Mr. Roger Wilson, a 32-year old man with a history asthma, was seen by his GP to complain of shortness, fever, headaches, and a productive cough.
The doctor diagnosed Mr Wilson as having a respiratory infection and prescribed him roxithromycin (Rulide), 150mg twice daily (BD).
Mr Wilson felt much worse after taking the antibiotic for 2 days.
A chest xray revealed bilateral pneumonia. Mr Wilson was taken to the emergency department (ED) and given antibiotics.
Roger has mild asthma since childhood.
He takes salbutamol, (Ventolin), via a metered dosage inhaler (MDI), for symptom relief.
Roger and Matthew have been working together to transform an old warehouse into their gym over the last few months.
Both of them experienced ‘flu-like symptoms’, sore throats, and chest infections during this period.
Roger appeared anxious and weak upon arrival at the ED.
Admission to The ED
Roger was sweating and flushed upon his admission to the ED.
Roger is alert, oriented, and very breathless. He rates his chest pain as a two-out of ten on a numerical pain scale.
He has a productive, green-colored cough and produces sputum that is both malodorous and green.
Roger does not smoke and only drinks socially.
Pathophysiology and Pharmacology Related to the Case Patient:
This clinical scenario is based upon Mr. Roger Wilson, a 32-year-old man who was admitted to the emergency department with symptoms of chest pain, cough, and breathlessness.
A chest x-ray showed bilateral pneumonia and he was diagnosed with respiratory tract infections (RTI).
This is a form of acute lower respiratory tract infections that affects both the lungs. It causes symptoms such as headache, sneezing and tightness in the chest.
Roger has similar symptoms, according to a review of the case.
Roger is most affected by the lungs, alveoli and other anatomical structures.
The patient experiences mild chest pain, productive cough, and breathlessness.
This is due to the anatomy and physiology the disease. Bilateral pneumonia causes inflammation of the alveoli, which then becomes filled with pus, causing symptoms of breathlessness (McCauley & Dean 2015). Breathing difficulty and wheezing can also result from a change in the physiology of lungs. (Craft & Gordon 2019, 2019).
Direct invasion of bacteria into the pleural space can cause structural changes in the lung and a cascade of inflammatory events.
Bilateral pneumonia anatomy and physiology are linked to the pathophysiology of the patient in this case study.
It is important to understand the pathophysiology of the disease in order to determine the reason behind Mr. Roger’s pharmacological regimen.
The disease’s pathophysiology includes direct bacterial invasion, inflammation of the lungs and pleural spaces, a cascade of inflammatory events, and bacteriologic virulence (Quinton Walkey & Mizgerd 2018, 2018).
Mr. Roger has had episodes of productive cough and shortness of breath.
Bilateral pneumonia is a pathophysiological condition that can cause this.
Pneumonia can be caused by either bacterial or viral infection.
Inflammation of the air sacs of the lung is caused by an immune response that the lung initiates after infection with bacteria or viruses.
Fluid location is caused by the acceleration of the immune reaction.
Fluid within the alveoli is caused by the migration of the neutrophils and activation the coagulation cascade.
The mucus plugs decrease the efficiency of gas exchange in lungs because the fluid is protein rich.
Further fluid buildup in the alveoli results in reduced gas exchange and increased risk of infection (McCauley & Dean 2015).
These pathophysiological changes could be responsible for Mr. Roger’s clinical manifestations of pneumonia. It is also linked to changes in anatomical structures that are associated with pneumonia. Changes in the lung structures can initiate a cascade of inflammatory events, which causes fluid accumulation (Gon & Hanshimoto 2018, 2018).
Bilateral pneumonia can be managed primarily with pharmacological treatment.
The type of infection is also important. Treatment aims to reduce symptoms such as impaired gas exchange and difficulty breathing for the patient.
Understanding the pharmacology of Mr. Roger’s prescribed pharmacology can help you understand the effects of the drug on your body.
The main treatment for pneumonia is an antibiotic.
Roger was given IV Benzylpencillin, a narrow-spectrum antibiotic. It is used primarily to treat pneumonia patients.
Because of poor oral absorption, it is administered intravenously. The drug acts by binding to penicillin binding protein within the bacterial cell walls.
It acts by inhibiting the final stage of bacterial cell wall production, leading to cell lysis (Drug Bank 2018, 2018).
