NGR 5172 Deliverable 5 Right Medication for the Right Situation

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NGR 5172 Deliverable 5 Right Medication for the Right Situation

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Student Name

Rasmussen University

NGR5172

Professor Name

Date

Medication Management and Discharge Planning for a Post–Coronary Artery Bypass Patient

Medication reconciliation is a vital procedure in patient care, especially during their recovery following a significant cardiac surgery like coronary artery bypass grafting (CABG). Since I am a newly graduated MSN-prepared nurse, I should know the reasons why it is necessary to continue, alter, or stop using medications in the postoperative and discharge stages to guarantee patient safety and the best recovery. The case of a 69-year-old patient with a lengthy medical history, such as myocardial infarction, hypertension, diabetes mellitus type II, cerebrovascular accident, COPD, chronic renal insufficiency, depression, and active smoking, has a complicated clinical picture that entails the intensive use of medications. The paper examines the medication used at home and on discharge by the patient to identify the possible medications that should be restarted, altered, or stopped, using the latest evidence and guidelines of postoperative care.

Part 1: Home Medications Review and Recommendations

• Zestril (Lisinopril): Continued Postoperative and at Discharge.

Lisinopril, as an ACE inhibitor, is employed to treat hypertension and avert the development of heart failure and kidney disease, especially in diabetic patients or those who have a history of a heart attack. It is better to continue after CABG to control blood pressure and enable cardiac remodeling (Alnemer, 2025). Nevertheless, close attention should be paid to the renal function and potassium content of the patient because of his chronic renal insufficiency. Research has shown that ACE inhibitors lower the death rate in patients with post-MI and post-CABG, provided that renal functions permit it.

• Metformin (Glucophage): Hold postoperatively, Resume when stable.

Metformin is the first-line agent in diabetes mellitus type II, but it is to be temporarily stopped during the postoperative period because of the likelihood of lactic acidosis, particularly in patients with renal failure or those who are undergoing contrast dye during cardiac catheterization. When the renal functionality is stable and the creatinine levels are within the safety limits, then metformin can be reintroduced (Liew et al., 2025). The American Diabetes Association (ADA, 2023) recommends safe administration of metformin in cases when the eGFR is above 45 mL/min/1.73 m 2 and the patient is hemodynamically stable.

• Eliquis (Apixaban): Hold First, Reassess before Resume.

Direct oral anticoagulant is prescribed apixaban, which is used to prevent atrial fibrillation stroke and systemic embolism. Temporary withholding of anticoagulants after CABG is to avoid the complications of surgical bleeding. The choice to resume relies on the risk of postoperative bleeding and cardiac rhythm stabilization. The evidence-based practice implies that anticoagulation should be resumed 4872 hours after surgery on the condition of hemostasis (Peng et al., 2023).

• Flomax (Tamsulosin): Continue at Discharge

Tamsulosin is given to treat benign prostatic hyperplasia (BPH) to help enhance urinary flow. No contraindications exist to continue with this medication following cardiac surgery, and normal urinary functioning aids in comfort and control of the bladder during the postoperative period. They should be continued so long as there is no problem of hypotension.

• Deltasone (Prednisone): Continue as Directed.

Prednisone is applied to chronic inflammatory complications, including COPD. Sudden withdrawal could cause adrenal insufficiency, particularly in cases where the patient was under long-term treatment (Shi et al., 2024). Thus, it must be maintained on a taper program as mentioned. Corticosteroids may predispose to infection, as well as worsen the healing of wounds, which is why it is vital to monitor them carefully.

• Cymbalta (Duloxetine): Continue Cautiously.

Duloxetine is an antidepressant that also helps with neuropathic pain. It should be continued to avoid withdrawal and stay sane (Prasad, 2024). Nevertheless, they can be monitored to interact with opioids and postoperative analgesics to avoid serotonin syndrome or CNS depression.

Part 2: Postoperative and Discharge Medications Review

• Aspirin (81 mg): Continue Indefinitely.

The guideline for secondary prevention of patients with coronary artery disease and post-CABG is aspirin. It inhibits graft occlusion and platelet aggregation. Research by the American College of Cardiology indicates that lifelong low-dose aspirin should be administered after CABG.

• Plavix (Clopidogrel): Continue for 12 Months Post-Surgery.

