Medical Case Study: Desyrel 300 Mg Paid
Case Study 1 40-year-old woman
* Desyrel 300 mg bid
* Klonopin 2 mg bid
* Aricept 10 mg qd
* Zoloft 100 mg qd
* Synthroid 0.25 mg qd
* Detrol XL 4 mg qd
* Norpace 150 mg bid
* Inderal 80 mg bid
* Bumex 2 mg qd
* Aldactone 100 mg qd
* Avapro 300 mg qd
* Prinivil 40 mg qd
* Glucophage 850 mg bid
DESYREL (1) 300 mg bid
The active pharmaceutical ingredient in it is trazadone, an oral drug available as a regular/extended release tablet to be taken twice daily.
STRUCTURE
MECHANISM OF ACTION
It is a selective serotonin receptor inhibitor that inhibits reuptake of serotonin and causes subsensitivity of adrenoceptors. It induces significant changes in 5HT presynaptic adrenoceptor. It also blocks histamine (H1) and α1- adrenergic receptors significantly. …show more content…
SIDE EFFECTS:
Headache, nausea, vomiting, diarrhea, constipation, weakness, nervousness, confusion, muscle pain, rash, sweating, blurred vision, ringing in ears, shortness of breath, dry mouth, fainting.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Disopyramide
Contraindicated QTc interval prolongation This combination is not to be used.
Sertraline
Serious interactions Increase in serotonin levels An alternative is to be used
Tolteridone and clonazepam Significant interactions Decrease cholinergic effects and increase sedation To be monitored closely
Metformin and bumetanide Minor interactions Increase in metformin effects by pharmacodynamic synergism To be monitored
KLONOPIN (1) 2mg bid
The active pharmaceutical ingredient in it is clonazepam, an oral drug to be taken twice daily.
STRUCTURE
MECHANISM OF ACTION
The exact mechanism is not clear, but it increases the activity of GABA receptors. In absence seizures it suppresses the spike and wave discharge by reducing nerve transmission in the motor cortex.
SIDE EFFECTS
Drowsiness, dizziness, coordination problems, blurred vision, increased saliva production, frequent urination and swelling of eyes, lips, and throat.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone Significant interactions Increases sedation To be monitored closely
ARICEPT (1) 10mg qd
The active pharmaceutical ingredient in it is donepezil. It is available as oral dosage form taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a centrally acting acetylcholinestarase inhibitor, an enzyme responsible for the hydrolysis of acetylcholine. This results in the increased concentrations of acetylcholine available for the synaptic transmission in CNS. It is mainly used in the treatment of Alzheimer’s disease, which increases cortical acetylcholine.
SIDE EFFECTS
Nausea, vomiting, loss of appetite, weight loss, muscle cramps, tiredness, depression, confusion, behavioral changes, hallucinations and red or itchy skin.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Tolteridone
Significant interactions Decreases cholinergic effects To be monitored
Sertraline and trazodone Minor interactions Effects hepatic enzyme CYP2D6 metabolism and decreases cholinergic effects To be monitored
ZOLOFT (1) 100mg qd
The active pharmaceutical ingredient is sertraline, to be taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is involved in the inhibition of CNS neuronal uptake of serotonin (5HT)
SIDE EFFECTS
Blurred vision, nausea, diarrhea, constipation, gas/bloating, drowsiness, dizziness, loss of appetite, sore throat, changes in sex drive, tingling in hands and feet.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone
Serious interactions Increase in serotonin levels An alternative is to be used
Propranolol
Significant interactions
Increased effects of propranolol by affecting hepatic enzyme CYP2D6 metabolism To be monitored closely
Donepezil, tolteridone and bumetanide
Minor interactions
Pharmacodynamic synergism
To be monitored
SYNTHROID (1,3) 0.25 mg qd
The active pharmaceutical ingredient in it is levothyroxine (T4), taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a synthetic form of thyroxine (T4), secreted by thyroid gland. T4 is converted to T3 (Triiodothyronine). T3 and T4 when bound to thyroid receptor proteins it stimulate metabolic effects by transcription and protein synthesis.
