Veras case study

For instance, she takes 50 mg of Zoloft once daily dose to manage depression, 75 mg twice daily dose of Voltaren SR to manage inflammation that causes pain and swelling of her ankle, 1000mg calcium carbonate supplements to replenish calcium in her body, and St. John Wort tablets for her anxiety. Thus, polypharmacy is being manifested here. In addition to that, she gets a regular massage to ease her stress and takes a balanced diet consisting of; whole grain, yogurt, grape and orange juice, salad, meat, tinned fish, espresso, and lots of water daily. This shows that she not only manages her health with drugs but also uses non-pharmacological remedies such as massage and diet. After administration, Sertraline’s absorption rate is relatively slow as more of the drug portion undergoes the first-pass effect to form a less potent active metabolite.

Its high protein bound when it reaches the plasma offering competition to other protein-bound drugs. It undergoes metabolism to form alcohol and a ketone and then removed from the body via renal excretion. Since it has a long elimination half-life of 26 hours, it is good for a single dose daily. It is a relatively safe drug since; it has a wide therapeutic window, it does not have influence on the cytochrome enzymes, and has fewer drug interactions that is life-threatening. It is a natural herb used in managing depression. Despite its good efficiency in managing depression, it has a potent inducer and a weak inhibitor activity of cytochrome enzymes, thus, posing a great risk for drug interactions (Zhou, Chan, Pan, Huang, & Lee, 2004). As stated above, both sertraline and Voltaren are highly protein bound, thus, there will be a displacement reaction.

Since NSAIDs have a strong affinity for the plasma proteins, Voltaren will displace sertraline already bound to plasma proteins, hence, increasing the levels of sertraline in blood. Thus, the dose of Sertraline given to Vera has to be reduced slightly to avoid sertraline toxicity (ME, 2019). Discuss any potential interactions and possible adverse events of the polypharmacy combination, dietary supplements, and diet. When polypharmacy, diet, and dietary supplements are combined, it is important for close monitoring of the patient to be done so as to prevent any adverse drug effects that may occur as a result of interactions. For the case of Vera, she had a combination of Voltaren SR, Sertraline hydrochloride, St. John Wort tablets, caffeine, calcium carbonate supplement, and grapefruit juice. The first possible drug-drug interaction is between Zoloft and diclofenac SR.

John Wort. Both of these drugs are used in the management of depression and work by increasing serotonin levels in the synaptic cleft. However, excess levels of serotonin in blood are dangerous and can lead to serotonin syndrome, a life-threatening condition characterized by hypertension, coma, hallucination, delirium, tremor, flushing, diarrhea, nausea, vomiting, and an elevated heart rate (Buckley, Dawson, & Isbister, 2014). Additionally, since St. Johns Wort is a potent inducer of cytochrome enzymes that metabolize antidepressants, thus, there will be a decreased concentration of the drug in the blood leading a decreased effect. As usual, grapefruit inhibits the metabolism of sertraline in the body, and as a result, it leads to accumulation of high concentration of sertraline in the blood leading to an elevated heart rate, nervousness, nausea, and drowsiness. The seventh possible diet and drug interaction is caffeine and Zoloft.

According to a study done by Szopa et al. caffeine causes an antidepressant effect. Therefore, when combined with antidepressants such as Zoloft, it enhances anti-depression caused by antidepressants. John Wort at the recommended dose of anxiety is 600-1800mg per day (Kobak, Futterer, & Warner, 2003). She needs to take St. John tablets in the morning while Sertraline tablets in the evening to avoid drug interaction. Since St. John wort tablets are natural, it will have less side effects on her. References Choi, H. K. Atkinson, K. Karlson, E. W. Liston, H. L. Markowitz, J. S. Clinical pharmacokinetics of sertraline.  Journal of Psychopharmacology, 18(2), 262-276. ME, W. Drug interactions with non-steroidal anti-inflammatory drugs (NSAIDs). PubMed - NCBI. Retrieved from https://www. J. Effects of St. John's wort supplementation on ibuprofen pharmacokinetics.  Annals of Pharmacotherapy, 41(2), 229-234.

Buckley, N. Serefko, A. Wośko, S. Wlaź, A. Wlaź, P. Caffeine enhances the antidepressant-like activity of common antidepressant drugs in the forced swim test in mice.  British Journal of Cardiac Nursing, 6(3), 142-143. Tabloski, P. A.  Gerontological nursing. Pearson Prentice Hall.