Cases 1 to 4 Pharmacological Case Studies

Pharmacological Case Studies

Student’s Name

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Date

SCENARIO 1

In this scenario, Donald is experiencing shortness of breath, wheezing, a chronic productive cough and fatigue. This problem is associated with chronic obstructive pulmonary disease (COPD). This is especially given that he smokes cigarettes every day. To establish the extent of Donald’s pulmonary action, according to clinical practice guidelines, there is need to conduct various tests including spirometry, lung volume test, lung diffusion test, pulse oximetry, and exercise stress test. A chest X ray and a CT scan would also be crucial to establish whether there is a possibility for lung cancer (Iheanacho, Zhang, King, Rizzo, & Ismaila, 2020).

Pharmacological intervention for Donald’s case would first be bronchodilators including Long Acting beta-agonists (LABAS), Long-acting muscarinic antagonists (LAMAS) and short acting bronchodilators. The purpose of the recommended bronchodilators is to relax the muscles around the airways and allow the patient to breath easily. I will also request for inhaled corticosteroids and oxygen therapy.

For the SABAS, I would prescribe albuterol (2-4) puffs every 5 hours. For the LABAS, I would prescribe salmeterol (2 puffs) twice a day, one in the morning and the other one in the evening. For LAMAS, I would prescribe titropium and umeclidinium, one inhalation a day of each. The patient will be required to get their refill before the current drugs run low. This will be after three weeks.

I would further recommend regular follow up of Donald to monitor his symptoms, his lung functions and overall wellbeing. I would also recommend that he reduces or stops his smoking behavior to prevent any drawbacks. I would prescribe biweekly clinic visits to review his medication and assess their effectiveness. I would request any family or relatives to monitor for side effects. If symptoms persist despite the medication, I would discontinue the treatment plan and consider other alternative medication.

SCENARIO 2

Allen’s scenario is a case of gastroesophageal reflux disease (GERD). According to the eight report of the Joint National Committee on prevention, Detection, and Treatment of high blood pressure (JNC 8), adults such as Allen are required to maintain

Allen’s bloating is likely caused by metformin which lowers blood sugar levels. Given the importance of metformin for Allen’s diabetic condition, I would recommend dietary adjustments for the patient. He will be required to avoid trigger foods such as carbonated beverages and dairy products. As part of his medication, Allen will be required to eat smaller portions more frequently to prevent the possibility of bloating.

Allen will also need to manage his asthma with prn albuterol. To improve management of this condition, He will need biweekly asthma assessments. I will prescribe a peak flow meter which will enable Allen to know how open his airways are. For diabetes metformin, if the current dose is not effective, it may be increased to 1000mg TID (three times daily).

My recommended dose for Allen would be:

· PPI (omeprazole)- 40mg everyday (crease to 80mg if need be)

· H2-receptor Antagonist (H2RA)-Famatodine 20mg twice a day

· metformin 1000 mg- three daily

· Nifedine 60mg once daily

In his visit, I would educate Allen about his condition based on his symptoms, and medical examination. I would advise him on the importance of making changes in his diet by avoiding trigger foods especially those in high rich of starch. I will explain to him about his medication, potential side effects and how to manage the side effects. I will emphasize on the importance of taking the medication as prescribed by the doctor. I will also schedule a follow up appointment for further assessment.

SCENARIO 3

Jessica is using albuterol and still experiencing nocturnal symptoms as a result of night coughing. Step up therapy for the patient will be medication changes. There is need to increase ICS dosage, fluticasone HFA 44 mcg will be increased to 88mcg twice a day. A higher dosage will help provide control of the asthma and the cough ultimately. I will also consider adding a LABA to the medication such as formoterol to allow for bronchodilation for a longer time (Williams, & Rubin, 2018). The combination of formoterol and fluticasone 88mcg will help provide anti-inflammatory effects as well as opening the airways.

I will assess the need for Medrol Dosepak especially after changes in ICS and LABA medication. If the two changed drugs control Jessica’s asthma, then I will discontinue Medrol Dosepak. Moreover, given that Jessica takes high blood pressure and diabetes medication, I will monitor these conditions.

To ensure that the medication and treatment plan works out well, I will encourage the patient to use the peak flow meter every day. She will be required to keep her daily records written on a book for analysis. Jessica will also be required to track her asthmatic symptoms and keep track of how often she uses the albuterol inhaler. I will recommend that she has follow up clinics every three months until she attains stability.

I will teach Jessica about asthma, the importance of adhering to medication, and how to properly use the inhaler. I will also teach her how to use the peak flow meter and also provide her with an emergency action plan.

SCANARIO 4

Analysis of June’s Lab tests shows that her levels of TSH, vitamin D and B12 are normal. This implies that she is not deficient in vitamin B12 and D, and also, she lacks the thyroid stimulating hormone. Therefore, these tests show that the suggested tests do not contribute to her current symptoms. Furthermore, a Hb of 12.1 is also within normal range, therefore she has adequate red blood cells in her body.A1C of 5.5% is ideal control for diabetic conditions. However, the stated conditions for June including daytime dizziness, fatigue and forgetfulness are consistent with Alzheimer’s disease (DeTure, & Dickson, 2019).