monitoring Mr. NX’s blood pressure, overall skin appearance for bruising, blood sugar levels, and his INR lab value. These are all ways to identify over or under use of the supplements (McPherson, 2016).

References

McPherson, Fujio (2016). Herbal Therapy and Nutritional Supplements. Pharmacotherapeutics for Advance Practice Nurse Prescribers, by Teri Moser Woo and Marylou V. Robinson, 4th ed., F.A. Davis Company, pp. 110–148.

Olson, Kent (2018). Warfarin and Superwarfarin Toxicity: Practice Essentials, Etiology, Epidemiology. Background, Pathophysiology, Etiology, Medscape, emedicine.medscape.com/article/821038-overview.

MN553 Unit 9 Assignment Case Study of Mr X