HNN215 Quality Use of Medicines: Assessment Answer

Slide 1

• Through this presentation, the aim is to communicate about concerns related to the administration of Tramadol to the patient named Imogen Carey
• Imogen is a 30 year old woman who had an open appendectomy due to severe abdominal pain.
• Post-surgery, she reports pain of 8/10 and found to be agitated.

Notes: Based on the review of past medical history and medications for Imogen, there is safety concerns associated with the use of Tramadol due to likelihood of drug-drug interaction and risk of other adverse effects on patiengt.

Slide 2

• Imogen has a past history of migraine and low mood.
• She is taking St. John’s Wort for low mood and the drug may decrease the effectiveness of tramadol (Sevendik, 2020)
• Imogen has been taking amitriptyline 10 mg nocte and rizatriptan 10 mg prn for her migraine. Tramadol has a chance of interaction with these two drugs and there is a high possibility of adverse effects (Vázquez et al., 2022)..

Note: Tramadol is a group of narcotics that is used to treat severe to moderate pain (Terman, 2020). Evidence shows that St. John’s wort should not be taken with any narcotics as it can decrease the drug effectiveness (Sevindik, 2020). Both tramadol and St John’s wort can increase the serotonin levels in the blood and can increase high blood pressure and heart rate in patient that can lead to shock (Sevindik, 2020). Hence, the surgeon should consider if St. John’s wort can be discontinued before administering tramadol to patient.

Amitriptylin is a drug given for management of depression and taking the drug with tramadol may increase the risk of seizures and other side-effects (Davis, 2020). Currently, Imogen is agitated and experiencing tremors and the use of amitriptyline along with tramadol can further complicate the problem. Hence, the patient safety needs to be considered and we should decide whether Tramadol is suitable to be used or it should be replaced with other drug that has no chance of interaction with other drugs. Similarly, use of tramadol along with rizatriptan can increase serotonin levels in the blood and cause side-effects such as hallucination, shivering and excessive sweating (Vázquez et al., 2022). Imogen may also experience fever, extreme changes in vital signs and shivering which could deteriorate her health condition further (Molina, Fairman & Sclar, 2018). Therefore, since Tramadol reduces the efficacy of the previously prescribed drugs or increases the risk of drug-drug interaction, it is advised to discontinue the drugs.

References

Davis, M. P. (2020). Amitriptyline and Depressions. NeuroPsychopharmacotherapy, 1-19.

Molina, K. C., Fairman, K. A., & Sclar, D. A. (2018). Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits. Drug, Healthcare and Patient Safety, 37-43.

Sevindik, C. S. (2020). St. John’s wort (Hypericum Perforatum)-Induced Psychotic Episode: Case Report. International Journal of Medical Reviews and Case Reports, 4(4), 114-114

Terman, G. (2020). Is Tramadol an Opioid or a Nonopioid Analgesic? Yes. Update, 10.

Vázquez, M., Guevara, N., Maldonado, C., Guido, P. C., & Schaiquevich, P. (2020). Potential pharmacokinetic drug-drug interactions between cannabinoids and drugs used for chronic pain. BioMed research international, 2020.

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