How to discuss a case study on advanced pharmacology essay

How to discuss a case study on advanced pharmacology essay

Case Study PROMPT

For these questions, please read the following case study and then respond to the questions noted below.

Ms. BD is a 33-year-old G2P1 African-American female who presents to your clinic today complaining of unusual fatigue, nausea, and vomiting for the last five days. She has a medical history of chronic hypertension (HTN) that was diagnosed shortly after her first pregnancy two years ago and GERD. MS. BD\’s blood pressure is controlled on Lisinopril-Hydrochlorothiazide 20/12.5mg by mouth twice a day, and GERD controlled on Bismuth Subsalicylate 262mg by mouth every 6 hours as needed. During the interview, you learn that she is single, sexually active, has one partner and that her menses is ten days late. She performed a home pregnancy the three days after missing her menstrual cycle, and the results were inconclusive. She states she feels terrible and needs relief. She has no other medical problems, symptoms, or concerns.

Assessment: Physical examination is unremarkable. BP128/68, HR is 74, Urine human chorionic gonadotropin (HCG) positive, beta HCG sent, potassium 4.2, blood
urea nitrogen (BUN) 14, creatinine is 0.6, Alanine aminotransferase (ALT) 29, White blood cells (WBCs) 6.5, hemoglobin (Hgb) 12.8, hematocrit (Hct) 39, and platelets 330,000.

List the additional questions you would need to ask this patient. Explain.
What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?
What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?
Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.
What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?
Would you treat this patient or refer her? Explain. If you refer, where would you refer this patient?

Case Study SOLUTION

Various questions can be asked to the mother. They include

  1. When was your last menstrual period? The patient needs to be asked when the first day of their last menstrual period was. The LMP can help calculate the gestational age accurately (Morris et al., 2018). The LMP confirms the status of pregnancy in women with bearing capacity. Additionally, it can be used to calculate the expected date of delivery.
  2. What is your past obstetric history? This question enables the healthcare practitioner to establish whether the mother has a bad obstetric history. This will allow the healthcare provider to plan for potential problems that may be related to pregnancy. The obstetric history that can be asked includes parity and gravidity, and previous pregnancies process and outcome.
  3. Do you take any drugs or substances? As the patient is currently taking prescribed drugs taking alcohol and other substances may interfere with the effectiveness of the drugs. Additionally, the substances may also cross the placenta and harm the baby. Determining the drug history will enable the healthcare provider to educate the patient on its impact on the health and wellbeing of the baby.
  4. What is your diet? The patient’s diet is fundamental. A good diet will enable the fetus to glow properly and prevent complications during childbirth. Additionally, certain foods and beverages may interfere with the effectiveness of the drug. Therefore asking for the diet is fundamental.

Safety Profile Of Lisinopril-Hydrochlorothiazide And Bismuth Subsalicylate In Pregnancy

Lisinopril should not be used in pregnancy. The drug class is ACE inhibitors. When used in pregnancy during the third and the second trimester, it can cause injury or even death to the fetus. Hence ACE inhibitors in the patient should be discontinued immediately. Hydrochlorothiazide is safe to use during pregnancy in low doses. The low doses minimize its metabolic effects, such as glucose intolerance and hypokalemia. Using hydrochlorothiazide in high doses has been associated with fetal electrolyte imbalance, such as thrombocytopenia and jaundice (Hock & Gralinski, 2019). Bismuth subsalicylate is not a safe drug to use during pregnancy.  It should be avoided, particularly during the third and the second trimesters, as it increases the risk of bleeding in the advanced stages of gestation.  Additionally, it can also increase the risk for birth defects.

Importance of assessing laboratory values when prescribing drugs

The assessment of laboratory values helps guarantee effective and safe medication therapy, particularly in those with higher risks of drug-induced toxicity. Lab findings enable the pharmacist to detect and prevent potential problems related to administering a particular drug (Satoskar & Bhandarkar, 2020). For instance, when a certain drug raises blood pressure, it cannot be administered if it is extremely high.

The laboratory findings will impact my treatment plan in the patient in many ways. Firstly a positive urine human chorionic gonadotropin reveals that the patient might be pregnant. Therefore, the healthcare provider needs to stop lisinopril and hydrochlorothiazide, and the elevation of the liver enzymes will prompt for stopping lisinopril.

Yes, I would make changes to the GERD and blood pressure medications. Firstly I will stop lisinopril and administer another antihypertensive medication, specifically labetalol. Labetalol is a drug of choice in pregnant women. Labetalol is a beta-blocker. It acts by blocking beta and alpha-adrenergic receptors resulting in a decreased peripheral vascular resistance. It can be administered orally or via an injectable solution. After oral administration, labetalol is readily reabsorbed. It undergoes the first-pass metabolism in the hepatic system. It has no active metabolite, and its elimination half-life is around six hours.  The drug is contraindicated in patients with severe hypotension, hypersensitivity, cardiogenic shock, severe bradycardia, and bronchial asthma. The drug should be used with caution during pregnancy.

Other drugs I could use include nifedipine. It is a calcium channel blocker and its acts directly on the smooth muscle of the vascular system by inhibiting the influx of calcium on voltage-dependent receptors. It has a half-life of 1.7 hours. Nifedipine is metabolized in the hepatic system by the CYP3AA. It comes in oral capsules or tablets, and it is eliminated predominantly in the urine. The drug is contraindicated in patients with hypersensitivity, severe heart failure, and skeletal muscle disorder.  The drug is effective to use in pregnancy.

To manage GERD, I would prescribe a histamine receptor antagonist such as ranitidine to manage its symptoms. Ranitidine is a safe drug to use during pregnancy. Ranitidine is a competitive inhibitor of histamine H2 receptors, thereby reducing gastric concentration and volume. It has a half-life of about 2.5 hours. It can be administered orally or intravenously. It is contraindicated in patients with decreased kidney function, liver problems, porphyria, and stomach cancer. Ranitidine also has a probable carcinogenic effect on humans.

Ethnopharmacology involves the use of drugs derived from naturally occurring origins. If the patient is not pregnant, various naturally occurring fungi or plants could be adjunct therapy, and these drugs will work to manage the patient’s condition.  An example of plants that could be used in the patient is hydroalcoholic leaf, bulb, and leaves.

Administering labetalol, ranitidine and nifedipine will require certain preventive education. In labetalol, I will educate her to avoid taking alcohol and avoid getting up too fast from lying or sitting position. In ranitidine, I will educate the client on taking it on an empty stomach. In nifedipine, I will advise them to avoid chewing or crushing the capsule.

I will refer the patient after providing them with the medication. The patient needs to be referred to an antenatal clinic so that she can start antenatal care. Antenatal care will improve the health and the well-being of the fetus and the mother.

 

References

Morris, J. M., Totterdell, J., Bin, Y. S., Ford, J. B., & Roberts, C. L. (2018). Contribution of maternal age, medical and obstetric history to maternal and perinatal morbidity/mortality for women aged 35 or older. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(1), 91-97.

Satoskar, R. S., & Bhandarkar, S. D. (2020). Pharmacology and pharmacotherapeutics. Elsevier India.

Sikaris, K. A. (2017). Enhancing the clinical value of medical laboratory testing. The Clinical Biochemist Reviews, 38(3), 107.

Related Posts:

Translate »