SIDE EFFECTS
Tremors, weight loss, headache, stomach cramps, menstrual cycle changes, nervousness, temporary hair loss and arrhythmia.
POTENTIAL DRUG INTERACTIONS (2)
No potential drug interactions were found.
DETROL (1) 4mg qd
The active pharmaceutical ingredient in it is tolterodine, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a competitive antagonist of muscarinic receptors, which involves in the contraction of urinary bladder. It increases residual urine volume and decreases detrusor muscle pressure.
SIDE EFFECTS
Dry mouth, blurred vision, stomach upset, constipation, rash, chest pain, difficulty urinating.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Donepezil and trazodone
Significant interactions
Donepezil increases cholinergic effects and tolteridone decreases cholinergic effects. To be monitored
Sertraline Minor interactions Increases tolteridone effects by affecting CYP2D6 metabolism To be monitored
NORPACE (1,3) 150mg bid
The active pharmaceutical ingredient is disopyramide to be taken twice daily.
STRUCTURE
MECHANISM OF ACTION
It is a class 1a anti-arrhythmic drug, which decreases myocardial excitability. It also decreases disparity in refractory period between normal and infarcted myocardium. It has anticholinergic, peripheral vasoconstrictive, and negative inotropic effects.
SIDE EFFECTS
Dizziness, dry mouth, stomach pain, headache, blurred vision, constipation, urination difficulty.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone
Contraindicated QTc interval prolongation This combination is not to be used
Spironolactone
Significant interactions
Increased effects of disopyramide by pharmacodynamic synergism. To be monitored closely
INDERAL (1) 80 mg bid
The active pharmaceutical ingredient is propranolol, taken twice daily.
STRUCTURE
MECHANISM OF ACTION
It is a non-selective beta-adrenergic blocker. It competitively blocks response to β1, β2 adrenergic stimulation.
SIDE EFFECTS
Dizziness, sleep difficulties, tiredness, stomach upset, rash, diarrhea, constipation.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Sertraline, irbesartan and spironolactone
Significant interactions
Increases propranolol effects by affecting CYP2D6 metabolism. Irbesartan increases serum potassium levels To be monitored closely
BUMEX (1,3) 2mg qd
The active ingredient is bumetanide, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It interferes with chloride binding co-transport system in ascending loop of henle and proximal convoluted tubule and thereby inhibits reabsorption of sodium and chloride ions.
SIDE EFFECTS
Muscle cramps, weakness, dizziness, faintness, thirst, stomach upset and diarrhea.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Lisinopril and propranolol Significant interactions
Pharmacodynamic synergism and propranolol increases serum potassium levels To be monitored closely
ALDACTONE (1,3) 100 mg qd
The active ingredient is spironolactone, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a potassium-sparing diuretic, specific pharmacologic antagonist of aldosterone that acts primarily through competitive binding of receptors at the aldosterone dependent sodium potassium exchange site in distal convoluted tubule.
SIDE EFFECTS
Headache, irregular menstrual periods, dizziness, thirst, tiredness, increased growth of hair on body parts, painful breasts, vaginal bleeding during post menopause.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Lisinopril
Significant interactions Pharmacodynamic synergism To be monitored closely
Disopyramide Significant interactions Increase in disopyramide effects by pharmacodynamic synergism To be monitored closely
AVAPRO (1) 300mg qd
The active pharmaceutical ingredient is irbesartan taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is an angiotensin receptor antagonist. It binds to angiotensin II receptor, which blocks the vasoconstriction and aldosterone secreting effects of angiotensin II.
SIDE EFFECTS
Diarrhea, heartburn and excessive tiredness.
POTENTIAL DRUG INTERACTIONS(2)
Drugs that interact Interaction category Parameters altered Suggestion
Lisinopril
Serious interactions
Increases toxicity of others by pharmacodynamic synergism An alternative is to be used
Propranolol and spironolactone Significant interactions Pharmacodynamic synergism To be monitored closely
Bumetanide Significant interactions Decreases serum potassium levels To be monitored closely
PRINIVIL (1,3) 40mg qd
The active ingredient in it is lisinopril, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a competitive inhibitor of angiotensin-converting enzyme. It inhibits conversion of angiotensin I to angiotensin II that decreases levels of angiotensin II. It also causes increase in plasma renin activity and decrease in the secretion of aldosterone.
