Pharmacology and Medicines Optimisation

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Introduction

The chosen scenario involves a 46-year-old male with seasonal rhinitis. Martin has been treating the symptoms with the over-the-counter (OTC) drug Piriteze 10 mg once daily. Following his recent diagnosis of hypertension, Martin was administered 10 mg of Enalapril. To ensure that Martins prescriptions do not interfere with his everyday activities, it is essential to consider medicines optimization, particularly for his prescribed medications. Medicines optimization is a patient-focused method that needs a comprehensive approach, a higher degree of patient-centered expertise, and collaboration between healthcare experts and a patient (Fellenor et al., 2021). Optimization of medicines involves ensuring that the correct patients get the right medication at the right time. By concentrating on patients and their experiences, the objective is to assist patients in improving their results, taking their medications appropriately, avoiding taking unneeded medications, reducing medication waste, and enhancing medicines safety. In the end, medication optimization can inspire patients to take responsibility for their treatment.

However, the strategy of optimizing medications will involve interdisciplinary teamwork. Healthcare providers will need to collaborate to individualize treatment, monitor results more closely, evaluate medications more regularly, and provide the necessary support for patients (Rosen et al., 2018). To ensure the most favorable results from medicines, there is a continuous, ongoing discussion with the patient and their carer about the patients choice and knowledge of using prescription drugs to manage their condition. This is in accordance with the understanding that the patients experience may vary over time even if the medications do not. All professionals, healthcare organizations, and patients are responsible for the safe use of medications, which should be addressed with patients and/or their caregivers. Safety encompasses all elements of medication use, including adverse effects, interactions, safe procedures and systems, and efficient professional communication (World Health Organization 2019). In Martins situation, medicines optimization would ensure that he complies with his prescribed medications, uses them safely, and is aware of their adverse and side effects. Consequently, this activity will emphasize the adverse and side effects of Martins prescription medicines as well as concerns associated with Martins drug adherence.

Therapeutic Effects and Adverse Effects of Piriteze

As a treatment for his seasonal rhinitis, Martin was administered Piriteze, commonly known as Cetrizine, 10 mg daily. According to Small, Keith and Kim (2018), the objective of therapy for rhinitis is symptom alleviation. Among the therapeutic alternatives available to accomplish this objective are avoidance strategies, nasal saline irrigation, and oral antihistamines. Martin was administered Piriteze, an oral antihistamine, to ease his problems. Piriteze, which is generated from the first-generation antihistamine hydroxyzine, does not pass the blood-brain barrier to the same amount as its first-generation competitors. As a consequence, Piriteze is an effective therapy for allergic rhinitis that lowers the risk of sedative side effects (Naqvi and Gerriets, 2022). Furthermore, Piriteze is a second-generation antihistamine that successfully reduces sneezing, runny nose, and watery eyes caused by allergens such as dust and mold (Naqvi and Gerriets, 2022). Regular use of oral antihistamines during the peak of symptoms has been shown to successfully decrease sneezing, rhinorrhea, and itching.

For the treatment of urticaria and allergic rhinitis, Piriteze is safe and generally well-tolerated. Even though uncommon, the most prevalent side effects include somnolence, lethargy, pharyngitis, vertigo, and dry mouth (Abdullah et al., 2019). It is indicated that dry mouth and somnolence caused by Piriteze are dose-dependent (Corsico et al., 2019). Research reveals that Piriteze adds to daytime drowsiness in certain people. Few incidences of temporary, reversible hepatic transaminase increase while using Piriteze have been recorded in the medical literature (Coskun et al., 2018). There are also cases of hepatitis with high bilirubin levels (Coskun et al., 2018). Rare, potentially serious side effects are documented in postmarketing trials, including severe hypotension, allergy, orofacial dyskinesia, hemolytic anemia, cholestasis, hepatitis, stillbirth, and thrombocytopenia.

The medicine Piriteze is reasonably safe and effective for the management of seasonal rhinitis. Therefore, while examining the numerous pharmacological alternatives accessible to Martin, Piriteze is the greatest option for alleviating his problems. Rapidly absorbed antihistamines with a modest sedative effect, such as Piriteze, are the most effective treatment for the symptoms (Fein et al., 2019). Martin had phoned complaining of dizziness, drowsiness, and loss of balance; thus, the optimum prescription would be an antihistamine with less drowsiness and adverse effects.

