Reflective Summary On Prescribing Practice Learning Nursing Essay

Reflective Summary On Prescribing en leave Learning breast feeding EssayThe author, a check practician found in an mite de fragmentizement (ED), from here on in exit be referred to as the practician. The practician is currently employed in a information role with the view, hobby training, of becoming an acute business organisation practitioner. This result entail working autonomously taking accurate clinical histories, physical examination, slang differential and working diagnosing and organise a architectural plan of c ar. This plan of cargon could well include a number of decreed medications. and then it is in the practitioners job description (as it is progressively in m both specialiser/autonomous nursing roles) to become a defy Indep wind upent and supplementary Prescriber (NISP).The Cumber rowlocke Report (1986) suggested that view ass should be able to prescribe independently and highlighted that longanimous cargon could be improved and resources employ much(prenominal) impellingly by doing so. It identify that nurses were wasting their time requesting prescriptions from Doctors. Since the publication of this seminal piece of work, non- checkup prescribing has been analysed, reflected upon, researched at nifty lengths and changes in practice made (DoH 1989, 1999, 2006 2008 Luker et al 1994 Latter et al 2011) and is unchanging under constant review.The aim of this portfolio is toReflect on practice as a means of on-going personal and professional development.Demonstrate a mental ability of integrating learn into practice.Submit a function of material mapped a netst the faculty learning outcomes, NMC 2006 prescribing standards, domains of practice and core competencies.Establish an evidence-based approach to practice competence as a safe independent supplementary prescriber.This prescribing practice portfolio pass on be a reflective portfolio using Rolfe et al (2001) poser of upbr serveing to aid learning from experienc e and close the gap surrounded by surmise and practice. This model has been chosen as it is something the practitioner is familiar with and has used before.The portfolio result conclude with a reflective summary on prescribing practice learning which depart draw together the evidence used to support performance of the competences identified. afterward addressing with colleagues who pee already completed the NISP course, the practitioner is aware(p)(predicate) of the labyrinthian nature and volume of work that is required over the duration of it. there is a feeling of nervousness due to this but in like manner a feeling excitement over what will be learnt. If successful the practitioner believes her practice will be enhanced signifi female genitalstly as she will bring in the ability to give patients seamless care.References part of Health. (1986) Neighbourhood nurse A Focus for fretfulness. (Cumberlege Report). capital of the United Kingdom HMSODepartment of Health. ( 1989) Report of the Advisory free radical on halt Prescribing. The Crown Report). capital of the United Kingdom HMSODepartment of Health. (1999) surveil Of Prescribing, fork out And Administration Of Medicines. (The Crown Report Two) London HMSO.Department of Health. (2006) Medicines Matters. London HMSODepartment of Health. (2008) Making Connections Using health care Professionals to Deliver Organisational Improvements. London HMSOLatter, S. Blenkinsopp, A. Smith, A. Chapman, S. Tinelli, M. Gerard, K. Little, P. Celino, N. Granby, T. Nicholls, P. Dorer, G. (2011) Evaluation of nurse and pharmacist independent prescribing. Faculty of Health Sciences, University of Southampton School of Pharmacy, Keele University on behalf of Department of Health On position Available at http//eprints.soton.ac.uk/184777/ Accessed 15th Sept 2012Luker, K. Austin, L. Hogg, C. Ferguson, B. Smith, K. (1998) support- enduring Relationships The context of obtain Prescribing. diary of Advanced breast feeding. (28) 2 235-242Rolfe, G. Freshwater, D. Jasper, M. (2001) Critical Reflection in Nursing and the Helping Professions a Users conduce. Basingstoke Palgrave Macmillan.ConsultationHolistic judgement Case probeIn this case hind endvas the cite, diagnosing, prescribing excerpts and decisions of a 35 year out of date female frontn in the ED will be discussed. This case drive will aim to improve the practitioners knowledge of conducting