Pharmacology Portfolio Case Study

Pharmacology Portfolio

Case Study One  

Polypharmacy and Antibiotic Use

Jane Jones is an 82-year-old resident of an aged care facility where you are completing your final clinical placement. She has an extensive past medical history which includes osteoarthritis, heart failure, GORD (Gastro-Oesophageal Reflux Disease), Type 2 Diabetes, Depression and Mild Dementia diagnosed two months ago. She had no known allergies and receives her influenza vaccine annually. She is 156cms tall and weighs 68kg. She is a non-smoker and has a recent history of falls.

Her father had a history of Type 2 Diabetes and died at the age of 81, whilst her mother had a history of Heart Failure and died at the age of 85. Her husband Jack passed away six months ago, her three adult sons all live interstates. She enjoys cups of tea and the occasional glass of red wine.

Her current medication includes:

• paracetamol (Panamax) 500 mg, 1 or 2 tablets every 4–6 hours when required
• ramipril (Tritace) 10 mg, 1 tablet daily
• omeprazole (Acimax) 20 mg, 1 tablet daily
• furosemide (frusemide) (Frusid) 20 mg, 1 tablet daily
• temazepam (Temaze) 10 mg, 1 tablet at night when required
• sertraline (Zoloft) 50 mg, 1 tablet daily
• metformin extended release (Diabex XR) 500 mg, 1 tablet daily
• donepezil 10 mg (Aricept), 1 tablet daily

Question One

At handover, this morning Jane's carer mentions that Jane has urge incontinence and has been making more frequent trips to the bathroom particularly overnight. You take her observations this morning as follows: Blood Pressure 118/70 mmHg, Heart Rate 80 bpm, Temperature 36.8

Review her current medication list. Based on your knowledge of these medications which of her medications produce adverse effects which may affect urinary continence?

Question Two

Three months later, Jane has noticed a sudden worsening urgency to urinate and a burning sensation when passing urine. On examination, Jane presents with a fever and has some suprapubic tenderness and appears a bit more confused than usual. A midstream urine culture is requested so that empirical treatment can commence. June is commenced on Trimethoprim 150mg once daily for 3 days.

Given your knowledge of this drug is this an appropriate prescription for Jane? Why is it important to review this prescription once the results of Jane's culture are available?

Question Three

Three months later, Jane has a recurrent symptomatic urinary tract infection and another midstream urine culture is collected for testing. Jane is prescribed prophylactic antibiotics to prevent recurrent infections

What are some of the risks associated with long term antibiotic use that need to be considered? What other options would you consider decreasing June's risk for recurrent urinary tract infection.

References

List all references used in the box below (references should also be cited in text where relevant). You must follow APA referencing requirements throughout.

Case study 2

Pharmacology Portfolio

Case Study Two   

COPD

Sarah is a 66-year-old woman and a regular patient at your respiratory clinic for the past 4 years. She was diagnosed with COPD of moderate severity 3 years ago. She has had one severe exacerbation of her COPD in the last 6 months. She is an ex-smoker (10 cigarettes/day), she quit when she was diagnosed with COPD.

Her past medical history includes: Hypercholesterolaemia adequately controlled with atorvastatin 40 mg once daily, and osteopenia.

Sarah is a widow who lives with her daughter, son-in-law and granddaughter. She is a retired teacher but volunteers as a tutor at the local indigenous community service. Sarah is careful to take all her medicines daily and on time.

Her medications include:

• Indacaterol DPI 150 micrograms once daily
• Salbutamol pMDI 100 micrograms as needed
• Atorvastatin 40 mg once daily

She presents today for her annual influenza vaccination. When you enquire how she’s been feeling, you learn that Sarah was discharged from hospital 2 weeks ago after a short stay to treat an infective exacerbation of her COPD. While Sarah is recovering well from the infection, she mentions she has been experiencing recurring headaches and a ‘funny’ heartbeat over the last week or so and wonders if these are side effects of her ‘new puffer’. She denies overusing her salbutamol pMDI, saying she’s only taken ‘a few puffs’ since discharge from hospital.

She was discharged from hospital with the following medication:

• Amoxicillin 500 mg three times daily for 5 days
• Prednisone 30 mg a day for 5 days
• Salbutamol 100 micrograms up to 10 actuations by inhalation via pMDI with spacer, as needed
• Budesonide/formoterol DPI (Symbicort Turbuhaler) 400/12 micrograms twice daily

Question One

You complete a quick assessment which includes Heart rate 86 bpm and regular, on auscultation of breath sounds you hear odd scattered wheeze, no focal signs, Blood Pressure 134/86 mmHg, You complete an ECG which shows sinus rhythm, occasional supraventricular ectopic beats. No ischaemic changes.

Question One- Consider Sarah's recent medical history and medication, what may be contributing to her presenting symptoms of recurring headache and palpitations

Question Two

During her hospital admission Sarah was commenced on an Inhaled Corticosteroid + Long-Acting Beta Agonist Fixed Dose Combination inhaler (Budesonide/formoterol DPI (Symbicort Turbuhaler) 400/12 micrograms twice daily)

Given your knowledge of these drugs and their use in COPD, what is the likely rationale behind this prescribing decision? 

Question Three

Her GP ceases Sarah’s prescription for indacaterol and explains to her why this is no longer needed. You update her Medicines List.

When Sarah returns to see you for her Care Plan follow up, her palpitations and headache have resolved. However, she explains she feels more breathless on exertion and is convinced the new inhaler she started in hospital is not as strong as the one she was on before.

Assuming Sarah’s breathlessness is not due to another infective exacerbation or cardiovascular cause, how would you suggest responding to her increase in symptoms?

References

List all references used in the box below (references should also be cited in text where relevant). You must follow APA referencing requirements throughout.