There is evidence that benzyl penicillin may be a suitable pharmacological option to treat patients with pneumonia.
This medication can be used early to provide many benefits, including a reduced need for nursing care, the elimination of injectable drugs, and a low cost of treatment (Agweyu, et al. 2014).
Benzylpenicillin is a medication that can speed up recovery and prevent complications for Mr. Roger.
Doxycyline was another medication that Roger received for his first day.
This medication works to treat and prevent the growth of bacteria.
It is part of the drug class Tetracycline antibiotics. It can be used to treat different types bacterial infections.
It has a similar mechanism of action to benzylpencillin. It inhibits protein synthesis through binding to the 30S-ribosomal unit.
This causes a decrease in bactetial growth, which in turn leads to a reduction in the patient’s symptoms (Nightingale & Bishai (2016)).
Because of his mild asthma history, Mr. Roger uses a metered dose inhaler (MDI) to take Salbutamol.
Salbutamol, a beta2adrenergic receptor agonist that acts quickly, is used to treat asthma.
Evidence suggests that glucocorticoids and b2?Adrenoceptor antagonists are the best pharmacological options to treat inflammation of the airways.
It is a first-line treatment for asthma.
b2?Adrenoceptor antagonists are the most important drug class in treating asthma.
Salbutamol, a short-acting drug, is given on a need basis. Long-term treatment is done with glucocorticoid in combination with a long-acting preparation (Amrani & Bradding 2017,).
Because this drug class has bronchodilator effects and can relieve breathlessness, it is linked to Mr. Roger’s treatment of bronchocontriction.
The Cases Study explains the Three Symptoms.
Mr. Roger has bilateral pneumonia. He experienced chest pain, productive cough, and breathlessness.
These are just a few of the symptoms of pneumonia.
These symptoms are linked to the pathophysiology and manifestations of bilateral pneumonia. This is because pathophysiology changes due to bacterial invasion, and inflammatory response contributes towards such symptoms (Fabbri et. al. 2017, 2017).
Patients with bilateral pneumonia are most commonly affected by productive cough and mucous.
Roger experienced productive cough. This is a sign of lower respiratory tract infection, which is why coughing can be a result of bilateral pneumonia.
A severe allergic reaction and acute bacterial infection can cause productive cough.
The result is thickened mucus plugs, which block the airway (Begic and colleagues, 2017).
Upon admission to the ED Mr. Roger developed a productive cough and sputum that was greenish-colored.
This is due to hypersection of the airway mucus caused by pathophysiological manifestations of the disease.
Normal conditions have mucous as a protective function that moistens the airway.
Purulent cough can occur when the lungs become anaerobic (Shen and al.
Roger and other patients with pneumonia need to be given the appropriate pharmacological treatment.
One of the symptoms Mr. Roger experienced was dyspnea or breathlessness.
According to the case study, Mr. Roger was experiencing shortness of breath for the past week.
This is directly related to the pathophysiology and treatment of pneumonia.
In pneumonia, breathing difficulties are caused by bacterial infection. The inflammatory cascade results is the release of macrophages and the filling of the alveolar spaces with fibrin rich exudates.
This makes the alveolar space less airy, resulting in pulmonary edema.
This is what causes oxygen deprivation and increases in work of breathing (Regunath & Oba 2018, 2018). As a result, symptoms of breathlessness are more common when there is less gaseous exchange.
(2016) explain that activation of multiple pathways results in increased breathing effort or decreased breathlessness.
This condition is characterized by tightness and increased respiratory effort.
A review of the clinical situation of Mr. Roger revealed that he had slight chest pain and breathlessness.
As the patient’s response, two out of ten rated their pain score, the intensity of the pain was very low.
This could be due to muscle strain, excessive coughing, or acute inflammation of the inner linings.
Only airway inflammation can cause chest pain.
The cause of chest pain in the middle is inflammation of the parietal, or pleural space. This triggers pain receptors.
Trauma to the rib cage or intercostals nerves can cause pain in the cutaneous distribution nerves. (Reamy Williams & Odom 2017, 2017).
This type of pulmonary embolism can be caused by many things, and in the case Roger it was linked to bilateral pneumonia.
Discussion of Three Medications Relating To The Pathophysiology of the Patient:
For the treatment and relief of symptoms and asthma, Mr. Roger was prescribed Salbutamol via IV benzylpenicillin, Salbutamol via an inhaler and Doxcycline via an intravenous benzylpenicillin.