While dispensing medication, it is essential to educate Martin regarding potential side effects such as sleepiness, fatigue, and dry mouth. When providing Piriteze to patients with compromised renal or hepatic function, physicians should be cautious (Coskun et al., 2018). It is essential to assess therapy efficacy and advise patients not to mix Piriteze with substances that induce central nervous system (CNS) depression (Werbel and Cohen, 2018). Additionally, the client must be warned against using alcohol or other CNS depressants in conjunction with the medication. The pharmacist should undertake a complete medication reconciliation and confirm that the client is not taking any drugs or supplements that might increase the undesirable effects of Piriteze. If the Piriteze overdose is deliberate, a psychiatrist should be contacted (Borowy and Mukherji, 2022). Communication and cooperation across interprofessional teams may improve patient outcomes and minimize healthcare expenditures.

Therapeutic Effects and Adverse Effects of Enalapril

Martin was administered 10 mg of Enalapril after his recent diagnosis of hypertension. Enalapril is a medicine used for the treatment of hypertension and heart failure. It is considered an angiotensin-converting enzyme inhibitor (Faruqi and Jain, 2022). Clinicians give Enalapril for both symptomatic and asymptomatic congestive heart failure to decrease mortality and morbidity. It is also used for the treatment of hypertensive emergencies and hypertensive urgency (Varounis et al., 2017). He stopped taking the dosage as he complained that it might be contributing to his dizziness. Cough is the most prevalent adverse event associated with ACE inhibitors. The cough is often nonproductive and ceases when the medication is discontinued (Faruqi and Jain, 2022). Hyperkalemia, hypotension, angioedema, cholestatic jaundice, and hypersensitivity response are other side effects of enalapril (Khalil and Zeltser, 2022). Rarely, ACE medications may cause fulminant hepatic necrosis and cholestatic jaundice by affecting the hepatobiliary system (Fahmy et al., 2019). The early sign may be an increase in hepatic transaminases; in such situations, ACE inhibitors should be discontinued. If there are any indications of anaphylaxis or anaphylactoid response, the physician must also withdraw the medicine.

ACE inhibitors are commonly used by physicians to treat hypertension, cardiovascular disease, and chronic kidney disease. Despite their efficacy, healthcare professionals (nurse practitioners, doctors, and pharmacists) who dispense these medications should be conscious of their adverse drug interactions and contraindications (Endal, Getnet. and Gebrie, 2019). The kidney function and electrolyte contents of patients should be checked routinely. These agents may cause a persistent dry cough, which should be noted by medical professionals. If the patient exhibits a dry cough, the practitioner must attempt a different type of antihypertensive medicine. Martin should be instructed and encouraged to take his medications as prescribed. By doing so, the first dose of 10 mg may be decreased to 5 mg per day to alleviate the symptoms of feeling dizzy, which influence his daily activities. Patient monitoring and blood pressure monitoring should be performed to ensure that blood pressure levels stay stable while adverse effects are minimized.

Although ACE inhibitors are one of the oldest accessible pharmacological families, there is a risk that familiarity might lead to complacency. Like any other medication, these drugs need the supervision and collaboration of a multidisciplinary team (Brown et al., 2017). Pharmacists must confirm the optimal dose and examine possible medication interactions. Every time a patient is seen, the nurse should take the patients blood pressure and record it precisely so that the physician may decide whether dosage or other adjustments are necessary. The physician must keep informed of these results from the other members of the interdisciplinary healthcare team to take appropriate remedial action. All staff members must meticulously document their observations and actions in the health record of the patient (Baumann et al., 2018). In addition, the interdisciplinary team technique of evidence-based therapy and patient-centered care is linked to reduced morbidity and death in ACE inhibitor-treated patients.

Conclusion

Medicines optimization is a patient-centered strategy requiring a complete approach, a greater level of patient-centered knowledge, and cooperation between healthcare professionals and the patient. The activity has emphasized the significance of medicine optimization, which guarantees that patients can comprehend the bad effects and side effects of prescription drugs. Active patient participation may enhance treatment results and provide patient-centered care, hence optimizing the use of medications for patients and ensuring patient-centered care. One of the proposed causes is that engagement promotes well-informed clients, who frequently make better decisions than less-informed clients, which may lead to sensible medicine. Patients may be able to exercise more influence over their medical therapy if measures are taken to improve their engagement by enhancing their understanding of their medicine and attempts are made to implement this information. As a viable method for medication optimization, the development of instruments that give health professionals patient input on their aims and preferences has been proposed.

