Case Study I A 45-year-old female presents to your clinic today with complaints of back pain and “just not feeling good”.  Regarding her back, she states that her back pain is a chronic condition that she has suffered with for about the last 10 years. She has not suffered any specific injury to her back. She denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. She describes the pain as a constant dull ache and tightness across the low back. She states she started a workout program about 3 weeks, and she is working out with a friend that is a body builder. She states her friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so she started those medications at the same time she began working out. She states she also takes Kava Kava for her anxiety and garlic to help lower her blood pressure. Past medication history includes: Type II diabetes since age 27, High blood pressure, Recurrent DVT’s Her other medications include: Glyburide 3 mg daily with breakfast, Lisinopril 20 mg daily and Coumadin 6 mg daily 1. What are your findings following reviewing this medication list? Explain concerns in detail. 2. Is there additional information you would obtain? If so, please discuss rationale. 3. What are your recommendations for managing this patient’s medications? 4. What are the components for educating the patient? 5. If your plan is to prescribe a medication/s, create a prescription and discuss, what are the important components necessary on the packaging or on the label? Please answer each question concisely. You do not need to write a long paragraph to prove your points. You need to provide a cover page and 1 reference page. Support answers with peer reviewed journals. Articles cannot be older than 5 years. Remember all paragraphs need to be cited properly, and the paper must be written in APA 6th format. A minimum of 3 references are required for this case study.

1. Findings after reviewing the medication list:
Upon reviewing the medication list, several concerns arise. Firstly, the patient is taking Glyburide, which is an oral antidiabetic medication used to control blood sugar levels in individuals with type II diabetes. Although the dosage is not mentioned, it is important to evaluate whether the current dose is effectively controlling the patient’s blood sugar levels. Additionally, the patient is taking Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure. The dosage of 20 mg daily seems appropriate, but monitoring blood pressure regularly is essential to ensure efficacy and prevent potential side effects.

Furthermore, the patient is prescribed Coumadin (warfarin) at a daily dose of 6 mg. Warfarin is an anticoagulant used as a preventive therapy for recurrent deep vein thrombosis (DVT). Given the dosage, the patient should be closely monitored for bleeding risks and have regular assessments of clotting parameters. Additionally, it is vital to evaluate the patient’s compliance with the medication regimen, as strict adherence to warfarin is crucial to prevent thrombotic events.

It is concerning that the patient is taking several over-the-counter supplements without discussing them with her healthcare provider. Creatine, a supplement commonly used by bodybuilders, can potentially interact with medications, and its impact on the kidneys should be considered. Coenzyme Q10 is also usually used to support cardiovascular health and can interact with blood thinners such as warfarin, potentially affecting its efficacy.

Lastly, the patient is taking Kava Kava for anxiety and garlic to lower blood pressure. Kava Kava has been associated with hepatotoxicity and can interact with certain medications used for mental health disorders. Garlic is known for its potential blood-thinning effects, which may increase the risk of bleeding in individuals taking anticoagulants like warfarin.

2. Additional information that should be obtained:
To better understand the patient’s condition, further information is necessary. It would be helpful to inquire about the duration and intensity of the workout program the patient started three weeks ago, as well as any changes in her routine that might have contributed to the exacerbation of her back pain. It is also important to ask about the recommended dosage and usage of the supplements the patient is taking, as well as her compliance with their use. Evaluating the patient’s mental health history and the efficacy of Kava Kava for anxiety is relevant in assessing her overall well-being.

Also, it would be beneficial to review the patient’s lifestyle and dietary habits, as it may offer insights into her blood pressure control and management of diabetes. Additionally, inquiring about any other healthcare providers involved in the patient’s care and the frequency of follow-up appointments can help ascertain the level of coordination in her medical management.

3. Recommendations for managing the patient’s medications:
To effectively manage the patient’s medications, it is crucial to establish an open and honest conversation. The patient should be educated about the potential interactions between her prescribed medications and the over-the-counter supplements she is taking. It is recommended to discontinue the use of creatine and Coenzyme Q10 due to their potential interactions with warfarin and lack of robust evidence supporting their use.

For anxiety management, alternative treatments or medications without potential hepatotoxic effects, such as selective serotonin reuptake inhibitors (SSRIs), should be discussed with the patient. Given the patient’s type II diabetes, keeping blood sugar levels under control is essential. Regular monitoring of blood sugar levels and potential adjustments in the dosage or type of antidiabetic agent should be considered in consultation with an endocrinologist.

4. Components for educating the patient:
When educating the patient, it is important to provide clear and concise information. The patient should be informed about the potential risks associated with the use of over-the-counter supplements and the importance of discussing their use with healthcare providers. Emphasizing the significance of medication adherence, regular follow-up appointments, and monitoring for potential side effects such as bleeding or changes in mental health is crucial. Moreover, providing information about lifestyle modifications, such as exercise programs tailored to the patient’s condition, can contribute to overall well-being.

5. Prescription components:
If prescribing a medication, the prescription label should include essential components such as the patient’s name, date of prescription, name and strength of the medication, dosage instructions, and any necessary warnings or precautions. Additionally, it is important to clearly communicate potential side effects or drug interactions, as well as instructions for storage and proper use. Finally, the prescription should be accompanied by clear instructions for follow-up appointments with the healthcare provider to assess the medication’s effectiveness and address any concerns or adverse reactions.