a cite and its kindred with making a diagnosis and handling options. To maintain confidentiality, in line with the code of professional conduct, the patient will be referred to as Mrs A (Nursing and midwifery Council (NMC), 2008).ConsultationExamining the holistic needs of the patient is the low gear of septet principles of good prescribing ( study Prescribing Centre (NPC), 1999) and must be under taken before making a decision to prescribe (NMC employ Standard 3, 2006). Holistic assessment takes into love the mind, body and spirit of the patient (Jarvis, 2008). Traditionally consultation and making a diagnosis has been completed by Doctors. However, nurse diagnosis would appear to have been formally acknowledged since The Crown Two Report (DoH, 1999) as part of the independent prescriber role. Horrocks et al, (2002), found greater patient satisfaction with nurse consultations than with GP consultations. Jennings et al, (2009) and Wilson Shifaza, (2008) also found this to be true of nurse practitioners working in emergency departments. Importantly, they also found no signifi crappert variation in former(a) health outcomes. Most of these studies found that consultations with nurses were to some extent longer, they offered more advice on self-care and self- anxiety and that nurses gave more training to patients.Although there are various consultation models that have been described (Byrne Long, 1976 Pendleton et al, 1984 Neighbour, 2005 Kurtz et al, 2003 Stott Davis, 1979), these are based upon observation o f doctor, non nurse consultations. Nevertheless, the consultation models and skills described in the medical lit are germane(predicate) to all practitioners (Baird, 2004). Consultation models second the practitioner centre the consultation approximately successful information exchange and try to provide a divinatory structure. Consultation models can also be used to help sterilize maximum use of the time available at each consultation (Simon, 2009). Traditionally the medical model is used to assess patients however it does non take into account the social, psychological, and other external factors of the patient. The model also overlooks that the diagnosis (that will affect handling of the patient) is a result of negotiation between doctor and patient (Frankel et al, 2003)In this case study, the practitioner has used Roger Neighbours model of consultation. This was found by the practitioner to be simple and easy to remember, whilst practical application all areas needed to m ake an issuingive consultation and assessment. He describes a 5 stage model which he refers to as a excursion with checkpoints along the wayConnecting establishing a relationship and ringing with the patient.Summarising taking a history from the patient including their ideas, expectations, concerns and summarising punt to the patient to ensure there are no mis minds.Handing over negotiating between the practitioners and patients agenda and agreeing on a charge plan.Safety netting the consideration of what if? and what the practitioner might do in each case.Housekeeping reflecting on the consultation.(Neighbour, 2005)ConnectingMrs A was called through to the Rapid Assessment and Treatment area in the ED. It was apparent from Mrs As facial scene and limp that walking caused her upset. Silverman Kinnersley, (2010) state that non-verbal communication is extremely primal and can often provide clues to underlying concerns or emotions. The practitioner had never met the patien t before so had no previous relationship with her but was aware that she may have pre-conceived ideas about the ED which may have caused her anxiety. The practitioner introduced herself to Mrs A, explained her job role, the process that was about to be undertook and consent obtained. During this time gist contact was maintained and the practitioner also asked Mrs A how she would like to be addressed. This was done to try and build up a rapport with Mrs A, to help her feel at ease and reassure her. Simon, (2009) and Moulton, (2007) agree and state that rapport is essential to effective communication and consultation. Mrs A was also offered a tram to sit on to make herself powderpuffable and the curtains pulled around for privacy and dignity. On reflection the practitioner was aware that the environment was a busy and wheezy assessment area and this can have a negative push on the consultation (Silverman et al, 