Reference List

Abdullah, B., et al. (2019) Using patient profiles to guide the choice of antihistamines in the primary care setting in Malaysia: expert consensus and recommendations,Therapeutics and Clinical Risk Management, 15, pp.12671275. Web.

Baumann, L.A., Baker, J. and Elshaug, A.G. (2018) The impact of electronic health record systems on clinical documentation times: a systematic review, Health Policy, 22(8), pp.827836. Web.

Endal, B., Getnet., D and Gebrie, D. W. (2019) Healthcare professionals awareness towards drug-drug interaction in Ayder comprehensive specialized. ResearchGate. Web.

Borowy, C.S. and Mukherji, P. (2022) Antihistamine Toxicity. Nih.gov. Web.

Brown, J.N., et al. (2017) Medication safety in clinical trials: Role of the pharmacist in optimizing practice, collaboration, and education to reduce errors, The Yale Journal of Biology and Medicine, 90(1), pp.125133. Web.

Corsico, A.G., et al. (2019) Focus on the cetirizine use in clinical practice: a reappraisal 30 years later Multidisciplinary Respiratory Medicine, 14(1). Web.

Coskun, A., et al., (2018) Cetirizine-induced hepatotoxicity: case series and review of the literature, Gastroenterology Report, 6(3), 228-230. Web.

Drugbank.com. (2016) Cetirizine: uses, interactions, mechanism of action. Web.

Drugbank.com. (2022) Enalapril: uses, interactions, mechanism of action. Web.

Fahmy, S.R., et al. (2019) Hepatotoxicity effect of short-term Bradykinin potentiating factor in cholestatic rats, Toxicology Letters, 301, pp.7378. Web.

Faruqi, A. and Jain, A. (2022) Enalapril. Nih.gov. Web.

Fein, M.N., Fischer, D.A., OKeefe, A.W. and Sussman, G.L. (2019) CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria, Allergy, Asthma & Clinical Immunology, [online] 15(1). Web.

Fellenor, J., et al. (2021) A multi-stakeholder approach to the co-production of the research agenda for medicines optimization, BMC Health Services Research, [online] 21(1). Web.

Khalil, H. and Zeltser, R. (2022) Antihypertensive medications. Nih.gov. Web.

Naqvi, A. and Gerriets, V. (2022) Cetirizine. Nih.gov. Web.

Rosen, M.A., et al. (2018) Teamwork in healthcare: key discoveries enabling safer, high-quality care, American Psychologist, [online] 73(4), pp.433450. Web.

Small, P., Keith, P.K. and Kim, H. (2018) Allergic rhinitis, Allergy, Asthma & Clinical Immunology, 14(51). Web.

Varounis, C., et al. (2017) Cardiovascular hypertensive crisis: Recent evidence and review of the literature, Frontiers in Cardiovascular Medicine, 3. Web.

Werbel, T. and Cohen, P.R. (2018) Ranitidine-associated sleep disturbance: Case report and review of h2 antihistamine-related central nervous system adverse effects, Cureus. Web.

World Health Organization (2019) Medication Safety in Polypharmacy. Web.

