Community Acquired Pneumonia Discharge Levofloxacin

COMMUNITY ACQUIRED PNEUMONIA DISCHARGE

Community Acquired Pneumonia Discharge

The 65-year-old in this scenario has been put on a therapy course with levofloxacin as part of treatment to help in the resolution of her community-acquired pneumonia. It would be prudent to note, from the onset, that this particular drug happens to be a fluoroquinolone whose tolerability as well as efficacy in a case such as the one presented has been well established (Noreddin and Elkhatib, 2010). To be more specific, in the words of the authors, the drug “has a broad spectrum of activity against several causative bacterial pathogens of community-acquired pneumonia (CAP)” (Noreddin and Elkhatib, 2010, p. 505). Essentially, levofloxacin, like is the case with other fluoroquinolones, acts by inhibiting two crucial enzymes that are critical in not only the replication, but also the transcription as well as recombination and repair of bacteria DNA (Noreddin and Elkhatib, 2010). The two enzymes are DNA gyrase and bacterial topoisomerase IV.

Some of the side effects that have been associated with levofloxacin are inclusive of, but they are not limited to; dizziness, insomnia, constipation, headache, diarrhea, as well as vomiting and nausea. It is also important to note that owing to the age of the patient, i.e. over 60 years of age, there is a risk for tendinopathy and tendon rapture. However, in the words of Kim (2010), “tendinopathy induced by fluoroquinolone (FQ) antibiotics is a topic of controversy, with many researchers believing in a direct causal relationship while others believing that the risk is negligible” (p. 49). To achieve maximum benefit for this particular drug, I would advise the patient to ensure that two hours prior to, and after taking the medication, she avoids milk and other related dairy products. Further, I would advise the patient to ensure that two hours elapse before and after she ingests antacids and/or vitamins. The same rule of thumb should be followed with regard to all other products likely to contain zinc, iron, magnesium or calcium.

The patient is on prescription for a number of other medications. These will be highlighted below;

1. For GERD

Esomeprazole (Nexium)

As a proton pump inhibitor, this particular medication works by inhibiting the secretion of gastric acid by blocking gastric H,K-ATPase (DiMario and Cohen, 2013). To a large extent, this makes it possible for the healing of damaged esophageal tissue to take place. It should be noted that in comparison to H-2 receptor blockers, proton pump inhibitors tend to have acid relief that is stronger. The medication has, however, been associated with a number of side effects which are inclusive of dry mouth, constipation, flatulence and nausea, diarrhea, as well as headache. To achieve maximum benefit from the drug, I would ensure that the patient is aware of possible interactions with any herbs, vitamins as well as other medications that she could be taking. I would also advise the patient to ensure that she takes the drug more than one hour after she takes food. This is more so the case given that as DiMario and Cohen (2013) observe, “taking this drug with food can decrease the amount of esomeprazole magnesium in your body” (p. 311).

Sucralfate (Carafate)

As an antiulcer drug, this particular medication, binds to the ulcer base following its dissociation to what Bardal, Waechter and Martin (2011) refer to its anionic form. This takes place in the stomach’s acidic environment. As a consequence, Bardal, Waechter and Martin (2011) point out that this leads to the establishment or a protective barrier to both bile and pepsin. It should also be noted that in this case, gastric acid’s diffusion is effectively inhibited. Due to the role it plays in the formation of a protective film, it helps protect both the stomach and the esophagus. Thus, it comes in handy in the treatment of gastroesophageal reflux disease. The medication happens to be a sucrose octasulfate and aluminum hydroxide complex. Some of the side effects that have been associated with the medication include; indigestion, vomiting, nausea, diarrhea, constipation, etc. For best results, the patients should seek to take the medication on an empty stomach. Thus, she would be advised that the best time for taking the medication would be more than an hour to any meal.

2. For Osteoporosis

Alendronate (Fosamax)

This happens to be a bisphosphonate. Thus, this particular medication works by inhibiting “osteoclastic bone resorption by attaching to hydroxyapatite binding sites on bony surfaces, especially surfaces undergoing active resorption” (Ciccone, 2013). The medication is instrumental in bone breakdown prevention as well as bone density increase. The medication has been associated with a number of gastrointestinal side effects. The said side effects are inclusive of cramping, constipation, as well as diarrhea and nausea. It has also been associated with joint and muscle pain. It should, however, be noted that some of the side effects highlighted in this case happen to be mild and disappear after a while. The more serious side effects that warrant the involvement of a doctor include severe muscle as well as joint and bone pain, muscle cramps and twitches (which could be symptoms of hypocalcaemia), jaw bone death, etc. To ensure that the patient achieves maximum benefit from the drug, I would advise on possible interactions with vitamins and other medications (such as NSAIDs and antacids), and seek to establish an effective medications management for her. I would also advise the patient to ensure that the medication is not taken with other liquids other than water. Thus, she should ensure that she does not take the medication with juice or tea. Further, she should allow for a minimum of 30 minutes to elapse before having anything else to drink or eat, after taking the medication.

3. For Dyslipidemia

Rosuvastatin (Crestor)

This happens to be a HMG-CoA Reductase Inhibitor. Thus, like all the other drugs in this class, this medication seeks to inhibit HMG-CoA reductase. In basic terms, HMG-CoA reductase happens to be a “rate-controlling enzyme of the mevalonate pathway, responsible for cholesterol and other isoprenoid biosynthesis” (Thompson and Taylor, 2020). It therefore follows that in seeking to inhibit HMG-CoA reductase, this medication ensures that the production of cholesterol in the liver is hampered. It should be noted that most of the cholesterol in circulation happens to be produced in the liver. For this reason, attempts to reign in cholesterol levels in the blood ought to be focused on interfering with the synthesis of cholesterol in the liver. This is exactly what rosuvastatin (Crestor) does.

Some of the side effects associated with this particular medication are inclusive of, but they are not limited to; stomach pain, nausea, constipation, insomnia, joint pain, pains and aches in muscles, depression, as well as headache. It should be noted that severe side effects such as rhabdomyolysis should be referred to a doctor as they could result in serious complications such as liver damage. To promote the effectiveness of the drug, the patent would be advised to avoid certain products and/or medications that could interact with rosuvastatin (Crestor). For instance, drugs or other products that contain magnesium or aluminum could interfere with the medication’s amount in the blood – effectively reducing its efficacy. The patient should also avoid alcohol (if she indulges in the same) when taking this medication as this could result in liver complications from the drug. It is also important to note that I will highlight the need to closely monitor her for side effects owing to her age. This is more so the case given that at her advanced age, the functioning of her kidneys could be impaired – effectively resulting in a slower pace of processing drugs. The implication in this case would be that a drug such as rosuvastatin (Crestor) stays longer in her body. Towards this end, the dosage indicated (i.e. 20 mg each day) could be revised to 10 mg daily if the need to do so is established. For optimal outcomes, there would also be need to start off the patient on a diet that helps lower her cholesterol levels.

4. For Hypothyroidism

Levothyroxine (Synthroid)