SIDE EFFECTS
Cough, dizziness, headache, nausea, weakness, runny nose, sneezing, decrease in sexual activity and tiredness.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Irbesartan
Serious interactions
Increases toxicity of other drugs by pharmacodynamic synergism An alternative is to be used
Bumetanide and spironolactone
Significant interactions
Pharmacodynamic synergism To be monitored closely
GLUCOPHAGE (1,3) 850mg bid
The active ingredient in it is metformin, taken twice daily.
STRUCTURE
MECHANISM OF ACTION
By decreasing intestinal absorption of glucose it decreases hepatic glucose production. It also increases insulin sensitivity.
SIDE EFFECTS
Diarrhea, bloating/gas, indigestion, constipation, stomach pain, heart burn, nail changes and muscle pain.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone Minor interactions Increase in metformin effects by pharmacodynamic synergism To be monitored
ASSESSMENT
From the above medication list given, we can diagonise that the patient suffers from depression, hypothyroidism, bladder muscle spasm, arrhythmia, hypertension and type-II diabetes. To manage depression, Desyrel, Klonopin, Aricept, and Zoloft were used. Synthroid was used for the management of hypothyroidism. For the condition of urinary incontinence, Detrol was used. For arrhythmia, Norpace and Inderal were used. Bumex, Aldactone, Avapro and Prinivil were used to treat hypertension. Glucophage was used to treat the condition of type II
diabetes.
References
1. Drug Information Handbook (Lexicomp's Drug Reference Handbooks) 22nd Edition
2. http://reference.medscape.com/drug-interactionchecker
3. Joseph T. Dipiro, “ Pharmacotherapy-A pathophysiological approach”, 9th edition.
Case Study 2
* Desyrel 300 mg bid
* Klonopin 2 mg bid
* Aricept 10 mg qd
* Zoloft 100 mg qd
* Synthroid 0.25 mg qd
* Detrol XL 4 mg qd
* Norpace 150 mg bid
* Inderal 80 mg bid
* Bumex 2 mg qd
* Aldactone 100 mg qd
* Avapro 300 mg qd
* Prinivil 40 mg qd
* Glucophage 850 mg bid
DESYREL (1) 300 mg bid
The active pharmaceutical ingredient in it is trazadone, an oral drug available as a regular/extended release tablet to be taken twice daily.
STRUCTURE
MECHANISM OF ACTION
It is a selective serotonin receptor inhibitor that inhibits reuptake of serotonin and causes subsensitivity of adrenoceptors. It induces significant changes in 5HT presynaptic adrenoceptor. It also blocks histamine (H1) and α1- adrenergic receptors significantly. …show more content…
SIDE EFFECTS:
Headache, nausea, vomiting, diarrhea, constipation, weakness, nervousness, confusion, muscle pain, rash, sweating, blurred vision, ringing in ears, shortness of breath, dry mouth, fainting.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Disopyramide
Contraindicated QTc interval prolongation This combination is not to be used.
Sertraline
Serious interactions Increase in serotonin levels An alternative is to be used
Tolteridone and clonazepam Significant interactions Decrease cholinergic effects and increase sedation To be monitored closely
Metformin and bumetanide Minor interactions Increase in metformin effects by pharmacodynamic synergism To be monitored
KLONOPIN (1) 2mg bid
The active pharmaceutical ingredient in it is clonazepam, an oral drug to be taken twice daily.
STRUCTURE
MECHANISM OF ACTION
The exact mechanism is not clear, but it increases the activity of GABA receptors. In absence seizures it suppresses the spike and wave discharge by reducing nerve transmission in the motor cortex.
