How to address a pharmacological case study (Solved)

How to address a pharmacological case study (Solved)

Case study of Mr. JD:
Mr. JD is a 24-year-old who presents to Urgent Care with a 2-week history of cough and congestion. He says it started out as a \”normal cold\” and it will not go away. He has a productive cough for green mucous and has green nasal discharge. He says he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known allergies.
In his assessment it is found that his vital signs are stable, temperature is 99.9 degrees F, tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no exudate; there is greenish postnasal drainage; turbinates are swollen and red; frontal sinus tenderness; no cervical adenopathy, and lungs are clear bilaterally.

Is there any additional subjective or objective information you need for this client? Explain.
Would you treat Mr. JDs cold? Why or why not?
What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the medication, mechanism of action, dosing, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings
What health maintenance or preventive education is important for this client based on your choice of medication/treatment?

Solution to Mr. JD’s Case Study

The common cold is a viral infection of the nose and upper respiratory tract that is commonly treated in outpatient clinics. Health adults can expect to experience colds twice or thrice a year while young infants and children may have even more frequent colds (Centers for Disease Control and Prevention (CDC), 2021). Most patients recover from colds within a week or two but sometimes failure to recover may indicate more serious illnesses of the upper respiratory tract. According to the CDC (2021), medical attention might not be necessary for most people, but persistent colds that go beyond 10 to 14 days should be evaluated and treated appropriately.

Additional Subjective/Objective Information

Mr. JD presents with various symptoms that indicate he has had a cold for the past two weeks. Apart from the medical information provided, I will ask if the patient smokes because these individuals tend to have persistent colds. I will ask if the patient experiences shortness of breath, ear pain, and other symptoms. A complete medical history of infections like pneumonia, bronchitis, or asthma may help in determining the probable cause of his condition. I will also focus on the use of medications including dosage and duration of the drug use to aid in the selection of the most appropriate treatment. Lastly, I will ask about the presence of facial pressure when bending, halitosis, and tooth pain that are consistent with other infections like sinusitis.

Treatment for Mr. JD

Mr. JD presents with symptoms of low-grade fever, nasal discharge, frontal sinus tenderness, and erythematous pharynx that indicate there is an infection. I will not treat Mr. JD for cold based on these symptoms because they indicate a serious bacterial infection. The patient has been experiencing these symptoms for two weeks meaning that if it was cold probably he would be feeling better. Practice guidelines recommend the use of antibiotics when cold persists for more than 14 days because it may indicate acute sinusitis (CDC, 2021). I will treat Mr. JD for sinusitis rather than a common cold. This infection mostly follows a cold or flu and is caused by bacteria including streptococcus aureus and Haemophilus influenza (Aring & Chan, 2016). Signs and symptoms may include discolored nasal discharge, pressure around the nose, coughing, and fever.

Medications

Watchful waiting and delayed prescribing are recommended when dealing with uncomplicated sinus infections. However, antibiotics can be used when the symptoms persist or the likelihood of the infection going away is low. The medication I would prescribe for Mr. JD is amoxicillin-clavulanate (Augmentin). This drug is FDA approved for the treatment of bacterial infections involving the skin, sinuses, ears, and urinary tract (Bergmark & Pynnonen, 2017). I will prefer to use Augmentin over amoxicillin alone because of its effectiveness against a wide range of bacteria. I will prescribe Augmentin 875mg/125mg PO taken twice daily for seven days.

Augmentin is an antibiotic that belongs to a class of drugs called penicillins. The Clauvulanate added to the drug anticipates resistance caused by bacterial enzymes that destroy the antibiotic before it can act on the pathogen. The mechanism of action of the drug involves hindering bacterial growth through inhibiting the biosynthesis of bacterial cell wall mucopeptide (Aring & Chan, 2016). Amoxicillin clavulanate is available as an injection, oral suspension, and oral tablets. The drug is absorbed well when absorbed orally and is optimized at the start of a meal. Peak concentrations of the drug occur about one hour after oral administration. Regarding the distribution, both clavulanate and amoxicillin have low levels of serum binding with about 70% of the drug remaining free in serum.

Amoxicillin-Clavulanate is metabolized in the liver and eliminated through urine. Contraindications for Augmentin include a history of hypersensitivity to amoxicillin, clavulanate, or to beta-lactam drugs such as penicillin, and/or in patients with a history of cholestatic jaundice/hepatic dysfunction that is associated with Augmentin (Aring & Chan, 2016). There is no black box warning for Augmentin with the only possible serious side effect being the development of a rash.

Treatment Variation

If Mr. JD was a 10-year-old 78 lb child, I would still choose to prescribe Augmentin. The drug is the first-line choice for pediatrics with sinusitis and a dosage of 25mg/kg/day is given in divided doses every 12 hours (Wald et al., 2013). This will translate to a dose of 500mg given orally twice daily for seven days. The mechanism of action, half-life, distribution, and elimination is the same as explained above.

Health Education

The first aspect of health education will focus on the intake of the drug whereby I will advise Mr. JD to take the drug at the start of a meal (Bergmark & Pynnonen, 2017). Secondly, I will focus on side effects that may include an allergic reaction that presents as a rash, nausea, vomiting, and diarrhea. Other health education measures will focus on taking plenty of fluids, maintaining hygiene, and completing the dose given.

 

 

References

Aring, A. M., & Chan, M. M. (2016). Current Concepts in Adult Acute Rhinosinusitis. American Family Physician, 94(2), 97–105. https://pubmed.ncbi.nlm.nih.gov/27419326/

Bergmark, R. W., & Pynnonen, M. (2017). Diagnosis and First-Line Treatment of Chronic Sinusitis. JAMA, 318(23), 2344–2345. https://doi.org/10.1001/jama.2017.18196

Centers for Disease Control and Prevention. (2021). Antibiotic prescribing and use: Common cold. https://www.cdc.gov/antibiotic-use/colds.html

Wald, E. R., Applegate, K. E., Bordley, C., Darrow, D. H., Glode, M. P., Marcy, S. M., Nelson, C. E., Rosenfeld, R. M., Shaikh, N., Smith, M. J., Williams, P. V., Weinberg, S. T., & American Academy of Pediatrics (2013). Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics, 132(1), e262–e280. https://doi.org/10.1542/peds.2013-1071

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