Appendix

Personal Formularies

Drug Name: PIRITEZE

Indication for use
Piriteze is indicated for the alleviation of symptoms related to seasonal allergic rhinitis brought on by allergens such as mold, grass, and tree pollen in adults and children older than 2 years. Sneezing, ocular pruritus, rhinorrhea, nasal pruritus, tears, and redness of the eyes are well-treated symptoms. It is also authorized for the treatment of adults and children older than 6 months with simple cutaneous symptoms of chronic idiopathic urticaria. It dramatically lowers the incidence, intensity, and duration of hives, as well as pruritus.
Pharmacokinetics
Absorption: Piriteze is quickly absorbed in the gastrointestinal system and is substantially eliminated by the kidney. After roughly one hour, the peak plasma concentration of Piriteze is reached (Drugbank.com, 2016). Typically, its effects begin within 20 to 60 minutes and last for at least 24 hours.
Distribution: The average protein binding of cetirizine in plasma is 93%.
Metabolism: Piriteze is oxidatively O-dealkylated to a metabolite with little antihistamine action. Piriteze is not a CYP450 system substrate (Drugbank.com, 2016). There is evidence that Piriteze is a P-glycoprotein substrate, which must be noted when Piriteze is administered concurrently with P-gp inhibitors.
Excretion: Piriteze has an elimination half-life of 8.3 hours and is eliminated predominantly via the kidney.
Pharmacodynamics
The potent metabolite of the piperazine H1-receptor antagonist hydroxyzine, piriteze, reduces the symptoms of allergic asthma, chronic idiopathic urticaria, seasonal allergic rhinitis, physical urticaria, and atopic dermatitis. Numerous clinical studies have conclusively shown Piritezes effectiveness against allergic respiratory disorders.
It possesses anti-inflammatory characteristics that may contribute to the treatment of asthma. There is proof that Piriteze alleviates urticaria symptoms. In babies, adolescents, and adults, wheal and flare responses are inhibited clinically within 20 minutes of a single oral dosage and last for 24 hours (Drugbank.com, 2016). Utilizing Piriteze concurrently minimizes the length and dosage of topical anti-inflammatory formulations used to treat atopic dermatitis.
Advice
Patients using cetirizine must be monitored for symptom alleviation. In addition to monitoring patients for side effects such as weariness and somnolence in adults and headaches in children, members of the healthcare team should also be on the lookout for adverse reactions such as drowsiness and fatigue (Naqvi and Gerriets, 2022). Patients with kidney dysfunction should take a reduced age-appropriate dose of medicine.
Potential Side Effects
Its most prevalent adverse effects in adults include fatigue, somnolence, pharyngitis, vertigo, and dry mouth.

Drug Name: ENALAPRIL

Indication for use
Enalaprils primary listed indications are cardiac arrest and persistent hypertension. Enalapril is administered to both symptomatic and non-symptomatic congestive heart failure patients to reduce mortality and morbidity. Additionally, it is utilized to treat hypertensive crises and hypertensive urgency.
Pharmacokinetics
Absorption:Good oral absorption where 5575% are absorbed following oral administration.
Distribution: The volume of its distribution is 1 to 2.4 L/kg. Crosses the placenta; small amounts enter breast milk (Drugbank.com, 2022).
Metabolism: De-esterified into enalaprilat, the active metabolite in the liver.
Excretion: Excreted by kidneys into the bile and urine.
Pharmacodynamics
Enalapril is an antihypertensive medication with uricosuric and natriuretic effects. Enalapril decreases blood pressure in all stages of essential and renovascular hypertension, as well as peripheral vascular resistance, without increasing heart rate. Enalapril is effective in the hypertensive population with low renin levels (Drugbank.com, 2022). The timeframe of hypertensive outcome in diastolic and systolic blood pressure stems for at least 24 hours following preliminary administration of a single dose. Repeated everyday administration of enalapril affords an extra decrease in blood pressure, and achieving a steady-state antihypertensive reaction may take several weeks.
In patients with profound congestive heart failure and poor clinical response to standard antihypertensive treatments, enalapril medication improve cardiac function, as measured by a decrease in both preload and afterload, and improved long-term clinical status. In addition, enalapril has been demonstrated to enhance cardiac output and stroke volume. In clinical tests, enalapril decreased the bulk of the left ventricle without affecting cardiac function during exercise (Drugbank.com, 2022). Enalapril, unlike the majority of diuretics and beta-blockers, is not strongly connected with the risk of bradycardia, nor does it generate rebound hypertension following the withdrawal of medication.
Advice
When delivering enalapril to people with potential contraindications, it is crucial to closely monitor their vital signs, kidney function, and heart activity. In addition, it is critical to check the frequency of prescription refills to determine compliance.
Potential Side Effects
Cough is the most prevalent adverse event associated with ACE inhibitors. The cough is often nonproductive and ceases when the medication is discontinued. Hypotension, angioedema, hyperkalemia, cholestatic jaundice, and hypersensitivity response are additional side effects of enalapril.

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