Pharmacology Case Studies
Scenario 1: Sara's Case Study
Problem
Sara presents with a persistently high blood pressure (hypertension), indicated by her current reading of 160/90 mmHg and her previous reading of 156/92 mmHg three months ago. Considering her weight and ongoing medication (ibuprofen, which can elevate blood pressure), addressing her hypertension is critical (National Institute for Health and Care Excellence, 2019).
Goal for Blood Pressure
According to the American College of Cardiology and the American Heart Association, the goal is to reduce Sara's blood pressure to below 130/80 mmHg to minimize her risk of cardiovascular disease (Whelton et al., 2018).
Medication Prescription
Given her hypertension and current use of ibuprofen (which can contribute to increased BP), a calcium channel blocker or a thiazide diuretic could be considered. Considering her profile, amlodipine, a calcium channel blocker, is a suitable choice due to its efficacy and safety profile.
Prescription
Amlodipine 5 mg, oral, once daily. Take one tablet by mouth once daily.
Education
Discuss the potential impact of ibuprofen on blood pressure and explore alternatives for back pain management. Emphasize the importance of lifestyle modifications, including a diet low in salt, regular physical activity, and weight loss to help manage hypertension. Advise on the importance of monitoring blood pressure regularly (Chobanian et al., 2003).
Scenario 2: Monty's Case Study
Problem
Monty's lipid profile indicates dyslipidemia with elevated total cholesterol, LDL cholesterol, and triglycerides, and low HDL cholesterol. He is a smoker, which adds to his risk for coronary artery disease (CAD) (National Institute for Health and Care Excellence, 2014).
Treatment Plan for Lipid Profile
According to the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol, the addition of a statin is recommended to manage Monty's lipid levels, particularly to lower his LDL cholesterol (Grundy, 2019).
Goals
The goals are to reduce Total Cholesterol (TC): <200 mg/dL, reduce LDL-C: <100 mg/dL (recommended for individuals at high risk like Monty), and increase HDL-C: >40 mg/dL.
Prescription
Atorvastatin 20 mg, oral, once daily. Take one tablet by mouth once daily at bedtime.
Monitoring Effectiveness
Follow-up lipid profile in 4-12 weeks to assess response and adherence, then every 3-12 months as needed. Monitor for potential statin side effects, including muscle pain or weakness.
Risk Factors for CAD
Risk factors for CAD include smoking, hypertension (assuming from the context of medication), dyslipidemia, and age (>45 years for men) (Greenland et al., 2010).
Scenario 3: Beatrice's Asthma Management
Problem
Beatrice is experiencing an increase in asthma symptoms, including frequent use of her albuterol rescue inhaler, nighttime coughing, and exercise-induced shortness of breath. This indicates her asthma is not well-controlled.
Treatment Plan
Given the increased frequency of rescue medication use and nighttime symptoms, stepping up her asthma treatment is advisable based on the asthma management guidelines (Cloutier et al., 2020a).
Medication Changes
Increase the dose of the inhaled corticosteroid (ICS): Considering...
…ICS alone, combining fluticasone with a LABA, such as salmeterol, could be beneficial. Ensure proper inhaler technique: Misuse of inhalers is common and can significantly affect medication efficacy (Cloutier et al., 2020b).
Prescription
Fluticasone/salmeterol (Advair Diskus) 250/50 mcg, one inhalation twice daily.
Monitoring Effectiveness
Schedule a follow-up visit in 4-6 weeks to assess asthma control and adjust the treatment plan as necessary. Educate Beatrice on monitoring her symptoms and peak flow readings at home. Review inhaler technique at every visit (Reddel et al., 2022).
Scenario 4: Daute's Chronic Obstructive Pulmonary Disease (COPD)
Problem
Daute exhibits symptoms indicative of COPD progression, such as increasing shortness of breath and a history of chronic bronchitis and smoking. His lack of maintenance medication adherence has likely contributed to symptom exacerbation.
Treatment Plan
Re-initiating pharmacological treatment along with lifestyle modifications is crucial for managing Daute's symptoms and preventing further exacerbations (Rabe et al., 2007).
Medications
Resume salmeterol/fluticasone (Advair Diskus): This combination inhaler is effective for managing COPD symptoms and reducing exacerbations. Consider short-acting bronchodilator as needed: For acute relief of symptoms. Smoking cessation support: Given his significant smoking history, assisting Daute in quitting smoking is vital (Celli et al., 2021).
Prescription
Salmeterol/fluticasone (Advair Diskus) 250/50 mcg, one inhalation twice daily.
Monitoring Effectiveness
Schedule regular follow-ups every 3-6 months or as clinically indicated to assess symptom control and medication adherence. Spirometry at follow-up visits to monitor lung function. Discuss and reinforce smoking cessation strategies…