2005). Identifying this with Mrs A and apologising may have re-assur ed her further and gained avow and respect.SummarisingThe practitioner began with an open ended question and did not interrupt the patients response. Neighbour, (2005) and Moulton, (2007) fire this to open the consultation. Gask Usherwood, (2002) found that if a practitioner interrupts, patients then rarely unwrap new information, which could lead to not finding out the real author for the consultation.Mrs A revealed that she received an insect bite to her right set down leg 5 twenty-four hour periods ago, since then the surrounding skin had become swollen, increasingly red, painful and hot to touch. She explained that the redness was cattle ranching up her leg and the pain was getting worse. Mrs A explained that she was concerned that it was not going to get weaken and was very worried that it had got worse during the last 3 days. Upon questioning Mrs A also complained of malaise and that she had been feeling very hot and cold and at generation. She had been managing to e at and drink as normal. Mrs A lived with her husband, was a non smoker and drank inebriant occasionally. She had no past medical history and took no prescribed or over the counter (otc) medications. It was also elicited that she was allergic to Penicillin which she had an anaphylaxis reaction to. pickings a medical, social, medication and allergy history is important as it can be relevant to the presenting complaint, makes sure key information has not been miss and is essential in preventing prescribing errors (Bickley, 2008 Young et al, 2009).The practitioner actively listened to what Mrs A was state by maintaining eye contact, using open questions and by summarising the history back to clarify points and to make sure nothing was missed. On reflection the practitioner feels this also gave the opportunity for Mrs A to add any(prenominal)(prenominal) further information not disclosed so far. Closed questions were then used to gain specific information related to the initial info rmation given, this is advised by Young et al, (2009) and Moulton, (2007). Effective communication is important as Epstein et al, (2008) explains that a nice history can supply at least 80% of the information necessary for a diagnosis.Upon examination there was obvious erythema. Light palpation revealed that the area was very warm and tender. Neurovascular assessment was performed and was unremarkable. Mrs As chest was clear, knocker sounds normal and her abdomen was soft, non tender. somatogenic examination is important as it is used to detect physical signs that the patient may not be aware of and can be used to confirm or disprove a possible diagnosis. It also suggests to the patient that their illness is being taken seriously. (Bickley, 2008, Charlton, 2006). Observations were taken including blood pressure, heart rate, temperature, respiratory rate and oxygen saturations. All were inside normal parameters except her temperature which was 38.2 degrees Celsius. Venous blood wa s taken to check haematological, biochemical and coagulation status. Mrs A white cell count (WCC) and C-reactive protein (CRP) levels were raise, all other blood results were normal.Handing OverBefore making a final diagnosis, it is important that differential diagnoses are excluded (Nazarko, 2012). The practitioners differential diagnoses were deep vein thrombosis (DVT) or venous eczema. However, Mrs A had a straightforward history (insect bite) that together with her observations (raised temperature), examination findings (redness, heat, extrusion and pain) and blood results (raised WCC and CRP) indicated an alternative diagnosis, so DVT and venous eczema were ruled out.The practitioners working diagnosis was cellulitis. This was discussed with Mrs A and she appeared reassured that a diagnosis had been made. The practitioner explained that she would like to discuss this with a senior Doctor to help decide on a interference plan. The practitioner presented the patient to an ED R egistrar who agreed with the diagnosis. Diagnosis, treatment and prescribing options were then discussed to aid the practitioners learning.Cellulitis is a bacterial infection of the skin and hypodermic waver which is potentially serious (Epstein et al, 2008). It is caused by one or more types of bacteria, most normally streptococci and staphylococcus aureus (Nazarko, 2012). Cellulitis usually occurs on