NURS2003-Pathophysiology And Pharmacology Related To The Case Patient


Question:


Mr. Roger Wilson, a 32year-old man suffering from asthma and currently a gym instructor, visited his GP last week complaining of shortness-of-breath, fever, headaches and a productive wheeze over the past week.

The GP diagnosed Mr Wilson with a severe respiratory tract infection. He prescribed 150mg of roxithromycin (Rulide), twice daily.

After taking the antibiotic two (2) days, Mr Wilson returned to his GP feeling even worse.

A chest radiograph revealed bilateral pneumonia. Mr Wilson received treatment at the emergency department (ED).

Roger has mild asthma and has had it since childhood.

Roger’s symptoms can get worse when he exercises. He uses a metered dose of inhaler (MDI), to relieve his symptoms.

Roger and Matthew have been building a gym out of an old warehouse over the past few months.

Both developed symptoms similar to the flu, such as sore throats and chest infection.

Roger looks anxious and is breathless when he arrives at the ED.

Admission to The ED

Roger was flushed and sweating upon his admission into the ED.

He is alert and well-oriented but has slight chest pain.

He has a productive cough that produces green and malodorous mucus.

Roger has never smoked, and he only drinks socially.

Answer to Question: NURS2003-Pathophysiology And Pharmacology Related To The Case Patient

Pathophysiology & Pharmacology Related The Case Patient

The clinical scenario below is based around Mr. Roger Wilson who is 32 years old and was admitted to an emergency department (ED). He complained of cough, chest pains, and breathlessness.

The chest xray revealed bilateral pneumonia.

It is a type o acute lower respiratory tract infection that affects both lungs. It can lead to symptoms like headaches, sneezings, breathlessness, tightening of the chest, and productive cough (Fabbri et.al., 2017).

Roger shows similar symptoms to those described in the case study.

Roger’s anatomical structure is most affected. It includes his lungs and his alveoli.

The patient suffers from mild chest pain, productive cough, and breathlessness.

This is because bilateral pneumonia can cause inflammation of the stomach and alveoli that results in the formation of pus. This causes breathlessness.

Invasion of bacteria directly into the pleural spaces can cause structural changes to the lung. This is followed by a series of inflammatory events (Quinton Walkey & Mizgerd (2018).

In the case study, we also discuss the anatomy and physiology of bilateral pneumonia.

Understanding the pathophysiology is critical in understanding the reason behind Mr. Roger’s pharmacological treatment.

The pathophysiology of the disease includes direct bacterial invasion, inflammation of the lungs or pleural space, a cascade inflammatory event and bacteriologic virulence characteristics (Quinton Walkey & Mizgerd 2018).

Roger has experienced episodes with productive cough and shortness o breath.

This is due to the pathophysiological process of bilateral pneumonia.

Pneumonia usually results from bacterial and viral infection.

The inflammation of the air spaces in the lungs is caused by the initiation of an immune reaction in the lungs following infection by bacteria and virus.

Fluid location is caused when the immune system responds faster.

This happens through the migration and activation by the coagulation chain that leads to fluid within alveoli.

The mucus plugs, which are made up of protein-rich fluid, reduce the efficiency and gas exchange in the lungs.

McCauley & Dean (2015). The fluid accumulated in the alveoli further reduces gas exchange and increases the risk of infection.

These pathophysiological conditions could cause Mr. Roger to develop pneumonia. This is due to changes in the anatomical structure of pneumonia. Fluid accumulation can also occur when there are inflammatory events.

Bilateral pneumonia management is dependent on pharmacological treatments.

Treatment of bilateral pneumonia is dependent on the type and severity of the infection. The primary goal is to decrease symptoms and improve patient’s ability to breathe.

To understand how the drug will act in the patient’s body, the pharmacology prescribed for Mr. Roger is helpful.

An antibiotic is the most effective treatment for managing pneumonia.

Roger has received IV Benzylpencillin. It is a broad-spectrum antibiotic. It’s used mainly to treat bacterial infections in patients with pneumonia.

Because of poor oral absorption, the drug is administered intravenously. It works by binding penicillin binding proteins to the bacterial cells wall.

It blocks the last stage of bacterial wall synthesis and causes cell lysis (Drug Bank (2018)).

Evidence suggests that benzylpenicillin can be used to treat pneumonia.

It is possible to reduce the need for nursing, eliminate injectable medications, and save money by using this medication early (Agweyu and co-authors, 2014).

Benzylpenicillin can be helpful in accelerating recovery by preventing infection progression and preventing complications from Mr. Roger.

