Parales, Danish Stephanie C.

BSN 3Y1-2

Case Scenario: Medications and Aging

Ms. Espinosa is a 90-year-old Hispanic woman admitted to the hospital from her assisted living facility. She has a history of hypertension
and dementia and had a stroke and a myocardial infarction 3 years ago. She has also had insomnia for the past month. Ms. Espinoza
is admitted due to an alteration in her mental status. She has had a cold and a cough for a week, for she took Coricidin (acetaminophen
and chlorpheniramine) and Tylenol PM (acetaminophen and diphenhydramine).

Her home medications include monthly

Nascobal (Vitamin B12) injections;

Toprol-XL ( Metoprolol succinate), 100 mg daily;

Plendil (Felodipine),10 mg daily;

Allegra (Fexofenadine),180 mg daily;

Ecotrin (Aspirin EC), 325 mg daily; and

Colace (Docusate Sodium), 100 mg daily.

She also has a very unsteady gait. Ms. Espinoza’s admitting diagnosis is pneumonia. The physicians order the following medications:

Lasix (Furosemide), 20 mg IV push, x 1;

Pepcid (Famotidine), 20 mg bid;

Ecotrin (Aspirin EC), 325 mg daily;

Toprol-XL (Metoprolol Succinate), 100 mg daily;

Colace ( Docusate Sodium),100 mg daily;

Allegra (fexofenadine), 180 mg daily;

Levoquin (Levofloxacin), 250 mg daily IVPB;

Plendil (Felodipine), 10 mg po daily; and

Ambien (Zolpidem), 5 mg at bedtime as needed

Questions

1. Which medication(s) may have contributed to Ms. Espinoza’s altered mental status? Make a drug study of all the medications taken by
Ms. Espinoza.

Drug Name Mechanism of Action Adverse Effect Nursing Considerations

Possible side effect:

GENERIC NAME: Thought to produce analgesia by GI: pseudomembranous colitis,  Many OTC and
inhibiting prostaglandin and diarrhea prescription products
Tylenol (Acetaminophen) other substances that sensitize contain acetaminophen;be
Hematologic: eosinophilia,
CLASSIFICATIONS: pain receptors. Drug may relieve thrombocytosis, leukopenia. aware of this when
fever through central action in Skin: pain, induration, tenderness calculating total daily dose.
Analgesics the hypothalamic heat-regulating at injection site, rash.  Consider reducing total
center.
ADMINISTRATION: daily dose and increasing
Other: hypersensitivity reactions,
serum sickness, anaphylaxis. dosing intervals in patients
with hepatic or renal
failure.
GENERIC NAME: It helps to control the symptoms  Drowsiness, dizziness,  Take with food if GI upset
of cold and allergies but will not constipation, blurred occurs; do not cut,crush or
Chlorpheniramine treat the cause of the symptoms vision chew the SR preparations.
CLASSIFICATIONS: or speed recovery. It works by
blocking the action of histamine,  Take as prescribed; avoid
Antihistamines a substance in the body that excessive dosage.
causes allergic symptoms.  Avoid alcohol; serious
ADMINISTRATION:
sedation may occur.

GENERIC NAME: Competes with histamines for H 1- CNS: drowsiness, sedation,  Stop drug 4 days before
receptor sites. Prevents, but sleepiness, dizziness, headache, diagnostic skin testing.
Diphenhydramine doesn’t reverse, histamine- fatigue, seizures
mediated responses, particularly  Injection form is for I.V. or
CLASSIFICATIONS: CV: palpitations, hypotension, I.M. administration only.
those of the bronchial tubes, GI
Antihistamines tract, uterus and blood vessels. tachycardia
 Dizziness, excessive
ADMINISTRATION: GI: dry mouth, nausea, epigastric sedation,syncope, toxicity,
distress, vomiting, diarrhea, paradoxical stimulation
constipation and hypotension are more
likely to occur in elderly
GU: dysuria, urine retention,
patients.
urinary frequency
  Arthralgia, Dizziness,
GENERIC NAME: Vitamin B12 can be converted to Headache,
coenzyme B12 in tissues, and as Nasopharyngitis
Nascobal (Vitamin B12) such is essential for conversion of
CLASSIFICATIONS: methylmalonate to succinate and
synthesis of methionine from
Vitamins homocysteine, a reaction which
also requires folate.
ADMINISTRATION:

Injectons

GENERIC NAME: Toprol-XL is a beta1-selective  Drowsiness, dizziness,  Monitor BP frequently;

(cardioselective) adrenoceptor tiredness, diarrhea, and drug masks common signs
Toprol-XL (Metoprolol succinate) blocking agent, for oral and symptoms of shock.
slow heartbeat may occur.
CLASSIFICATIONS: administration, available as
extended release tablets. It has  Always check patient’s
Beta-blocker been formulated to provide a apical pulse rate before
controlled and predictable giving drug. If it’s slower
ADMINISTRATION: than 60 beats/minute,
release of metoprolol for once-
daily administration.  withhold drug and call
100 mg daily
prescriber immediately.

 dizziness,
GENERIC NAME: A dihydropyridine-derivative lightheadedness,  Monitor patient carefully
calcium channel blockerthat headache, flushing, or (BP, cardiac rhythm and
Plendil (Felodipine) prevents entry of calcium output)
 stomach upset 
CLASSIFICATIONS: ionsinto vascular smooth muscle  Administer drug without
and cardiac cells; shows some regard to meals
Antihypertensives selectivityfor smooth muscle
compared with cardiac muscle.  Have patient swallow
ADMINISTRATION:
tablet whole; do not chew
10 mg daily or crush.