SIDE EFFECTS
Drowsiness, dizziness, coordination problems, blurred vision, increased saliva production, frequent urination and swelling of eyes, lips, and throat.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone Significant interactions Increases sedation To be monitored closely
ARICEPT (1) 10mg qd
The active pharmaceutical ingredient in it is donepezil. It is available as oral dosage form taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a centrally acting acetylcholinestarase inhibitor, an enzyme responsible for the hydrolysis of acetylcholine. This results in the increased concentrations of acetylcholine available for the synaptic transmission in CNS. It is mainly used in the treatment of Alzheimer’s disease, which increases cortical acetylcholine.
SIDE EFFECTS
Nausea, vomiting, loss of appetite, weight loss, muscle cramps, tiredness, depression, confusion, behavioral changes, hallucinations and red or itchy skin.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Tolteridone
Significant interactions Decreases cholinergic effects To be monitored
Sertraline and trazodone Minor interactions Effects hepatic enzyme CYP2D6 metabolism and decreases cholinergic effects To be monitored
ZOLOFT (1) 100mg qd
The active pharmaceutical ingredient is sertraline, to be taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is involved in the inhibition of CNS neuronal uptake of serotonin (5HT)
SIDE EFFECTS
Blurred vision, nausea, diarrhea, constipation, gas/bloating, drowsiness, dizziness, loss of appetite, sore throat, changes in sex drive, tingling in hands and feet.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone
Serious interactions Increase in serotonin levels An alternative is to be used
Propranolol
Significant interactions
Increased effects of propranolol by affecting hepatic enzyme CYP2D6 metabolism To be monitored closely
Donepezil, tolteridone and bumetanide
Minor interactions
Pharmacodynamic synergism
To be monitored
SYNTHROID (1,3) 0.25 mg qd
The active pharmaceutical ingredient in it is levothyroxine (T4), taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a synthetic form of thyroxine (T4), secreted by thyroid gland. T4 is converted to T3 (Triiodothyronine). T3 and T4 when bound to thyroid receptor proteins it stimulate metabolic effects by transcription and protein synthesis.
SIDE EFFECTS
Tremors, weight loss, headache, stomach cramps, menstrual cycle changes, nervousness, temporary hair loss and arrhythmia.
POTENTIAL DRUG INTERACTIONS (2)
No potential drug interactions were found.
DETROL (1) 4mg qd
The active pharmaceutical ingredient in it is tolterodine, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a competitive antagonist of muscarinic receptors, which involves in the contraction of urinary bladder. It increases residual urine volume and decreases detrusor muscle pressure.
SIDE EFFECTS
Dry mouth, blurred vision, stomach upset, constipation, rash, chest pain, difficulty urinating.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Donepezil and trazodone
Significant interactions
Donepezil increases cholinergic effects and tolteridone decreases cholinergic effects. To be monitored
Sertraline Minor interactions Increases tolteridone effects by affecting CYP2D6 metabolism To be monitored
NORPACE (1,3) 150mg bid
The active pharmaceutical ingredient is disopyramide to be taken twice daily.
STRUCTURE
MECHANISM OF ACTION
It is a class 1a anti-arrhythmic drug, which decreases myocardial excitability. It also decreases disparity in refractory period between normal and infarcted myocardium. It has anticholinergic, peripheral vasoconstrictive, and negative inotropic effects.
SIDE EFFECTS
Dizziness, dry mouth, stomach pain, headache, blurred vision, constipation, urination difficulty.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone
Contraindicated QTc interval prolongation This combination is not to be used
Spironolactone
Significant interactions
Increased effects of disopyramide by pharmacodynamic synergism. To be monitored closely
INDERAL (1) 80 mg bid
The active pharmaceutical ingredient is propranolol, taken twice daily.
STRUCTURE
MECHANISM OF ACTION
It is a non-selective beta-adrenergic blocker. It competitively blocks response to β1, β2 adrenergic stimulation.
SIDE EFFECTS
Dizziness, sleep difficulties, tiredness, stomach upset, rash, diarrhea, constipation.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Sertraline, irbesartan and spironolactone
Significant interactions
Increases propranolol effects by affecting CYP2D6 metabolism. Irbesartan increases serum potassium levels To be monitored closely
BUMEX (1,3) 2mg qd
The active ingredient is bumetanide, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It interferes with chloride binding co-transport system in ascending loop of henle and proximal convoluted tubule and thereby inhibits reabsorption of sodium and chloride ions.
