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NR 565 Week 3 Discussion: ANS Case Study/ Responses Responses Kaycee Parrillo Hello Kaycee. Thanks for your post. I agree with your treatment goals of discontinuing clonidine since the patient presents with adverse side effects. As reported by the patient, the tremors have since increased since she was placed on clonidine. However, you should have a plan to gradually discontinue the medication by tapering before eventually introducing propranolol. Considering the side effects on both drugs on patient with tremor, research shows that propranolol has been effective in reducing tremors with limited side effects as opposed to clonidine (Hall et al., 2016). I could not locate the article you used in this post, but found a similar study investigating the effect of clonidine in patients with essential tremor in double- blind placebo-controlled design, clonidine therapy was ineffective in treating essential tremor (Koller et al., 1986). It could be argued that the introduction of clonidine did not yield any effects on the patient. Therefore, a replacement would be the best option for Margaret. References: Hall, K., Kossowsky, J., Oberlander, T., Kaptchuk, T., Saul, J., & Wyller, V. et al. (2016). Genetic Variation in Catechol-O-Methyltransferase Modifies Effects of Clonidine Treatment in Chronic Fatigue Syndrome. The Pharmacogenomics Journal, 16(5), 454- 460. DOI: 10.1038/tpj.2016.53 Koller, W., Herbster, G., & Cone, S. (1986). Clonidine in the treatment of essential tremor. Movement Disorders, 1(4), 235–237. https://doi.org/10.1002/mds.870010403 Shawna MacMillan Hello Shawna. Thanks for your post. The first thing that I find outstanding in your post is patient education. To improve drug tolerance and adherence, the patient should be educated on the reason for the change of her drug alongside the importance of lifestyle modification. Studies have shown that patients education improves adherence to treatment and patient outcomes, especially when drugs are either stopped or changed (Scott, Magagnoli, & Hardin, 2016). Additionally, I agree with your alternative prescription of propranolol/hydrochlorothiazide 40mg/25 mg tablet BID, and a follow up in one week to evaluate BP monitor the tremors (Woo & Robinson, 2016). Finally, going through your teaching points, I find them consistent with most research studies in improving patient outcomes. Taking medication according to the prescription, taking propranolol with or without food, giving the patient the side effects to watch out for them, and prescribing an exit plan for tapering would help the patient stick to their dosage and follow the treatment plan. References: Scott S., Magagnoli, J., & Hardin, J. W. (2016). Impact of Pill Burden On Adherence, Risk of Hospitalization, And Viral Suppression in Patients with HIV Infection and Aids Receiving Antiretroviral Therapy. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(4), 385-401. Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (4th ed.). F.A. Davis Company.

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