Assignment 1 Upload
Assignment 1 Upload
Assignment 1 Upload
Table of Contents
Question 1.........................................................................................................................................3
Question 2.........................................................................................................................................5
Question3..........................................................................................................................................8
Question 4.......................................................................................................................................10
References.......................................................................................................................................11
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HNN215 Quality Use of Medicines in Nursing
Question 1
Cefaclor SR
Society of Australia, 2010). This requires caution when the patient is allergic to penicillin, as
3%-10% of patients will have a cross reaction with cephalosporin’s (Clinical Pharmacologly,
2010). Cefaclor works by interfering with bacteria cell wall, which leads to the cell dying.
Pharmacologly, 2010). Cefaclor SR is the reason that Cefaclor is being used for Mrs Seville is
due to recent chest infection, to help prevent any new infections forming after the surgry
Tramadol SR
Tramadol is an opioid analgesic, used for moderate to severe pain. Tramadol is active in pain
management by acting upon the mu opioid receptors and prevents the reuptake of
is metabolised by the liver, with bioavailability after 6 hours approximately 95% with the use
of the sustained release(Clinical Pharmacologly, 2010). Food does not affect the rate of
either with or without food (Clinical Pharmacologly, 2010). Tramadol is being used to
Gentamycin
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HNN215 Quality Use of Medicines in Nursing
Gentamycin has been prescribed to Mrs Seville to help prevent infection, due to her hip
prohibiting the protein synthesis (Pharmaceutical Society of Australia, 2010). The majority of
gentamycin eliminated by kidneys as gentamycin is not metabolised. The half life of the
gentamycin, is generally 2-3hours, provided the patient has normal renal function (Clinical
Pharmacology, 2010).
Amitriptyline
management of pain, as in the case with Mrs Seville. Amitriptyline is classed as a Tricyclics
After 24 hours 25-50% of the dose of Amitriptyline would have be excreted through the
Celecoxib
Australia, 2010). Celecoxib is metabolised in the liver, where 97% of the celecoxib being
metabolised. The peak plasma concentrations occur 3 hours after the oral dose of celecoxib
is administered. If celecoxib is taken with fatty foods, the peak plasma is delayed (Clinical
Pharmacology, 2010).
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HNN215 Quality Use of Medicines in Nursing
Question 2
Cefaclor SR No
Celecoxib Yes
Enoxaparin Yes
Gentamycin Yes
Ginko No
Panadeine Forte No
Paracetamol Yes
Tramadol SR Yes
Mrs Seville is at an increase risk of suffering an allergic reaction Cefaclor, due to her previous
anaphylaxis reaction to penicillin (Pichichero, 2006). Under the quality use of medicines,
this fails to provide a safe and appropriate treatment due to the potential risks, which out
way the benefits when there is a more appropriate medication (National Medicines Policy,
2000). Pichichero (2006) states that Cefaclor is unsafe cephalosporin due to having a similar
Ginkgo (Ginko) has been known to contain antiplatelet which is of concern when Mrs Seville
is taking Celecoxib, a NSAID (Abebe, 2002). The reason for concern is that it increases the
risk of bleeding, greater than aspirin taken alone. Ginkgo also decreases the analgesic affect
of the NSAID, due to the inhibitory effect on the thromboxane synthesis (Abebe, 2002).
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HNN215 Quality Use of Medicines in Nursing
These affects and interaction between the ginkgo and the Celecoxib means that there are
undesirable side effects, and is not the quality use of medicines due to the fact that it
Mrs Seville is at risk of paracetamol overdose when she is on her current home medications,
due to the taking both her Panamax (paracetamol) and Panadeine forte (paracetamol with
codeine) with her evening medicines (Pharmaceutical Society of Australia, 2010). This
results in a higher than recommend doses within the 4 – 6 hourly window, where only 1g is
recommend compared to Mrs Sevilles 2g she is taking each evening (Pharmaceutical Society
of Australia, 2010). This increases her risk of liver complications and could result in an
adverse event, and can lead to increased risk of renal failure (Waring, Jamie, & Leggett,
2010).
There is an increase risk that Mrs Seville could be exposed to serotonin toxicity, which can
lead to serotonin syndrome. The increased risk is due to Mrs Seville being prescribed
multiple medicines which increase CNS serotonergic activity (Ringland et al.2008).In Mrs
Sevilles case the Tramadol, and Amitriptyline increase the risk of serotonin syndrome
(Haanpää et al. 2010). According to Horn & Hansten (2009, p25) mild cases of serotonin
syndrome can still impair quality of life due to sleep disruption and agitation. Although rare,
Serotonin syndrome has in some cases proven to be fatal when the signs and symptoms have
The use of Panadeine Forte when Mrs Seville suffers from asthma
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HNN215 Quality Use of Medicines in Nursing
Panadeine forte contains codeine, which the Pharmaceutical Society of Australia (2010)
states that extreme caution must be used when the patient has asthma. Under the quality
use of medicines, when there is a more appropriate medication available, this should be
used, as it provides better outcomes for Mrs Seville (National Medicines Policy, 2000). As
Mrs Seville has mild asthma, there is a risk that it can increase the likely hood of an asthma
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HNN215 Quality Use of Medicines in Nursing
Question3
To reduce the risk of an allergic reaction to Cefaclor, another cephalosporin should be used
or the Roxithromycin which was originally use, and ordered for her use during her stay on
the ward (Pichichero, 2006). Roxithromycin would be the ideal drug in this case as it has
been proven to be safe when a patient suffers from a penicillin allergy (Pharmaceutical
Society of Australia, 2010, p.18). The nurse would need to discuss this case with the
prescribing doctor or the pharmacist to ensure the quality use of medicines is being
To prevent the risk of bleeding and post-operative haemorrhage the nurse should disuses
the increase risk of taking Ginkgo with Mrs Seville. The nurse should encourage Mrs Seville
to have the Ginkgo withheld during her hospitalisation and until she is off the Celecoxib
(Abebe, 2002). This will be able to provide a better quality use of medicines, due to the
decreased risk of haemorrhage and provides the most benefit for Mrs Seville in the short
term.
