Question

B.Y. is a 78 year-old woman that was brought to the ER of her local hospital when she developed symptoms of a stroke. Her neighbor had checked on her and found that she couldn’t speak or move her right arm. The neighbor knows B.Y. quite well and told the ambulance crew that B.Y. had stopped taking her Toprol XL a few weeks ago because it made her feel so tired. She’d stopped taking her daily aspirin because it upset her stomach. The Toprol XL was prescribed for atrial fibrillation and the aspirin to prevent clot formation from atrial fibrillation. In the hospital, B.Y. was determined to have had a stroke and was admitted to the neuro floor for further treatment. She was started on subcutaneous heparin and an intravenous beta blocker. Because she was unable to swallow, a nasogastric tube was placed and she was started on 2 tablespoons of an antacid TID through the tube. All further medications were given by the parenteral route, including a BID medication to prevent ulcers and a QID pain reliever. She also had an order for an acetaminophen rectal suppository, 500 mg., if fever of >101 degrees developed. On her third hospital day, she developed an arrhythmia and her physician ordered lidocaine to be given intravenously immediately. 5. What advantage, in general, do intravenous drugs have that enteral doses do not, in terms of gastrointestinal effects of drug absorption? 6. What compliance issues did B.Y. have? 7. What could have been done to prevent the above compliance issues? 8. What conclusions about the ulcer prevention medications half-life could you reach, based of the dose frequency? 9. What kind of a drug classification is “beta blocker,” a therapeutic or pharmacological classification? 10. Was a topical medication contraindicated with this patient?

Answer 1

5. Intravenous route of drug administration has a rapid delivery of the drug. It allows administration of higher doses which cannot be given orally. It undergoes first pass metabolism. It does not depend on the gut function and allows administration of large volume of fluids.
6. The compliance issues that B.Y. had are tiredness and upset stomach.
7. For tiredness she can be asked to increase her calorie intake, take frequent rests and get assistance for doing her works. For upset stomach she can be put on antacids.