Doxycyline, another medication that Roger was given for his first day, was also prescribed.

This medication prevents bacteria growth and is used to treat infections.

It belongs to a drug class called tetracycline antibiotics. It is used to treat a variety of bacterial infections.

Similar to benzylpencillin, it has the same mechanism of action and inhibits protein synthesis by binding with the 30S ribosomal element.

This causes a decrease of bactetial swell and consequently, improvement in patient’s symptoms (Nightingale & Bishai 2016).

Roger is prescribed Salbutamol via an MDI (metered dose inhaler) because of his mild asthma.

Salbutamol can be used as an asthma treatment. It is a beta2adrenergic agonist with short acting beta2adrenergic receptors.

Evidence suggests that glucocorticoids, b2?Adrenoceptor-agonists, and salbutamol are the most effective pharmacological options in treating airway inflammation.

It is an important part of the first line therapy for asthma.

The most important class of drugs for asthma treatment is b2?Adrenoceptor-agonists.

The short-acting salbutamol preparation is available on a case-by-case basis. Long-acting formulations in combination of glucocorticoid are used for long-term management (Amrani & Bradding, 2017).

This pharmacological therapy is related to the treatment of bronchoconstricttion for Mr. Roger, as this drug class has a strong bronchodilator and can relieve breathlessness.

Study The Three Symptoms:

Mr. Roger’s bilateral pneumonia symptoms include chest pain, productive and breathlessness.

These symptoms are not the only clinical manifestations of pneumonia.

These symptoms are associated with bilateral pneumonia’s pathophysiology. As pathophysiology changes to combat bacterial invasion and inflammation, symptoms like these can occur (Fabbri et.al. 2017).

The most common sign of bilateral pneumonia is a productive cough with mucous.

Roger suffered from productive cough. This could be linked to the pathophysiology and severity of bilateral pneumonia. Because the lower respiratory tract infection causes cough, it is also a sign of a lower respiratory tract infection.

The symptoms of severe allergic reactions or acute bacterial infected are reflected by productive cough.

This can lead to thick mucus blocks that block the airway (Begic. et. al., 2017).

During admission, Roger had a productive, green-colored cough with malodorous sputum.

This is caused by hypersection of airways due to the pathophysiological manifestations.

Normal mucous serves the primary function of protecting the airway by moistening it.

Anaerobic infection in the lungs can cause purulent cough (Shenet al. 2018).

Roger, a victim of pneumonia, needs to receive appropriate pharmacological management.

Mr. Roger was afflicted by dyspnea (breathlessness).

Shortness of breath was an issue that Roger had experienced over the last week, according to the case study.

This symptom can also be linked to the pathophysiology associated with pneumonia.

As a result of bacterial infections, breathlessness can be caused by pneumonia. In this case, macrophage is released and the inner linings are filled with fibrin rich exudates.

This results in the alveolar area becoming less airy, which causes pulmonary edema as well as impaired lung expansion.

A reduced gaseous exchange is the main cause of oxygen deprivation. This leads to decreased lung expansion and pulmonary edema (Regunath & Oba 2018). Coccia et al.

(2016) states that there are several pathways involved in the activation of which can lead to increased or decreased breathing.

This condition is most commonly characterized as tightness and increased work effort.

Also, Mr. Roger experienced slight chest pains and breathlessness according to the review of his clinical case.

The pain intensity was minimal as the pain score according to patient’s responses was only two out 10

This symptom can be caused by muscle strain or inflammation in the inner lung linings.

Only when airway inflammation is progressing, chest pain can occur.

Most pleural chest pain can be attributed to inflammation of parietal lung and release of inflammatory mediators from the pleural space.

Trauma to a rib cage or intercostals can lead to pain in the cutaneous distributions of nerves.

It can happen for many reasons. In the case of Roger, it is related to bilateral pneumonia.

Discussion of Three Medications Associated With The Pathophysiology The Patient

Salbutamol via the nebulizer IV benzylpenicillin or Doxcycline were prescribed to Mr. Roger in order to treat his asthma symptoms. The main goal of providing Salbutamol is to achieve symptom relief by the suppression of airway inflammation and decrease of bronchial hyper-responsiveness.

Salbutamol should not be administered to Mr. Roger if he has symptoms that are indicative of bilateral pneumonia. Hence, it can initiate action quickly.

It is possible to see the pharmacokinetics and pharmacydynamics of Salbutamol in action.

Understanding absorption distribution metabolism and excrettion (ADME), will give an idea of how quickly Mr. Roger can receive relief.

Salbutamol’s pharmacodynamics may help to understand its mechanism of actions.