the lower legs, arms and face but can arise anywhere on the body (Bickley, 2008). Patients with cellulitis present with signs of inflammation, distinctively heat, redness, swelling and pain (Nazarko, 2012). Inflammation is localised ab initio but amplifys as the infection progresses. Patients can be systemically unwell (pyrexial, tachycardic, hypotensive) and white cell count and C-reactive protein levels will be markedly raised (Beldon, 2011, Wingfield, 2009, Nazarko, 2012).It appears there is a general lack of evidence based literature surrounding the treatment of patients with cellulitis. The practitioner could only find one exit area guideline on the management of cellulitis in adults, which was published in 2005 by the clinical Resource might Support Team (CREST, 2005). However, to the practitioners knowledge, these have not been validated by a clinical study. Morris, (2008) found in his dictatorial review that antibiotics cure 50-100% of cases of cellulitis but did not find out which antibiotic regime was most successful. Kilburn et al, (2010) also could not find any classical conclusions in their Cochrane review on the optimal antibiotics, duration or travel plan of administration.Eron, (2000) devised a classification system for cellulitis and its treatment which CREST used in their guidelines. This system divides people with cellulitis into four classes and can serve as a useful guide to admission and treatment decisions. However Koerner Johnson, (2011) found in their retrospective study, comparing the treatment received with the CREST guidel ines, that patients at the mildest end of the spectrum were over treated and at the more severe end undertreated. They also found a significant variation in antibiotic regimes prescribed for patients with cellulitis. Marwick et al, (2011) questioned whether classes I and II could actually be merged to improve treatment.The practitioners trust has antibiotic guidelines (updated yearly) which also include a classification system. This aids the prescriber in choosing the correct antibiotic, venereal disease, route and duration for certain conditions, cellulitis being one of them. After discussion with the Registrar it was determined that Mrs A was in Class I or non-severe which meant she could be managed with oral exam antibiotics on an outpatient basis.The practitioners trust and CREST, (2005) guidelines advise first line treatment for non-severe or class I cellulitis as oral Flucloxacillin 500mg, three times a day. Flucloxacillin is a goly narrow-spectrum antibiotic commissioned for the treatment of cellulitis. However, Flucloxacillin was contra-indicated for Mrs A as she had a severe penicillin allergy (British depicted object Formulary, (BNF) 2012).Clarithromycin is a macrolide which has an antibacterial spectrum that is similar but not identical to that of penicillin they are thus an alternative in penicillin-allergic patients (BNF, 2012). Clarithromycin is commissioned and recommended by CREST, (2005), and by the practitioners trust, as an alternative to Flucloxacillin in cellulitis for patients with a Penicillin allergy. It is indicated in the BNF, (2012) for the treatment of mild to concord skin and soft-tissue infections. It demonstrates suitable pharmacokinetics, with good distribution into skin and soft tissues, and is effective against the large majority of staphylococcal and streptococcal bacteria that cause cellulitis (Accord Healthcare Limited, 2012), (See drug monologue page 21-28). There were no contraindications in prescribing Clarithromy cin for Mrs A.The option of not having any medication was discussed with Mrs A however, she wanted treatment so the benefits and side effects of Clarithromycin was explained, and consent obtained from Mrs A to prescribe the antibiotics and to be discharged, (NMC serve Standard 5, 2006). Dose and duration were then also clarified and the brilliance of taking the antibiotics as prescribed and to complete the full course. On reflection, by discussing and deciding on the best treatment together this would hopefully parent concordance. Negotiating with patients and agreeing on a management plan is very important human face of reaching patient centred care (Neighbour, 2005). Using an FP10 Clarithromycin tablets 500mg twice a day was prescribed by the Registrar (as the practitioner was not a licensed prescriber, NMC workout Standard 1, 2006), as per trust guidelines, for 