SIDE EFFECTS
Muscle cramps, weakness, dizziness, faintness, thirst, stomach upset and diarrhea.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Lisinopril and propranolol Significant interactions
Pharmacodynamic synergism and propranolol increases serum potassium levels To be monitored closely
ALDACTONE (1,3) 100 mg qd
The active ingredient is spironolactone, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a potassium-sparing diuretic, specific pharmacologic antagonist of aldosterone that acts primarily through competitive binding of receptors at the aldosterone dependent sodium potassium exchange site in distal convoluted tubule.
SIDE EFFECTS
Headache, irregular menstrual periods, dizziness, thirst, tiredness, increased growth of hair on body parts, painful breasts, vaginal bleeding during post menopause.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Lisinopril
Significant interactions Pharmacodynamic synergism To be monitored closely
Disopyramide Significant interactions Increase in disopyramide effects by pharmacodynamic synergism To be monitored closely
AVAPRO (1) 300mg qd
The active pharmaceutical ingredient is irbesartan taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is an angiotensin receptor antagonist. It binds to angiotensin II receptor, which blocks the vasoconstriction and aldosterone secreting effects of angiotensin II.
SIDE EFFECTS
Diarrhea, heartburn and excessive tiredness.
POTENTIAL DRUG INTERACTIONS(2)
Drugs that interact Interaction category Parameters altered Suggestion
Lisinopril
Serious interactions
Increases toxicity of others by pharmacodynamic synergism An alternative is to be used
Propranolol and spironolactone Significant interactions Pharmacodynamic synergism To be monitored closely
Bumetanide Significant interactions Decreases serum potassium levels To be monitored closely
PRINIVIL (1,3) 40mg qd
The active ingredient in it is lisinopril, taken once daily.
STRUCTURE
MECHANISM OF ACTION
It is a competitive inhibitor of angiotensin-converting enzyme. It inhibits conversion of angiotensin I to angiotensin II that decreases levels of angiotensin II. It also causes increase in plasma renin activity and decrease in the secretion of aldosterone.
SIDE EFFECTS
Cough, dizziness, headache, nausea, weakness, runny nose, sneezing, decrease in sexual activity and tiredness.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Irbesartan
Serious interactions
Increases toxicity of other drugs by pharmacodynamic synergism An alternative is to be used
Bumetanide and spironolactone
Significant interactions
Pharmacodynamic synergism To be monitored closely
GLUCOPHAGE (1,3) 850mg bid
The active ingredient in it is metformin, taken twice daily.
STRUCTURE
MECHANISM OF ACTION
By decreasing intestinal absorption of glucose it decreases hepatic glucose production. It also increases insulin sensitivity.
SIDE EFFECTS
Diarrhea, bloating/gas, indigestion, constipation, stomach pain, heart burn, nail changes and muscle pain.
POTENTIAL DRUG INTERACTIONS (2)
Drugs that interact Interaction category Parameters altered Suggestion
Trazodone Minor interactions Increase in metformin effects by pharmacodynamic synergism To be monitored
ASSESSMENT
From the above medication list given, we can diagonise that the patient suffers from depression, hypothyroidism, bladder muscle spasm, arrhythmia, hypertension and type-II diabetes. To manage depression, Desyrel, Klonopin, Aricept, and Zoloft were used. Synthroid was used for the management of hypothyroidism. For the condition of urinary incontinence, Detrol was used. For arrhythmia, Norpace and Inderal were used. Bumex, Aldactone, Avapro and Prinivil were used to treat hypertension. Glucophage was used to treat the condition of type II
diabetes.
References
1. Drug Information Handbook (Lexicomp's Drug Reference Handbooks) 22nd Edition
2. http://reference.medscape.com/drug-interactionchecker
3. Joseph T. Dipiro, “ Pharmacotherapy-A pathophysiological approach”, 9th edition.
Case Study 2