It is a beta 2 beta2 adrenergic anagonist and induces bronchodilator by activating receptors.

It opens a pathway that causes AMP to be released and increases calcium ion concentration. This results in symptom relief.

Further, the pharmacokinetics explains the duration of the above-mentioned actions (Bryant & Knights, 2019).

Salbutamol lasts for between 4 and 6 hours.

Inhalation causes the medication to be absorbed into the bronchial smooth muscular tissues. After 2-3 hours, the drug concentration begins to drop.

After that.

The drug is absorbed in your gut.

The blood concentration of the drug has a bronchodilatory impact of between 5-20 ng/ml.

The drug is distributed mostly to the lungs as unmetabolized drugs, and the rest is deposited within the oropharynx.

Salbutamol, although it is not metabolized by the lungs is converted to salbutamol-4′-O sulfate.

Salbutamol as well as its metabolites are excreted through the urine.

Thus, the elimination half-life is 5.5 hours after inhaled or oral administration.

The way the drug is administered will affect how quickly it passes through the kidneys.

Injectable administration causes renal clearance to occur at 38ml/min while oral administration can cause it to happen at 70ml/min. Drug Bank 2018.

This information explains Salbutamol’s pharmacokinetic characteristics and the speed at which Salbutamol can provide relief to Mr. Roger.

Pathophysiology is involved in the prescription drug’s ability to reduce bronchoconstriction that occurs due to asthma patient’s airway inflammation.

Mr. Roger was then prescribed IV Benzylpenicillin.

Mr. Roger was suffering from increased work and breathing difficulties. Benzylpenicillin was prescribed for him to improve his breathing.

Benzylpenicillin is an antibiotic used to treat bacterial infections.

Because of poor oral absorption it is an intravenously administered antibiotic with a narrow spectrum.

It is a penicillin Beta-lactum antibiotic, used in the treatment of infections due to gram negative bacteria.

The drug inhibits cell wall synthesis. It also binds with penicillin binding proteins (Waller & Sampson 2017.)

This form of binding causes cell wall inhibition and cell lysis.

Bilateral pneumonia patients are usually prescribed antibiotics.

Mr. Roger was given Benzylpenicillin for his symptoms of productive cough and malodorous sputum.

Rapid absorption allows for Benzylpenicillin’s quick action.

After being distributed to the lungs the drug is metabolized and converted to penicilloid acids, which is an inactive metabolic compound.

The drug is eliminated by the kidneys and its half-life is 0.4 to 0.9% (Ajavon & Takt, 2016).

The drug’s pathophysiology links allow it to target the issue of mucus excess during bacterial infections as well as lung inflammation.

Also, Mr. Roger had Doxycycline prescribed.

Doxycycline is an antibiotic that can be used for various types of infections.

Doxycycline was prescribed to Mr. Roger due to its immune suppressing effect. Bhattacharyya et al.

It was shown by Bhattacharyya, et al. that prolonged use of the drug results in improvement of symptoms and reduction in the severity of pneumonia.

Roger has been given this medication to help improve his lung function, and reduce chronic asthma obstruction.

Doxycycline’s Pharmacodynamics Review can provide information about the drug’s potential therapeutic properties.

Its ability to bacteriicide is due to its inhibition of bacterial protein synthesis binding the 30S ribosomal unit.

It stops the replication of bacteria through inhibition of protein synthesis. This contributes to bacteriostatic effects (Xing et.al. 2015).

ADME has shown that Mr. Roger will be receiving a fixed dosage of the drug.

It is easily absorbed once it has been taken orally and metabolized by the gastrointestinal system.

The drug is mainly excreted in urine and feces. Its half life is approximately 16.33 hour.

The drug is eliminated via the kidney.

Roger is likely to experience relief with the combination of these three drugs. It will also reduce the chance of further exacerbations in the future (Drug Bank 2018.References:Agweyu, A., Gathara, D., Oliwa, J., Muinga, N., Edwards, T., Allen, E., … & Awuonda, B. (2014).

Oral amoxicillin against benzylpenicillin to treat severe pneumonia in children from Kenya: A pragmatic randomized controlled trial that was noninferior. Clinical infectious diseases, 60(8), 1216-1224. https://doi.org/10.1093/cid/ciu1166Ajavon, A. D., & Taft, D. R. (2016). 4 Pharmacokinetics/ADME of Small Molecules.

Preclinical Drug Development. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=HFnvBQAAQBAJ&oi=fnd&pg=PA71&dq=ADME+OF+Benzylpenicillin&ots=KjBC5q2Wwe&sig=GitjPZC05ZeoRtH-6tz8I7Uvph0#v=onepage&q=ADME%20OF%20Benzylpenicillin&f=falseAmrani, Y., & Bradding, P. (2017).