To help reduce Mrs Sevilles risk of paracetamol overdose, the nurse would need to educate
Mrs Seville on how Panamax and Panadeine forte both contain paracetamol. The nurse
should explain that Mrs Seville should only take either the Panamax or the Panadeine forte
within a 4-6hour window, depending on her pain levels experienced at the time, with
Panadeine forte for stronger pain (Pickering, Estrade, Dubray, 2005, p707). Mrs Seville also
should understand that she is only able to take a maximum of 4 grams of paracetamol a day,
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When caring for Mrs Seville the nurse needs to be monitoring her for any signs and
symptoms of serotonin syndrome, to help prevent the serotonin toxicity developing and to
insure her quality of life is not affected. Close (2005. P79) states there need to be at least
three of the signs and symptoms, which include a change in their mental state, agitation,
In the event that serotonin syndrome is detected it can clear in as little as 24 hours
To reduce the risk of an asthma attack or worsening symptoms which are related to
Panadeine forte, another pain relief should be used considered. The nurse would need to
discuss this case with the prescribing doctor or the pharmacist to ensure the quality use of
medicines is being achieved, and the new more appropriate medication ordered for her use
during her stay on the ward. Tramadol SR may prove to be a more appropriate medication,
as it does not affect the repertory system as greatly compared to over opioids
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HNN215 Quality Use of Medicines in Nursing
Question 4
Genta levels are required to ensure that the gentamycin remains within the
therapeutic range and is used to help prevent toxicity levels reaching a critical point where
Nephrotoxicity , vestibular (balance and spatial awareness) and auditory (hearing) toxicity
monitoring for changes in their vestibular and auditory, with a baseline audiometry levels
taken (Therapeutic Guidelines, 2010). In order for the nurse to be able to monitor any changes
in the vestibular system they should ask Mrs Seville about any atatxia, disequilibrium and
loss of balance, oscillopsia any loss of visual activity during any head movement. To help
prevent Nephrotoxicity, serum creatinine levels also need to be monitored, and creatinine
clearance needs to be calculated, to ensure that the appropriate starting dose and to ensure
In the event that Mrs Seville will be on gentamycin for more than two days, plasma
levels also need to be taken and monitored, to help reduce the onset of nephrotoxicity and
also it helps to reduce the risk of vestibular and auditory toxicity ( Therapeutic Guidelines,
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References
Abebe, W, 2002, ‘Herbal medication: potential for adverse interactions with analgesic
drugs.’ Journal of Clinical Pharmacy & Therapeutics, Vol. 27, No.6, p 391-401, retrieved 2nd
Clinical Pharmacologly, 2010, Gold Standard, Retrieved 8th April 2010, <http://www.
clinicalpharmacology-ip.com.ezproxy-f.deakin.edu.au/default.aspx>
Close, B, 2005, ‘Tramadol: does it have a role in emergency medicine?’, Emergency Medicine
Australasia, Vol 17, No.1, p73-83, retrieved 2nd April 2010, CINAHL with Full Text database.
‘Treatment Considerations for Patients With Neuropathic Pain and Other Medical
Comorbidities’, Mayo Clinic Proceedings, Vol. 85, pS15-S25, retrieved 2nd April 2010,
Horn, J., & Hansten, P. 2009, ‘Tramadol and Serotonin Syndrome’. Pharmacy Times, Vol.75,
No. 25, p25, Retrieved 1st April, Academic Search Complete database.
<www. nmp.health.gov.au/pdf/nmp2000.pdf>
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patients’, Journal of Family Practice, Vol. 55, No.2, P106-113, Retrieved 5th April,
Fundamental & Clinical Pharmacology, Vol.19, No.6, p707-711, Retrieved 10th April,
Kelman, Nicholas Buckley, & Sallie-Anne Pearson, 2008, ‘Uncovering the potential
British Journal of Clinical Pharmacology, Vol.66, no. 5, p682-688. Retrieved 6th April,
=http://etg.tg.com.au/conc/tgc.htm?id=682f7a09b0a275b32f9a52d564f6d7e7>
Waring, W, Jamie, H, & Leggett, G, 2010, ‘Delayed onset of acute renal failure after
Vol.29, No.1, p63-68, Retrieved 5th April, from Academic Search Complete database.
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