Salbutamol should be given to Mr. Roger as his symptoms are indicative of bilateral pneumonia.
Review of pharmacokinetics, pharmcodynamics, and the rationale for giving Salbutamol to a patient can also help explain the reason.
Understanding the absorption, distribution metabolism and excretion of medication (ADME), can help Mr. Roger determine how quickly it can provide relief.
A review of Salbutamol’s pharmacodynamics can help you understand the drug’s mechanism of action.
It is a beta2 beta2 adrenergic antagonist. This drug induces bronchodilator effects by activating adrenergic receivers.
It activates a cascade of pathways that leads to AMP release and an increase in calcium ion concentration, thereby causing symptom relief (Neame et. al. 2015).
The pharmacokinetics also details the time it takes for the above-mentioned action to occur (Bryant & Knights 2019, 2019).
Salbutamol has a half-life of 4 to 6 hours.
The medication is absorbed through the bronchial smooth muscle and then the concentration drops after inhalation.
This is followed by a lowering of the drug’s concentration.
The drug is then absorbed into the stomach.
Blood concentrations between 5-20 ng/ml show bronchodilatory effects.
Most of the medication is distributed to the lungs unmetabolised and the remainder is stored in the oropharynx.
Salbutamol does not get metabolized in the lungs. However, it is converted into salbutamol 4’-O-sulfate.
Salbutamol and its metabolites can be excreted from the urine.
The elimination half-life of Salbutamol and its metabolites is approximately 5.5 hours after oral or inhaled administration.
The mode of administration determines the rate of renal clearance.
The renal clearance of the drug depends on how it is administered. After oral administration, it occurs at 38ml/min, while intravenous administration takes 70ml/min (Drug Bank 2018,).
This is how Salbutamol works and how fast it will provide relief for Mr. Roger.
This drug works by reducing bronchoconstriction in patients with asthma.
Mr. Roger was also prescribed IV Benzylpenicillin.
To improve his breathing, Mr. Roger received IV Benzylpenicillin because he was suffering from breathlessness and increased breathing work.
Benzylpenicillin can be used to treat a variety of bacterial infections.
Because of poor oral absorption, it is an intravenously administered narrow-spectrum antibiotic.
This antibiotic is penicillin beta-lactum and used to treat gram positive infections.
It inhibits cell wall synthesis and binds to penicillin binding protein, which is what causes the bactericidal effects (Waller & Sampson 2017).
This binding inhibits cell wall synthesis, leading to cell lysis.
Patients with bilateral pneumonia are often prescribed antibiotics.
Mr. Roger was prescribed Benzylpenicillin to treat his productive cough and malodorous sputum.
Rapid absorption of Benzylpenicillin explains the rapid action of this drug.
The drug is then metabolized into penicilloid, an inactive metabolite.
Half life of the drug is between 0.4 and 0.9 hours. (Ajavon, Taft 2016).
The drug is linked to pathophysiology and works to treat the problem of mucus oversecretion that occurs during lung inflammation and bacterial infections.
A review of the medical records of Mr. Roger revealed that he was prescribed Doxycycline.
Doxycycline can also be used to treat different types of infections.
Doxycycline has been prescribed to Mr. Roger because of its immune suppressing properties.
The evidence from Bhattacharyya et al. (2017) shows that the drug can be used long-term to improve symptoms and reduce the severity of the condition.
Roger was prescribed this medication to improve lung function and reduce chronic obstruction, which are both part of the pathophysiology for bilateral pneumonia.
A review of Doxycycline’s pharmacodynamics can help to determine the drug’s therapeutic effects on patients.
The inhibition of bacterial protein synthesis binding to the 30S subunit of the ribosomal ribosomal molecule is what gives Doxycycline its bactericidal effect.
It inhibits protein synthesis and stops bacteria replication (Xing et. al., 2015).
ADME review reveals why Mr. Roger is receiving a fixed dose.
After oral administration, it is easily absorbed and metabolized in your gastrointestinal tract.
The drug is mostly excreted through urine and faeces. Its half-life is approximately 16.33 hours.
The drug is cleared by the kidneys.
Combining three drugs will likely provide relief for Roger’s current symptoms and decrease the risk of future exacerbations (Drug Bank 2018,).
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