Medication for Chronic Cough and Related Symptoms

Pharmacology Case Studies

Scenario 1: Sara's Case Study

Problem

Sara presents with a persistently high blood pressure (hypertension), indicated by her current reading of 160/90 mmHg and her previous reading of 156/92 mmHg three months ago. Considering her weight and ongoing medication (ibuprofen, which can elevate blood pressure), addressing her hypertension is critical (National Institute for Health and Care Excellence, 2019).

Goal for Blood Pressure

According to the American College of Cardiology and the American Heart Association, the goal is to reduce Sara's blood pressure to below 130/80 mmHg to minimize her risk of cardiovascular disease (Whelton et al., 2018).

Medication Prescription

Given her hypertension and current use of ibuprofen (which can contribute to increased BP), a calcium channel blocker or a thiazide diuretic could be considered. Considering her profile, amlodipine, a calcium channel blocker, is a suitable choice due to its efficacy and safety profile.

Prescription

Amlodipine 5 mg, oral, once daily. Take one tablet by mouth once daily.

Education

Discuss the potential impact of ibuprofen on blood pressure and explore alternatives for back pain management. Emphasize the importance of lifestyle modifications, including a diet low in salt, regular physical activity, and weight loss to help manage hypertension. Advise on the importance of monitoring blood pressure regularly (Chobanian et al., 2003).

Scenario 2: Monty's Case Study

Problem

Monty's lipid profile indicates dyslipidemia with elevated total cholesterol, LDL cholesterol, and triglycerides, and low HDL cholesterol. He is a smoker, which adds to his risk for coronary artery disease (CAD) (National Institute for Health and Care Excellence, 2014).

Treatment Plan for Lipid Profile

According to the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol, the addition of a statin is recommended to manage Monty's lipid levels, particularly to lower his LDL cholesterol (Grundy, 2019).

Goals

The goals are to reduce Total Cholesterol (TC): <200 mg/dL, reduce LDL-C: <100 mg/dL (recommended for individuals at high risk like Monty), and increase HDL-C: >40 mg/dL.

Prescription

Atorvastatin 20 mg, oral, once daily. Take one tablet by mouth once daily at bedtime.

Monitoring Effectiveness

Follow-up lipid profile in 4-12 weeks to assess response and adherence, then every 3-12 months as needed. Monitor for potential statin side effects, including muscle pain or weakness.

Risk Factors for CAD

Risk factors for CAD include smoking, hypertension (assuming from the context of medication), dyslipidemia, and age (>45 years for men) (Greenland et al., 2010).

Scenario 3: Beatrice's Asthma Management

Problem

Beatrice is experiencing an increase in asthma symptoms, including frequent use of her albuterol rescue inhaler, nighttime coughing, and exercise-induced shortness of breath. This indicates her asthma is not well-controlled.

Treatment Plan

Given the increased frequency of rescue medication use and nighttime symptoms, stepping up her asthma treatment is advisable based on the asthma management guidelines (Cloutier et al., 2020a).

Medication Changes

Increase the dose of the inhaled corticosteroid (ICS): Considering her current use of fluticasone (Flovent HFA 44 mcg), increasing the dose or switching to a higher strength may provide better control. Consider adding a long-acting beta-agonist (LABA): If not adequately controlled by ICS alone, combining fluticasone with a LABA, such as salmeterol, could be beneficial. Ensure proper inhaler technique: Misuse of inhalers is common and can significantly affect medication efficacy (Cloutier et al., 2020b).

Prescription

Fluticasone/salmeterol (Advair Diskus) 250/50 mcg, one inhalation twice daily.

Monitoring Effectiveness

Schedule a follow-up visit in 4-6 weeks to assess asthma control and adjust the treatment plan as necessary. Educate Beatrice on monitoring her symptoms and peak flow readings at home. Review inhaler technique at every visit (Reddel et al., 2022).

Scenario 4: Daute's Chronic Obstructive Pulmonary Disease (COPD)

Problem

Daute exhibits symptoms indicative of COPD progression, such as increasing shortness of breath and a history of chronic bronchitis and smoking. His lack of maintenance medication adherence has likely contributed to symptom exacerbation.

Treatment Plan

Re-initiating pharmacological treatment along with lifestyle modifications is crucial for managing Daute's symptoms and preventing further exacerbations (Rabe et al., 2007).

Medications

Resume salmeterol/fluticasone (Advair Diskus): This combination inhaler is effective for managing COPD symptoms and reducing exacerbations. Consider short-acting bronchodilator as needed: For acute relief of symptoms. Smoking cessation support: Given his significant smoking history, assisting Daute in quitting smoking is vital (Celli et al., 2021).

Prescription

Salmeterol/fluticasone (Advair Diskus) 250/50 mcg, one inhalation twice daily.

Monitoring Effectiveness

Schedule regular follow-ups every 3-6 months or as clinically indicated to assess symptom control and medication adherence. Spirometry at follow-up visits to monitor lung function. Discuss and reinforce smoking cessation strategies at each visit (Qaseem et al., 2011).

References

Celli, B. R., Anderson, J. A., Cowans, N. J., Crim, C., Hartley, B. F., Martinez, F. J., ... &

Calverley, P. M. (2021). Pharmacotherapy and lung function decline in patients with chronic obstructive pulmonary disease. A systematic review. American journal of respiratory and critical care medicine, 203(6), 689-698.

Cloutier, M. M., Baptist, A. P., Blake, K. V., Brooks, E. G., Bryant-Stephens, T., DiMango, E.,

... & Walsh, C. G. (2020). 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. Journal of Allergy and Clinical Immunology, 146(6), 1217-1270.

Cloutier, M. M., Dixon, A. E., Krishnan, J. A., Lemanske, R. F., Pace, W., & Schatz, M. (2020).

Managing asthma in adolescents and adults: 2020 asthma guideline update from the National Asthma Education and Prevention Program. Jama, 324(22), 2301-2317.

Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo Jr, J. L., ... &

National High Blood Pressure Education Program Coordinating Committee. (2003). Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. hypertension, 42(6), 1206-1252.

Greenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., ... &

Wenger, N. K. (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular .... Journal of the American College of Cardiology, 56(25), e50-e103.