Pharmacological Case Studies

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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 Donalds 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 Donalds 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

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 <140/90 mmHg. The first step to improving his therapy drug plan is evaluating his interactions with drugs. For the high blood pressure, I would prescribe Nifedine, which is a calcium channel blocker (Flack, Calhoun, & Schiffrin, 2018). This will help reduce blood pressure and mitigate the risk of heart attack, stroke, and any other kidney related malfunctioning. Nifedine will also improve insulin sensitivity, allowing blood cells to absorb glucose from the patients blood.

Allens bloating is likely caused by metformin which lowers blood sugar levels. Given the importance of metformin for Allens diabetic condition, I would recommend dietary adjustments for the patient....

…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 Alzheimers disease (DeTure, & Dickson, 2019).

Jessicas updated drug plan will include the donepezil 5mg po qh. Jessica will be required to continue with the current dose, it should be taken orally and during bedtime. Zolpidem is used to treat insomnia, it can however result to daytime dizziness in older people like Jessica. zolpidem 10mg po qhs may be reduced to 5mg to reduce the risk od day time sleep and night insomnia. Memantine can be added to Junes dosage to work hand in hand with donepezil to manage Alzheimers disease. I will prescribe her with memantine; an initial dose of 10mg one tablet daily for a week, after which the patient will increase the dosage to 10mg twice a day for one week. Thereafter she will increase the dosage to 20mg twice daily for a week. The increase in dosages will however be determined following frequent doctors visitations to ascertain the accurate dosage.

To monitor the patients drug therapy, I will recommend weekly visitations to the doctor to monitor cognition ability. Moreover, cognitive function tests will be conducted to establish the extent of the disease. In addition, medication adjustments will be conducted to establish the drugs…