Over the course of these past 2 semesters of nursing school, one aspect of care that often surprises me is the extensive use of pharmacological medications as a means of both temporary and long-term treatment.  This is by no means to say that medications are not necessary or should not be used, however patients should also be aware that there are circumstances when a variety of treatment options are available.  And I wonder (perhaps prematurely), if these other options are clearly described to the patient as alternatives to pharmacological treatment.  The patient education component of nursing is an area that I find incredibly important and look forward to learning more about as we progress in UNE’s nursing program.

         My patient’s medication list included a variety of cardiovascular medications such as Dyrenium (Triamterene), Cozaar (Losartan), Cardizem (Diltiazem), Xarelto (Rivaroxaban), and Zetia (Exetimibe). All of these medications included headache as a side effect, and my patient also was prescribed Aleve (Naproxen) to counteract this side effect.  Zetia is known to cause hives as an allergic reaction, and my patient was prescribed Zyrtec to treat the hives that she recently developed.  She did not mention if her provider asked if the hives developed shortly after she started the medication; he mentioned that the hives are most likely age related.  These side-affects are acceptable given the indications for these other medications; however I do wonder what other treatment was offered or tried after she developed these consistent side effects. 

Some of these medications have more adverse interactions when taken together.  Triamterene and Losartan are contraindicated together and can increase the risk of atrial fibrillation, which my patient happens to have as pre-existing condition. Losartan and Diltiazem should not be taken together since Diltiazem decreases Losartan’s absorption capability in the body.  While my patient was very aware of the medications she was taking and their indications, there may be a more conducive course of therapeutic treatment with fewer side effects or contraindications.  And she admitted that she was not following the administration directions.  This project highlighted for me the importance adhering to the administration directions (morning vs. evening, with or without food) in order for them to be most efficient and effective. 

         Providers have a tremendous responsibility in prescribing patients’ medications and ensuring patient safety during the course of treatment.  From this project, I realize that there is a great deal of gray area when it comes to putting together a treatment plan for a patient based on their values, goals, and diagnosis.  There are also factors that determine a provider’s approach, such as a patient preferring medications versus lifestyle changes.  I look forward to learning more about what kinds of interventions, both pharmacological and non-pharmacological, work well for patients with varying conditions, and how to best care for them as a nurse.