St John's Wart Research Paper

Naproxen sodium, a nonsteroidal anti-inflammatory drug or NSAID, possesses analgesic, antipyretic and anti-inflammatory effects. Naproxen sodium was added to Jeff’s plan of care to treat his chronic back pain. NSAIDs are absorbed through the GI tract and decreases pain by reversibly blocking cyclooxygenase which inhibits the formation of prostaglandins. Naproxen sodium has an onset of 30 minutes and duration of approximately seven hours (Sutton, 1996). Jeff should be educated to avoid drinking alcohol and taking aspirin while on this medication as well as to avoid taking other meds such as ibuprofen or other meds similar to naproxen which could cause an overdose. Medications that Jeff is currently taking that could cause a drug interaction
are heart or blood pressure medications (Lisinopril or HCTZ), Insulin or oral diabetes medicines (Lantus and Metformin) and antidepressants (duloxetine). If the naproxen does not help relieve Jeff’s back pain, he should notify his primary care provider at his next visit so that his dosage can be changed or another medication can be prescribed.
Lantus and Congruence with Practice Guidelines
Insulin is a natural hormone produced by the body that helps lower levels of glucose (sugar) in the blood. Lantus, is a synthetic form of this medication used to mimic the natural effects of the insulin hormone for people with diabetes (Lantus (insulin pen) Uses, Dosage, Side, n.d.). Lantus is a long-acting insulin that is prescribed once a day and works evenly over a 24 hour period. Things to remember with Lantus is that it can cause hypoglycemia and should not be used when experiencing low blood sugars. It is important for Jeff to check his blood sugar throughout the day to avoid this. Jeff’s educated should be reinforced about symptoms of hypoglycemia including drowsiness, confusion, blurred vision, numbness or tingling in the mouth, trouble speaking, muscle weakness, clumsy or jerky movements, seizure, or loss of consciousness before beginning to take this new medication. It is important for him to take his Lantus at the same time each day, rotate injection sites and only use disposable needles and syringes once. He should also store the Lantus vials in the refrigerator or at room temperature and that the vials expire after 28 days.
Food, Drug and Herb Interactions
St Johns Wart interacts with many different medications.
It can either increase the effect of the drug or decrease it. It is broken down by liver enzymes, meaning any other drugs broken down by the same enzymes may cause an interaction. Atorvastatin is one of those drugs. St Johns Wart is known to decrease the effects of atorvastatin. St Johns Wart also increases the serum level of LDL and increases total cholesterol. Taking St Johns Wart with antidepressants may cause an interaction, mainly serotonin syndrome. A few medications that would cause this dangerous condition are Celexa, Zoloft, Lexapro, Cymbalta and Elavil. Serotonin syndrome symptoms include seizure, extreme changes in blood pressure, increased heart rate, confusion and could cause death. In people with major depressive disorders St Johns Wart may cause mania. St Johns Wart should be stopped 2 weeks before any surgery due to its effect on serotine levels in the brain affecting how sedatives work. Overall, St. John’s Wort can cause interactions with antidepressants, antihistamines, cough medications, anticoagulants, sedatives, alcohol, triptans, antifungals, and statins. Besides medications, St. John’s Wort should also not be taken with medications high in tyramine. Taking this herbal medicine with tyramine can cause an elevation in blood pressure. Foods with tyramine include sausage, poultry, beer, aged cheese, and cough medicines. Jeff should be educated on all of these negative effects of St. Johns Wort and his current antidepressant medication should be reevaluated for effectiveness. Another antidepressant or a combination of medications may be prescribed to better control Jeff’s depression and make his transition away from this herbal medication more
successful.