7 days. Paracetamol tablets 1g four times a day was also prescribed for its analgesic and anti-pyretic properties ( BNF, 2012). A stat venereal infection of both were prescribed and the practitioner asked the nurse to administer the first dose (NMC Practice Standard 9 14, 2006), and was aware that by delegating this delegate the prescriber remained accountable. The FP10 was given to the patient to take to the pharmacy of her choice for them to dispense (NMC Practice Standard 10, 2006), (See mock prescription page 29).The practitioner did not initially contemplate cost effectiveness but on reflection it has been prize that this needs to be taken into consideration when prescribing (NPC, 1999). Intravenous antibiotics may have been prescribed, which may have meant an admission into hospital or administration by nurses on an outpatient basis thus would have enlarged the cost of treatment significantly. Admission to hospital can also be overwhelming and can put the patient at find of hospital acquired infections and increase risk of antibiotic resistance (Wingfield, 2008).Safety NettingThe eryt hematous border was marked, with the patients consent, with invariable pen to monitor for any improvement or additional spread of infection (CREST, 2005, Beldon, 2011). The practitioner advised Mrs A that she should return or see her GP if she had worsening symptoms or if by the completion of the course of antibiotics symptoms had failed to resolve. Mrs A was also advised that, if a similar incident occurred, she should seek medical assistance early so that treatment could begin as in brief as possible to reduce the risk of severe and long-term complications. In addition it was recommended that she should drink plenty of fluids to prevent dehydration, elevate the leg for comfort and to help reduce the swelling (CREST, 2005, Beldon, 2011). Mrs A was warned that there could be an increase in erythema in the first 24-48 hours of treatment (CREST, 2005). This advice and information empowered Mrs A and made sure that her discharge was as safe as possible.The practitioner brought the co nsultation to a close by asking Mrs A if she had any questions or if there was anything else she would like to discuss. This gave Mrs A the opportunity of clarifying any information given by the practitioner and the opportunity to divulge any information or concerns not previously mentioned. This re-assured the practitioner that she had addressed her difficulty purloinly.HousekeepingThe practitioner made sure there was clear aphoristic documentation of the consultation and choice of prescription in Mrs A notes (NMC Practice Standard 7, 2006). A discharge letter was also produced to send to her GP NMC Practice Standard 6, 2006). Once the prescription was ready, Mrs A was discharged.This case study has shown the practitioner the importance of effective communication in consultation. By following Neighbours consultation checkpoints it gave structure to the consultation and will be used by the practitioner in future practice. It has also helped the practitioner to gain an understandi ng of different prescribing options and how to explore these further. For example, the practitioner did find when reading around the subject that there has been some research on the use of corticosteroids in cellulitis to increase resolution, however, to the practitioners knowledge, this is not currently advised in any guidelines and further research is needed. The practitioner would also like to be involved in the development of a cellulitis pathway at her place of work. This could include an algorithm to aid practitioners to differential diagnosis so patients can receive appropriate treatment and reduce the incorrect prescribing of antibiotics.As there are no National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment and management of cellulitis, treatment of patients is not standardised and consequently quality of care could be affected. The optimal choice for antimicrobial therapy requires review and definitive study in clinical trials.ReferencesAcc ord Healthcare Limited (2012) Summary of Product Characteristics for Clarithromycin Capsules 500mg. online. electronic Medicines Compendium. Datapharm Communications Ltd. Available from http//www.medicines.org.uk/EMC/medicine/25914/SPC/Clarithromycin+500mg+Tablets/ Accessed 21ST September 2012Byrne, P. Long, B. (1976) Doctors Talking to