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 Martin’s 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 patient’s choice and knowledge of using prescription drugs to manage their condition. This is in accordance with the understanding that the patient’s 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 Martin’s 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 Martin’s prescription medicines as well as concerns associated with Martin’s 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 patient’s 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.
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Appendix
Personal Formularies
Drug Name: PIRITEZE
Drug Name: ENALAPRIL