PHAR 1000 – Basic Pharmocotherapeutics
Eileen J. Arellano
Norquest College
Practical Nurse- Section D01
PHAR 1000 Written Assignment
Heather Zirk RN, BN
September 15, 2014 CASE STUDY:
Name of Client: Maggie Sears
Age: 66 years old
Primary Diagnosis: Cellulitis to left leg
Secondary Diagnosis: Depression Osteoporosis Type 2 Diabetes Mellitus
Past Surgical History: Tonsillectomy- as child Cholecystectomy- 15 years ago (51 years old)
Current Medications: “migraine pills” St. John’s wort oil – for skin inflammation to left leg (for a week)

Past History: Smokes ½ a pack of cigarettes per day (since she was a teenager)
Weight: 70 kg
Height: 150 cm

DOCTOR’S ORDER:
Medications:
Ancef 750 mg IV q12h
Elavil 50 mg po
NSAIDs (Aspirin)- Cross-sensitivity may exist
Sulfonamides- History of allergic-type reactions.
Interaction with Medications Ordered:
ASPIRIN: Cross-Sensitivity
Elavil (Amitriptyline)
Potential Drug Interaction: Amitriptyline is metabolized in the liver by the cytochrome P40 2D6 enzyme, and its action may be affected by drugs that compete for metabolism by this enzyme, including antidepressants.
Phenothiazines, Carbamazepine, class 1C Antiarrhythmics (Propafenone and Flecainaide)- reduce dosage when used with amitriptyline d/t metabolic competition.
Cimetidine, Quinidine, Amiodarone, and Ritnovir - ↑ effect of amitriptyline.
MAOI Inhibitors- hypotension, tachycardia and potential fatal reactions.
SSRI antidepressants- ↑toxicity. Should be avoided.
Clonidine- hypertensive crisis. Should be avoided.
Levodopa- delayed or ↓absorption of levodopa or hypertension.
Rifamycins- blood levels and effects may be decreased.
Moxifloxacin/Sparfloxacin- ↑ risk of adverse cardiovascular reactions.
CNS depressants (alcohol, antihistamines, clonidine, opiods and sedative/hypnotics –additive CNS depression.
Barbiturates- alter blood levels and effects.
Adrenergics and Anticholinergics- side effects may be additive with other agents having anticholinergic properties.
Phenothiazinesand Oral Contraceptives- ↑ metabolism and alter effects.
St.John’s Wort- may ↓ serum concentrations and efficacy.
Interaction with Medications Ordered:
ST. JOHN’S WORT (was not ordered but