Herbal Sleeping Potion Was Mixed Into Tea And Taken At Bedtime

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Case Study 8-1: Cardiac Disease and Crisis

P.L., who has a 4-year history of heart disease, was brought to the emergency room by ambulance with chest pain that radiated down her arm, dyspnea, and syncope. Her routine meds included: Lanoxin to slow and strengthen her heart beat, Inderal to support her heart rhythm, Lipitor to decrease her cholesterol, Catapres to lower her hypertension, nitroglycerin prn for chest pain, Hydro-DIURIL to eliminate fluid and decrease the workload of her heart, Diabinese for her diabetes, and Coumadin to prevent blood clots. She also took Tagamet for her stomach ulcer and several OTC preparations, including an herbal sleeping potion that she mixed in tea, and Metamucil mixed in orange juice every morning for her bowels. Shortly after admission, P.L.'s heart rate deteriorated into full cardiac arrest. Immediate resuscitation was instituted with cardiopulmonary resuscitation (CPR), defibrillation, and a bolus of IV epinephrine. Between shocks she was given a bolus of lidocaine and a bolus of diltiazem plus repeated doses of epinephrine every 5 minutes. P.L. did not respond to resuscitation. On the death certificate, her primary cause of death was listed as cardiac arrest. Multiple secondary diagnoses were listed, including polypharmacy.

Case Study 8-2: Inflammatory Bowel Disease

A.E., a 19-year-old college student, was diagnosed at the age of 13 with Crohn disease, a chronic inflammatory disease that can affect the entire gastrointestinal tract from mouth to anus. A.E.'s disease is limited to his large bowel. During a 9-month period of disease exacerbation, he took oral corticosteroids (prednisone) to reduce the inflammatory response. He experienced many of the drug's side effects, but has been in remission for 4 years. Currently, A.E.'s condition is managed on drugs that reduce inflammation by suppressing the immune response. He takes Pentasa (mesalamine) 250mg 4 caps po bid. Pen-tasa is of the 5-ASA (acetylsalicylic acid or aspirin) group of anti-inflammatory agents, which work topically on the inner surface of the bowel. It has an enteric coating, which dissolves in the bowel environment. He also takes 6-mercaptopurine (Purinethol) 75 mg po qd and a therapeutic vitamin with breakfast. A.E. may take acetaminophen for pain but must avoid NSAIDs, which will irritate the intestinal mucosa (inner lining) and cause a flare-up of the disease.

Case Study 8-3: Asthma

E.N., a 20-year-old asthmatic woman, visited the preadmission testing unit one week before her cosmetic surgery to meet with the nurse and anesthesiologist. Her current meds included several bron-chodilators, which she takes by mouth and by inhalation, and a tranquilizer that she takes when needed for nervousness. She sometimes receives inhalation treatments with Mucomyst, a mucolytic agent. On E.N.'s preoperative note, the nurse wrote: Theo-Dur 1 cap tid.

Flovent inhaler 1 spray (50 mcg) each nostril bid. Ativan (lorazepam) 1 mg po bid.

Albuterol—metered dose inhaler 2 puffs (180 mcg) prn q4-6h for bronchospasm and before exercise.

E.N. stated that she has difficulty with her asthma when she is anxious and when she exercises. She also admitted to occasional use of marijuana and ecstasy, a hallucinogen and mood-altering illegal recreational drug. The anesthesiologist wrote an order for lorazepam 4 mg IV 1 hour preop. The plastic surgeon recommended several herbal products to complement her surgery and her recovery. He ordered a high-potency vitamin 3 tabs with breakfast and dinner to support tissue health and healing. He also prescribed Bromelain, an enzyme from pineapple, to decrease inflammation, 1 po qid 3 days before surgery and postoperatively for 2 weeks. Arnica Montana was prescribed to decrease discomfort, swelling, and bruising; 3 tabs sublingual tid the evening after surgery and for the following 10 days.


Multiple choice: Select the best answer and write the letter of your choice to the left of each number.

_ 1. P.L.'s nitroglycerine is ordered: prn SL. This means:

a. as needed, under the tongue b. at bedtime, under the tongue c. as needed, on the skin d. by mouth, on the skin e. by mouth, under the skin

Case Studies, continued


P.L. took several OTC preparations. OTC means:

a. on the cutaneous

b. off the cuff

c. over the counter

d. do not need a prescription

e. c and d


P.L.'s herbal sleeping potion was mixed into tea and taken at bedtime. The dissolved mix-

ture is called a(n) and is taken at .

a. elixir and QAM

b. emulsion and bid

c. suspension and hs

d. aqueous solution and hs

e. aqueous solution and QAM


During P.L.'s resuscitation, epinephrine was given in an IV bolus. This means it was


a. intrathecally in a continuous drip

b. parenterally in a topical solution

c. intravenously in a continuous drip

d. intravenously in a rapid concentrated dose

e. intrathecally in a rapid concentrated dose


P.L. had a secondary diagnosis of polypharmacy. This means that she:

a. used more than one drug store

b. had polyps

c. used more prescription than OTC drugs

d. had a toxic dose

e. used many different drugs


A.E. takes several drugs to prevent or act against his inflammatory response. These agents

are called drugs.

a. contrainflammatory

b. counterinflammatory

c. anti-inflammatory

d. corticosteroids



A.E. presented with several untoward results or risks from the corticosteroid therapy. These

sequelae are called:

a. contraindications

b. side effects

c. antagonistic effects

d. exacerbations

e. synergy states

8. A.E. takes four 250-mg capsules of Pentasa po bid. How many capsules does he take in one day?

9. A.E. must avoid NSAIDs; therefore, these drugs are__in inflammatory bowel disease.

a. contraindicated b. indicated c. complementary d. synergistic e. prescriptive

10. E.N. used a mucolytic drug when needed. This drug's action is to:

a. increase secretions b. decrease spasm c. calm anxiety d. decrease mucus secretions e. simulate mucus

11. E.N.'s Flovent inhaler is indicated as 1 spray of 50 mcg in each nostril bid. How many micrograms (mcg) does she get in 1 day?

a. 100 mcg b. 200 mcg c. 250 mcg d. 500 mcg e. 5,000 mcg

12. The Ativan that E.N. takes for nervousness is a(n) _ drug.

a. anxiolytic b. potentiating c. antiemetic d. analgesic e. bronchodilator

13. The anesthesiologist ordered lorazepam (Ativan) to be given IV preop to decrease anxiety and to smooth E.N.'s anesthesia induction. The complementary way that lorazepam and anesthesia work together is called:

a. antagonistic b. complementary medicine c. parasympathomimetic d. tolerance e. synergy

14. Bromelain and Arnica Montana are herbal products that can be described as all of the following except:

a. phytopharmaceutical b. alternative c. herbal d. complementary e. chronotropic

15. Arnica Montana was prescribed 3 tabs SL tid. How many tabs would E.N. take in 1 day?

16. Flovent is administered as an inhalant. The form in which the drug is prepared is called a(n) _.

a. emulsion b. elixir c. aerosol d. suspension e. unguent


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Anxiety and Panic Attacks

Anxiety and Panic Attacks

Suffering from Anxiety or Panic Attacks? Discover The Secrets to Stop Attacks in Their Tracks! Your heart is racing so fast and you don’t know why, at least not at first. Then your chest tightens and you feel like you are having a heart attack. All of a sudden, you start sweating and getting jittery.

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