Question

PN 200 Fundamentals of Nursing II Anticoagulants - Coumadin A patient is taking phenytoin, warfarin (Coumadin), promethazine (Phenergan), meperidine (Demerol), and diazepam (Valium) . Prepare a patient medication teaching plan for this patient being sure to include specifics about probable drug interactions During the teaching session, the patient shares that he plans to start taking OTC products to boost his energy. What is the nurse's best response to the patient's comment being sure to explain the rationale for your answer? 2. 3. List four adverse effects of each of the medications this patient is receiving Reviewed 11/18

Answer 1

In this case, the patient is taking more than one medication ( Phenytoin, Warfarin, Promethazine, Meperidine, Diazepam). Therefore, it is important to teach about the drug interactions.

1) Drug interaction mainly occur when we take more than one or two medication and it can happen in two ways:

• Pharmacokinetic
• Pharmacodynamic

In Pharmacokinetic the interaction occur on the basis of elimination, spreading and metabolism of the drug.,whereas pharmacodynamic relay on antagonistic and addictives for this.

Therefore, in short

• Phenytoin reduces the effect of anticoagulant drugs such as warfarin, therefor the dose of Warfarin should be increased to balance it.
• When Promethazine and Meperidine are given together it increase the chance of common side effects.
• Diazepam, should not be given along with grape drink or alcohol due to adverse reaction.

2) The best response to the intake OTC produces is to say a big NO. As this may have long term and short term effects even without any combination of drugs. Hence, in this case it should be discourage by explaining the dermerits of it, such as

• ringing in the ear.
• skin itching.
• eye pain
• nausea and blurred vision.

Note that if the client do so then the treatment regimen should also be changed accordingly due to its resistance.

3) Adverse Effects:

a) Phenytoin

• headache
• slurred speech
• loss of balance
• swollen or tender gums

b) Warfarin

• altered sense of taste
• stomach pain
• bloating
• easy bruising and bledding

c) Promethazine

• variation in blood pressure
• skin reactions
• elleviated platelet count
• breathing difficulties

d) Meperidine

• nausea
• vomiting
• constipation
• lightheadedness

e) Diazepam

• blurred vision
• loss of balance
• drowsiness
• dizziness