Clopidogrel is used together with aspirin in the form of dual aspirin platelet therapy (DAPT) to avert graft thrombosis and enhance the long-term outcomes. Its use is supported during 6-12 months of the postoperative period unless the risk of bleeding is more significant than the benefits (Peng et al., 2023). This should be sustained during discharge because of DAPT.

• Lopressor (Metoprolol): Continue at Discharge

Metoprolol is a beta-blocker that is vital in the regulation of heart rate, prevention of arrhythmias, and decreasing myocardial oxygen demand in case of cardiac surgery. It is also effective in the management of postoperative atrial fibrillation that was present in this patient before the operation (Ren et al., 2024). It is demonstrated that beta-blocker therapy after CABG reduces mortality and enhances cardiac outcomes.

• OxyContin (Oxycodone/ Acetaminophen): Short-Term Only.

Oxycodone-acetaminophen mix must be administered on a short-term basis to manage postoperative pain. The patient ought to be educated about safe use, tapering, and dependency likelihood. Since he has a history of depression and has several comorbidities, non-opioid pain management strategies should be used as a priority, where possible (Prasad, 2024).

• Seroquel (Quetiapine): Continue with Monitoring.

Quetiapine is employed to treat mood and sleep disorders. It can be carried on when prescribed due to the prevention of postoperative delirium or stabilization of depression (Liew et al., 2025). Cardiac monitoring is, however, significant as quetiapine may increase the QT interval, which may be dangerous in heart disease. Follow-up and dose review are recommended regularly.

Summary of Recommendations

The patient is to be discharged on lisinopril, tamsulosin, prednisone (with taper), duloxetine, aspirin, clopidogrel, metoprolol, and quetiapine. Only in case of renal functioning and the risks of bleeding, metformin and apixaban must be reintroduced. Oxycodone-acetaminophen must be administered for short-term pain treatment under close monitoring. This practice is in accordance with evidence-based cardiac recovery, secondary prevention, and chronic disease management guidelines (Alnemer, 2025).

Conclusion

In complex cardiac patients, medication reconciliation is a crucial procedure in the continuity of care and avoidance of adverse drug interactions. I am an MSN-prepared nurse, which means that working with the interdisciplinary team, I can evaluate renal activity, hemodynamics, and examine the current level of medication effectiveness to facilitate safe discharge. Using clinical judgment based on evidence-based practice, the nurse will be able to guarantee maximum recovery and reduce the risk of readmission. Adequate discharge planning, patient education, and follow-up monitoring are essential in obtaining long-term cardiovascular stability and a better quality of life.

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References for NGR 5172 Deliverable 5 Right Medication for the Right Situation

Alnemer, K. A. (2025). Exploring the impact of beta-blockers post-acute myocardial infarction in patients with preserved ejection fraction: A meta-analysis. Journal of Clinical Medicine, 14(11), 3969–3969. https://doi.org/10.3390/jcm14113969

Liew, A., Sunita Bavanandan, Hao, C., Lim, S. K., Prasad, N., Sahay, M., Paweena Susantitaphong, Roberts, V., Eranga Wijewickrama, Wong, M. G., & Sydney. (2025). 2025 Update. Nephrology, 30(S2), 3–56. https://doi.org/10.1111/nep.70030

Peng, S., Chek Tien Tan, Li, D., Niu, Y., Liu, X., & Wang, R. (2023). BMC Pulmonary Medicine, 23(1), 304. https://doi.org/10.1186/s12890-023-02602-5

Prasad, K. (2024). Functional outcomes and complications of plate fixation in displaced midshaft clavicle fractures: A retrospective study. Azerbaijan Pharmaceutical and Pharmacotherapy Journal, 23(3), 1–5. https://doi.org/10.61336/appj/24-03-28

Ren, Y., Zhu, Y., Yan, Q., Jin, H., & Luo, H. (2024). A multicenter retrospective cohort study demonstrates a superior safety profile of indobufen over aspirin for post-CABG antiplatelet therapy. Frontiers in Pharmacology, 15(1), 1474150. https://doi.org/10.3389/fphar.2024.1474150

Shi, Y., Chen, S., Liu, G., Lian, B., Chen, Y., & Zhang, L. (2024). Journal of Cardiothoracic Surgery, 19(1), 422. https://doi.org/10.1186/s13019-024-02937-y

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