The 65-year-old in this scenario has been put on a therapy course with levofloxacin as part of treatment to help in the resolution of her community-acquired pneumonia. It would be prudent to note, from the onset, that this particular drug happens to be a fluoroquinolone whose tolerability as well as efficacy in a case such as the one presented has been well established (Noreddin and Elkhatib, 2010). To be more specific, in the words of the authors, the drug has a broad spectrum of activity against several causative bacterial pathogens of community-acquired pneumonia (CAP) (Noreddin and Elkhatib, 2010, p. 505). Essentially, levofloxacin, like is the case with other fluoroquinolones, acts by inhibiting two crucial enzymes that are critical in not only the replication, but also the transcription as well as recombination and repair of bacteria DNA (Noreddin and Elkhatib, 2010). The two enzymes are DNA gyrase and bacterial topoisomerase IV.

Some of the side effects that have been associated with levofloxacin are inclusive of, but they are not limited to; dizziness, insomnia, constipation, headache, diarrhea, as well as vomiting and nausea. It is also important to note that owing to the age of the patient, i.e. over 60 years of age, there is a risk for tendinopathy and tendon rapture. However, in the words of Kim (2010), tendinopathy induced by fluoroquinolone (FQ) antibiotics is a topic of controversy, with many researchers believing in a direct causal relationship while others believing that the risk is negligible (p. 49). To achieve maximum benefit for this particular drug, I would advise the patient to ensure that two hours prior to, and after taking the medication, she avoids milk and other related dairy products. Further, I would advise the patient to ensure that two hours elapse before and after she ingests antacids and/or vitamins. The same rule of thumb should be followed with regard to all other products likely to contain zinc, iron, magnesium or calcium.

The patient is on prescription for a number of other medications. These will be highlighted below;

1. For GERD

Esomeprazole (Nexium)

As a proton pump inhibitor, this particular medication works by inhibiting the secretion of gastric acid by blocking gastric H,K-ATPase (DiMario and Cohen, 2013). To a large extent, this makes it possible for the healing of damaged esophageal tissue to take place. It should be noted that in comparison to H-2 receptor blockers, proton pump inhibitors tend to have acid relief that is stronger. The medication has, however, been associated with a number of side effects which are inclusive of dry mouth, constipation, flatulence and nausea, diarrhea, as well as headache. To achieve maximum benefit from the drug, I would ensure that the patient is aware of possible interactions with any herbs, vitamins as well as other medications that she could be taking. I would also advise the patient to ensure that she takes the drug more than one hour after she takes food. This is more so the case given that as DiMario and Cohen (2013) observe, taking this drug with food can decrease the amount of esomeprazole magnesium in your body (p. 311).

Sucralfate (Carafate)

As an antiulcer drug, this particular medication, binds to the ulcer base following its dissociation to what Bardal, Waechter and Martin (2011) refer to its anionic form. This takes place in the stomachs acidic environment. As a consequence, Bardal, Waechter and Martin (2011) point out that this leads to the establishment or a protective barrier to both bile and pepsin. It should also be noted that in this case, gastric acids diffusion is effectively inhibited. Due to the role it plays...

…muscle weakness. In seeking to maximize the benefits of the drug, it would be prudent to advise the patients on the best time of day to take the medication. As Bolk, Visser, and Nijman (2010) observe, there appears to be a consensus of sorts that levothyroxine (Synthroid) is best taken on an empty stomach in the morning. It therefore follows that most patients are advised to take the medication in the morning, one hour before ingesting any food. In a study seeking to establish the best time of day to take the medication, Bolk, Visser, and Nijman (2010) established that this general consensus could be mistaken. In the present study, it was established that levothyroxine taken at bedtime significantly improved thyroid hormone levels (Bolk, Visser, and Nijman, 2010, p. 97). Thus, on the strength of these findings, I would advise the patient to take the medication at bedtime.

Final Assessment

In the final analysis, it would be prudent to note that there are a number of concerns posed by a number of medications highlighted above with regard to the levofloxacin therapy course. To begin with, there is need to indicate that no adverse reactions exist between levofloxacin and esomeprazole (Nexium), alendronate (Fosamax), as well as levothyroxine (Synthroid).

However, I would in this case advise the patient to ensure that she takes levofloxacin approximately 2 hours before taking sucralfate (Carafate). This is more so the case given that sucralfate (Carafate) could interfere with the effective absorption of levofloxacin if taken at the very same time.

I would also advise the patient to stop taking Rosuvastatin over the next 12 days to eliminate the possibility of adverse interaction with levofloxacin. This is more so the case given that for persons at an advanced age, the combination of a statin such as Rosuvastatin and a fluoroquinolone such as…