Patients. London, HMSO.Baird, A. (2004) The Consultation. Nurse Prescriber. (1) 3 1-4British National Formulary No. 64 (2012) London BMJ Group and Pharmaceutical Press.Bickley, L. (2008) Bates Guide to Physical Examination and History Taking. sixth Ed. London Lippincott, Williams and Wilkins.Beldon, P. (2011) The Assessment, Diagnosis and Treatment of Cellulitis. Wound Essentials. (6) 60-68.Clinical Research Efficiency Support Team (2005) Guidelines on the oversight of Cellulitis in Adults. Belfast Clinical Research Efficiency Support Team.Charlton, R. (2006) Learning to Consult. Abingdon Radcliffe.Department of Health (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report) London HMSO.Epstein, O. Perkin, G. Cookson, J. De Bono, D. (2008) Clinical Examination. 4th Ed. London Mosby.Eron, L. (2000) Infections of throw together and Soft Tissues Outcome of A Classification Scheme. Clinical infectious Diseases. (31) 287Frankel, R. Quill, T. McDaniel, S. (2003) The Biopsychosocial Approach Past, Present, and Future. Rochester University Of Rochester Press.Gask L, Usherwood, T. (2002) ABC of Psychological Medicine The Consultation. British Medical Journal (324) 7353 1567-1569.Horrocks, S. Anderson, E. Salisbury, C. (2002) regular Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors. British Medical Journal. (324) 7341 819-823.Jarvis, C. (2008) Physical Examination and Health Assessment. 5th Ed. Missouri Saunders Elsevier.Jennings, N., Lee, G., Chao, K., Keating, S. (2009) A Survey of Patient Satisfaction in a Metropolitan Emergency Department analyse Nurse Practitioners to Emergency Physicians. International Journal of Nursing Practice (15) 213-218.Kilburn, S., Featherstone, P., Higgins, B., Brindle, R. Interventions for Cellulitis and Erysipelas. Cochrane Database Systematic Reviews. 2010 Issue 6, Art. No. CD004299. DOI10.1002/14651858.Koerner, R. Johnson, A. (2011) Changes in the classification and management of Skin and Soft Tissue Infections. Journal of Antimicrobial Chemotherapy. (66) 232-234.Kurtz S, Silverman J, Benson J, Draper J. (2003) Marrying Content and Process in Clinical Method Teaching Enhancing the Calgary-Cambridge Guides. Academic Medicine (78) 8 802-809.Marwick, C. Broomhall, J. McCoowan, C. Phillips, G. Gonzalez-McQuire, S. Akhras, K. Merchant, S. Nathwani. Davey, P. (2011) sharpness Assessment of Skin and Soft Tissue Infections Cohort Study of Management and Outcomes for Hospitalised patients. Journal of Antimicrobial Chemotherapy. (66) 387-397Morris, A. (2008) Cellulitis and Erysipelas. Clinical Evidence . online BMJ Publishing Group Ltd. Available at http//www.ncbi.nlm.nih.gov/pmc/articles/PMC2907977/ Accessed 10th September 2012Moulton L. (2007) The Naked Consultation A practical Guide to Primary Care Consultation skills. Abingdon Radcliffe.National Prescribing Centre. (1999) Signposts for Prescribing Nurses General Principles of Good Prescribing. Prescribing Nurse Bulletin. (1) 1-4.Nazarko, L. (2012) An Evidence-Based Approach to Diagnosis and Management of Cellulitis. British Journal of Community Nursing. (17) 1 6-12.Neighbour, R. (2005) The Inner Consultation. How to Develop an Effective and Intuitive Consulting Style. 2nd Ed. Oxford Oxford-Radcliffe.Nursing and obstetrics Council (2006) Standards of Proficiency for Nurse and Midwife prescribers. London Nursing and Midwifery Council.Nursing and Midwifery Council (2008) The Code Standards of Conduct, Performance and Ethics for Nurses and Midwives. London Nursing and Midwifery Council.Pendleton, D. Schofield, T. Tate, P. Haveloc k, P. (1984) The Consultation An Approach to Learning and Teaching. Oxford Oxford University Press.Silverman, J. Kurtz, S. Draper, J. (2005) Skills for Communicating with Patients. 2ND Ed. Oxford Radcliffe.Silverman, J. Kinnersley, P. (2010) Doctors Non-Verbal Behaviour in Consultations Look at the Patient Before You Look at The Computer. British Journal of General Practice. (60) 76-8.Simon, C. (2009) The Consultation. InnovAiT (2) 2 113-121. online Available at http//rcgp-innovait.oxfordjournals.org/content/2/2/113.full. Accessed 13th September 2012Stott, N. Davis, R. (1979) The Exceptional Potential in from each one Primary Care Consultation. Journal of the Royal College of General Practitioners. (29) 201-5.Wingfield, C. (2009) Lower branch Cellulitis A Dermatological Perspective. Wounds UK. (5) 2 26-36.Wingfield, C. (2008) Cellulitis Reduction of Associated Hospital