Asthma: The b2-Adrenoceptor Function.

Advances in immunology, Vol. 136, pp. 1-28).

Academic Press. Retrieved from: https://lra.le.ac.uk/bitstream/2381/40466/6/GPCR-b2%20receptor%20Chapter%202017%20Final.pdfBegic, E., Begic, Z., Dobraca, A., & Hasanbegovic, E. (2017).

Productive Cough in Children, Adolescents and Adolescents – View from Primary Health Care System. Medical archives (Sarajevo, Bosnia and Herzegovina), 71(1), 66-68. doi: 10.5455/medarh.2017.71.66-68Bhattacharyya, P., Sarkar, S., Das, S., & Saha, D. (2017).

Long term effects of doxycycline for asthma: A real world observation. European Respiratory Journal 2017 50 (61), DOI: 10.1183/1393003.congress-2017.PA4686Bryant,B.,& Knights,K.

(2019). 5th edition of Pharmacology for Health Professionals. )New South Wales, Australia: ElsevierCoccia, C. B., Palkowski, G. H., Schweitzer, B., Motsohi, T., & Ntusi, N. A. B. (2016).

Dyspnoea. A clinical approach and pathophysiology.

SAMJ South African Medical Journal. DOI:10.7196/SAMJ.2016.v106i1.10324Craft,J,& Gordon,C.(2019).

Understanding pathophysiology (3rd.ed). New South Wales, Australia: Elsevier. Retrieved from: https://www.elsevier.com/books/understanding-pathophysiology-anz/craft/978-0-7295-4264-7Drug Bank (2018). Benzylpenicillin. Retrieved from: https://www.drugbank.ca/drugs/DB01053Drug Bank (2018).

Doxycycline Retrieved from: https://www.drugbank.ca/drugs/DB00254Drug Bank (2018). Salbutamol. Retrieved from: https://www.drugbank.ca/drugs/DB01001Fabbri, L., Tonelli, R., Andreani, A., Castaniere, I., Fantini, R., Marchioni, A., & Clini, E. M. (2017).

The golden diagnosis for pneumonia: An uncommon cause. Respiratory medicine case reports, 22, 51-52. https://doi.org/10.1016/j.rmcr.2017.06.010McCauley, L., & Dean, N. (2015).

Pneumonia or empyema can be causal, accidental, or undetermined.

Journal of thoracic disorders, 7(6). 992. 10.3978/j.issn.2072-1439.2015.04.36Nightingale, C. H., & Bishai, W. R. (2016).

The Role of Macrolides and Community-Acquired Infected Pneumonia.

Community-Acquired Respiratory Illnesses (pp. 66-79).

CRC Press. Retrieved from: https://www.taylorfrancis.com/books/e/9780203912140/chapters/10.3109/9780203912140-9Quinton, L. J., Walkey, A. J., & Mizgerd, J. P. (2018).

Integrative pneumonia physiology. Physiological reviews, 98(3), 1417-1464. https://doi.org/10.1152/physrev.00032.2017Reamy, B. V., Williams, P. M., & Odom, M. R. (2017).

Pluritic chest pain: Sorting through the Differential Diagnosis. American family physician, 96(5).Retrieved from: https://www.aafp.org/afp/2017/0901/p306.htmlRegunath, H., & Oba, Y. (2018). Pneumonia, community-acquired.

StatPearls.

StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430749/Shen, Y., Huang, S., Kang, J., Lin, J., Lai, K., Sun, Y., Xiao, W., Yang, L., Yao, W., Cai, S., Huang, K., … Wen, F. (2018).

Chinese expert consensus for management of chronic airway inflammation: Hypersecretion of airway mucus in chronic airway disease. International journal of chronic obstructive pulmonary disease, 13, 399-407. doi:10.2147/COPD.S144312Waller, D. G., & Sampson, T. (2017).

E-Book Medical Pharmacology and Therapeutics. Elsevier Health Sciences. Retrieved from: https://dspace.fue.edu.eg/xmlui/bitstream/handle/123456789/1757/9327.pdf?sequence=1Xing, R., Witso, I. L., Jugowiec, D., Tiainen, H., Shabestari, M., Lyngstadaas, S. P., … & Haugen, H. J. (2015).

Antibacterial action of doxycycline coated dental abutment sands. Biomedical Materials, 10(5), 055003. doi:10.1088/1748-6041/10/5/055003


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