 CNS: Drowsiness and  Assess respirations and

GENERIC NAME: The H1 histamine receptor is sedation. adventitious sounds to
responsible for mediating  GI: Drying of the GI monitor drug effects.
Allegra (Fexofenadine) hypersensitivity and allergic
mucous membranes, GI  Evaluate orientation,
CLASSIFICATIONS: reactions. upset, nausea. affect, and reflexes to
 GU: Dysuria, urinary monitor for changes due
Antihistamine
hesitancy. to CNS effects.
ADMINISTRATION:  Skin: Skin eruption and  Evaluate renal and liver
itching. function tests to monitor
180 mg daily for factors that could
affect the metabolism or
excretion of the drug.

It works by blocking a certain GI: Nausea, dyspepsia,

GENERIC NAME: natural substance in your body to heartburn, epigastric discomfort,  Assess pain and/or pyrexia
reduce pain and swelling. It is also anorexia, hepatotoxicity one hour before or after
Ecotrin (Aspirin EC) medication.
used to reduce fever and relieve
CLASSIFICATIONS: mild to moderate pain from  upset   Be aware that aspirin is a
conditions such as muscle stomach, heartburn; common constituent of a
Nonsteroidal anti-inflammatory
aches, toothaches, common cold, drowsiness; or variety of over-the-counter
drug (NSAIDs)
and headaches. It may also be mild headache
 used to reduce pain and swelling
ADMINISTRATION: in conditions such as arthritis. medications.

325 mg daily

 Abdominal cramping,
GENERIC NAME: Docusate is an emollient stool diarrhea, excessive bowel  Assess: cause of
softener (surfactant laxatives). By activity, Intestinal constipation - is fluid, fibre
Colace (Docusate Sodium) lowering the surface tension of or exercise missing from
obstruction, throat irritation
CLASSIFICATIONS: the oil-water interface of the lifestyle; fluid balance.
stool, it allows the passage of
Surfactant water and lipids into the stool  Drug should be
mass. As a result, the stool discontinued if cramping,
ADMINISTRATION: rectal bleeding, nausea or
softens and passes easily through
the intestinal tract. vomiting occur. 
100 mg daily

GENERIC NAME: Furosemide inhibits tubular  Dehydration, headache,  Monitor weight, BP, and
reabsorption of sodium and dizziness, diarrhea, pulse rate routinely with
Lasix (Furosemide) chloride in the proximal and abdominal discomfort and long-tem use.
CLASSIFICATIONS: distal tubules, as well as in the pain, nausea, vomiting,
thick ascending loop of Henle by constipation  Monitor fluid intake and
Antihypertensives inhibiting sodium-chloride output and electrolyte,
cotransport system resulting in BUN, and carbon dioxide
ADMINISTRATION: levels frequently.
excessive excretion of water
20 mg IV push, x1 along with sodium, chloride,  Monitor glucose level in
magnesium, and calcium diabetic patients.

GENERIC NAME: Competitively inhibits action of CNS: headach,dizziness,  Assess patient for
histamine on the H2-receptor irritability, agitation (younger age abdominal pain.
Pepcid (Famotidine) sites of parietal cells, decreasing than 1)  Look for blood in emesis,
gastric acid secretion. stool, or gastric aspirate.
CLASSIFICATIONS: GI: constipation, diarrhea,
vomiting (younger than age 1)  Monitor patients with
Anti-ulcer drugs
renal dysfunction for QT-
ADMINISTRATION: interval prolongation.

20 mg BID

GENERIC NAME: Inhibts bacterial DNA gyrase and CV: edema, chest pain  Patients with acute
prevents DNA replication , hypersensitivity reactions
Levoquin (Levofloxacin) transcription, repair and CNS: encephalophaty, seizures, may need treatment with
CLASSIFICATIONS: recombination in susceptible dizziness, headache, insomnia epinephrine oxygen.
bacteria. Respiratory: allergic
Antibiotics  Monitor glucose level and
pneumonitis, dyspnea results of renal function
ADMINISTRATION: tests, LFTs, and blood
counts.
250 mg daily IVPB
 Drug may cause an
abnormal ECG.

GENERIC NAME: Although drug interacts with one CNS: headche, amnesia,  Use drug only for short-
of three identified GABA- drowsiness, lethargy, dizziness, term management of
Ambien (Zolpidem) benzodiazepine receptor memory disorder insomnia, usually 7 to 10
CLASSIFICATIONS: complexes, it isn’t a days. Reevaluate patient if
benzodiazepine. It exhibits CV: palpitations, chest pain insomnia persists.
Hypnotics hynotic activity and minimal GI: abdominal pain, constipation,
muscle relaxant and  Use the smallest effective
diarrhea, dry mouth, dyspepsia,
anticonvulsant properties.
ADMINISTRATION: nausea dose in all patients.

5 mg at bedtime as needed

2. In addition to the drug regimen, does Ms. Espinoza have other risk factors for altered mental status?

3. Would you alter her drug regimen?  Does Ms. Espinoza have any risk factors for altered mental status?