Admissions. Dermatological Nurse 7(2) 44-50.Wilson, A. Shifaza, F. (2008) An Evaluation of the Effectiveness and Acceptability of Nurse Practitioners in an Adult Emergency Department. International Journal of Nursing Practice. (14) 149-156.Young, K. Duggan, L. Franklin, P. (2009) Effective Consulting and History-Taking Skills for Prescribing Practice. British Journal of Nursing. (18) 17 1056-1061.Drug Monologue.Name of DrugClarithromycinDrug ClassificationMacrolideTherapeutic Uses(s)Clarithromycin film-coated tablets are indicated in adults and adolescents 12 years and older for the treatment of the following bacterial infections, when caused by clarithromycin-susceptible bacteria. Acute bacterial exacerbation of chronic bronchitis Mild to moderate community acquired pneumonia. Acute bacterial sinusitis Bacterial pharyngitis. Skin infections and soft tissue infections of mild to moderate severity, such as folliculitis, cellulitis and erysipelasClarithromycin film-coated tablets can also be used in appropriate combination with antibacterial therapeutic regimens and an appropriate ulcer healing agent for the eradication of Helicobacter pylori in patients with Helicobacter pylori associated ulcersDose range and route(s) of administrationAdults and adolescents (12 years and older) Standard dosage The usual dose is 250 mg twice daily. High dosage treatment (severe infections) The usual dose may be increased to 500 mg twice daily in severe infections.Children junior than 12 yearsUse of Clarithromycin film-coated tablets is not recommended for children younger than 12 years. Use Clarithromycin paediatric suspensions. Clinical trials have been conducted using clarithromycin paediatric suspension in children 6 months to 12 years of age.ElderlyAs for adultsDosage in renal functional impairmentThe maximum recommended dosages should be reduced proportionately to renal impairment. In patients with renal impairment with creatinine headroom less than 30 mL/min, the dosage of clarithromycin should be reduced by one-half, i.e. 250 mg once daily, or 250 mg twice daily in more severe inf ections. Treatment should not be continued beyond 14 days in these patients.Patients with hepatic impairmentCaution should be exercised when administrating clarithromycin in patients with hepatic impairmentAdministered orally.PharmacodynamicsMode of ActionClarithromycin is a semi-synthetic first derivative of erythromycin A. It exerts its antibacterial action by binding to the 50s ribosomal sub-unit of susceptible bacteria and suppresses protein synthesis. It is highly potent against a wide variety of aerobic and anaerobic gram-positive and gram-negative organisms.The 14-hydroxy metabolite of clarithromycin also has antimicrobial activity. The MICs of this metabolite are equal or two-fold higher than the MICs of the parent compound, except for H. influenzae where the 14-hydroxy metabolite is two-fold more active than the parent compound. spatial relation EffectsDyspepsia, tooth and tongue discoloration, smell and taste disturbances, stomatitis, glossitis, and headache less commonly arthralgia and myalgia rarely tinnitus very rarely dizziness, insomnia, nightmares, anxiety, confusion, psychosis, paraesthesia, convulsions, hypoglycemia, renal failure, interstitial nephritis, leucopenia, and thrombopeniaInteractionsAprepitantClarithromycin possibly increases plasma concentration of aprepitantAtazanavirPlasma concentration of both drugs increased when Clarithromycin given with atazanavir.AtorvastatinClarithromycin increases plasma concentration of atorvastatin.CabazitaxelAvoidance of clarithromycin advised by manufacturer of cabazitaxel.Calcium-channel BlockersClarithromycin possibly inhibits metabolic process of calcium-channel blockers (increased risk of side-effects).CarbamazepineClarithromycin increases plasma concentration of carbamazepine.CiclosporinClarithromycin inhibits metabolism of ciclosporin (increased plasma concentration).ColchicineClarithromycin possibly increases risk of colchicine toxicity-suspend or reduce dose of colchicine (avoid backup use in hepatic or renal impairment).CoumarinsClarithromycin enhances anticoagulant effect of coumarins.DisopyramideClarithromycin possibly increases plasma concentration of disopyramide (increased risk of toxicity).DronedaroneAvoidance of clarithromycin advised by manufacturer of dronedarone (risk of ventricular arrhythmias).EfavirenzIncreased risk