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Knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis. Review assignment rubric and case studies. Be sure to thoroughly answer ALL Explain the problem and discuss how you would address the problem. When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications. Answer questions using your required learning resources, clinical practice guidelines, Medscape and JNC 8. Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
SCENARIO 2
GP is a 21-year-old female presenting with thick white, odorless vaginal discharge and itching for 3 days. She is sexually active and has had unprotected sex with a new male partner for the last month. Current medications include ethinyl estradiol/norgestrel 30 mcg/0.3 mg po daily and alprazolam 2 mg po TID prn. This patient is allergic to sulfa drugs. What medication would you prescribe for this patient (include complete medication order)? How long should GP abstain from sexual activity? What patient education would you provide? What possible drug interactions exist?
SCENARIO 3
LW is a 66-year-old male seen in the clinic today. He presents with extreme fatigue, brain fog, minor sore throat and temperature of 100.8. He reports that symptoms began two days ago with a sore throat and have progressively worsened. He also mentions loss of appetite. Oxygen sat 96%, respiratory rate 18, bp 130/80. His rapid COVID-19 antigen test is positive. Chest x-ray is clear, no signs of pneumonia. What treatment
SCENARIO 4
FS is a 35-year-old female trying to conceive with a medical history of PCOS. Her labs today show a MCV 77, MCHC 26, Ferritin 9, TIBC 415, BG 90 mg/dL, A1C 5% Current medications include metformin 500 mg po BID and a B vitamin complex. What treatment plan would you implement for FS? Why is this patient on metformin? How would you monitor this patient’s response to the medication? What patient education would you provide?
Full Answer Section
Prescription:
Fluconazole (Diflucan) 150 mg po x 1 dose
Dispense: 1 tablet
Refills: 0
Sig: Take one tablet by mouth once.
Sexual Activity:
GP should abstain from sexual activity until her symptoms resolve, generally about 7 days after treatment (ACOG, 2021). This helps prevent reinfection and allows the medication to work effectively.
Patient Education:
Explain that fluconazole is an antifungal medication that will treat the yeast infection.
Advise her to complete the full course of treatment, even if symptoms improve before then.
Discuss potential side effects, such as headache, nausea, or abdominal pain.
Counsel her on safe sex practices, including using condoms to prevent future infections.
Emphasize the importance of completing treatment and refraining from sexual activity until symptoms resolve.
Inform her that if symptoms persist or worsen after 7 days, she should return for a follow-up evaluation.
Drug Interactions:
Fluconazole can interact with several medications, including alprazolam.Fluconazole is a CYP3A4 inhibitor and can increase alprazolam levels, potentially leading to increased sedation (FDA, n.d.). While a single dose of fluconazole is less likely to cause a significant interaction, it's important to be aware of the potential. I would advise GP to monitor for excessive sedation and contact me if she experiences this. I would also document this potential interaction in her chart.
References:
ACOG. (2021). Vulvovaginal candidiasis. Practice Bulletin No. 183. American College of Obstetricians and Gynecologists.
FDA. (n.d.). Diflucan (fluconazole) prescribing information. U.S. Food and Drug Administration. [URL]
SCENARIO 3
LW's presentation suggests an acute viral illness, likely COVID-19 given the positive rapid antigen test. His symptoms (fatigue, fever, sore throat) are consistent with this diagnosis (CDC, 2023). His oxygen saturation is good, and his lungs are clear, indicating no current signs of pneumonia.
Treatment Plan:
Given his symptoms and positive COVID-19 test, treatment would focus on symptom management.
Acetaminophen (Tylenol) 650 mg po q4-6h prn for fever and discomfort.
Dispense: 20 tablets
Refills: 0
Sig: Take two tablets by mouth every 4 to 6 hours as needed for fever or pain.
Ibuprofen (Advil, Motrin) 400 mg po q6h prn for fever and discomfort (alternate with Acetaminophen if needed).
Dispense: 20 tablets
Refills: 0
Sig: Take one tablet by mouth every 6 hours as needed for fever or pain.
Encourage oral hydration: Recommend drinking plenty of fluids (water, electrolyte drinks) to prevent dehydration.
Rest: Advise LW to rest and avoid strenuous activity.
Isolation: Instruct LW to follow current CDC guidelines for isolation to prevent spreading the virus.
Follow-up:
I would advise LW to monitor his symptoms closely. If he develops shortness of breath, chest pain, or worsening symptoms, he should seek immediate medical attention. A telehealth or in-person follow-up appointment in a few days would be helpful to monitor his progress.
References:
CDC. (2023). COVID-19 Treatment Guidelines. Centers for Disease Control and Prevention. [URL]
SCENARIO 4
FS's lab results indicate microcytic, hypochromic anemia (low MCV and MCHC) and iron deficiency (low ferritin). This is common in women with PCOS, who may experience heavy menstrual bleeding (ACOG, 2019).
Treatment Plan:
Iron Supplementation: I would prescribe an oral iron supplement to address her iron deficiency.
Ferrous Sulfate 325 mg po TID
Dispense: 90 tablets
Refills: 2
Sig: Take one tablet by mouth three times a day.
Dietary Counseling: Recommend increasing iron-rich foods in her diet (red meat, leafy greens, beans).
Metformin: FS is likely on metformin for insulin resistance, which is often associated with PCOS.Metformin helps regulate blood sugar and can improve ovulation in some women with PCOS (Barbieri, 2018). I would continue this medication.
Further Evaluation: I would consider further evaluation for other potential causes of anemia, although iron deficiency is the most likely given her history and labs.
Monitoring:
Follow-up Labs: Repeat CBC and ferritin levels in 4-6 weeks to assess her response to iron supplementation.
Menstrual Cycle: Monitor her menstrual cycle for any changes in bleeding patterns.
Side Effects: Monitor for side effects of iron supplementation, such as constipation or GI upset.
Patient Education:
Explain the importance of iron supplementation and dietary changes to address her anemia.
Advise her to take iron with food to reduce GI side effects, but avoid taking it with calcium-rich foods or beverages, as these can impair iron absorption.
Discuss the importance of regular follow-up appointments to monitor her progress.
Reinforce the role of metformin in managing her PCOS and improving fertility.
Provide education about PCOS and its potential impact on fertility.
References:
ACOG. (2019). Management of women with polycystic ovary syndrome. Practice Bulletin No. 200. American College of Obstetricians and Gynecologists.
Barbieri, R. L. (2018). Clinical review: Metformin and the polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 103(8), 3090-3100.
Sample Answer
SCENARIO 2
GP's symptoms strongly suggest a vaginal yeast infection (candidiasis). The thick, white, odorless discharge and itching are classic signs (ACOG, 2021). Her unprotected sexual activity increases the likelihood of this infection.
Treatment Plan:
I would prescribe an antifungal medication to treat the infection. Since GP is allergic to sulfa drugs, I would avoid medications like sulfanilamide vaginal cream. Fluconazole is a safe and effective option.