MR is 65-year-old woman with a past medical history of hypertension, chronic obstructive pulmonary disease (COPD)
Module 1 Discussion
Her current medications include:
- Atorvastatin (Lipitor) 80mg po daily
- Aspirin 81mg po daily
- Metformin (Glucophage) 1000mg po BID
- Tiotropium bromide (Sprivia) Respimat inhaler – 2 inhalations daily
- Fluticasone/salmeterol (Advair) 250mcg/50mcg Diskus – 1 inhalation BID
- Albuterol MDI – 2 inhalations prn shortness of breath/wheeze
- Lisinopril (Zestril) 20mg po daily
- Hydrochlorothiazide 12.5 mg daily
At this visit, the MR’s blood pressure is uncontrolled at 152/96 mm Hg. The patient states that she has missed a few doses of her medications. In reviewing the patient’s prescription profile, you note that she is very behind on refilling her medications.
Reflecting on the common reasons why patients do not take their medication, give 2 potential reasons you think she could be non-compliant and specific suggestions of how to help this patient be more compliant with her medications.
Expert Answer and Explanation
Addressing Non-Compliance to Medication
While non-compliance to medications can be attributed to various factors, MR possibly missed her dosses because she is concerned about the adverse effects associated with taking the medications she is prescribed. The listed medications have different side effects that can discourage MR from taking the medications. The adverse events linked to Atorvastatin include headache, nausea and nosebleed (Pinal-Fernandez, Casal-Dominguez, & Mammen, 2018). It is also possible that she forgets to take her medication given her age considering that old age is associated with dementia.
Interventions for the Adverse Drug Events
If MR missed her medication because of the adverse drug events, switching to different sets of drugs that she can tolerate, can encourage her to comply with the treatment. It is also important to initiate follow-up to observe the patient’s progress including their side effects. Alternatively, putting the patient on a treatment program that starts with a lower dosage, and gradually stepping up with higher dosage can help reduce the impact of the adverse drug events (López-Campos et al., 2021). If a provider is unable to recommend alternative medication, they can assure the patient that the medications are safe.
Interventions Related to MR’s forgetting when to Take Her Medications
Because MR may be forgetting to take her drugs, a provider should consider recommending the use of alarm reminder. This would alert her when to take her medication. When assisting the patient to remember taking her medication, one should consider incorporating medication into the tasks she routinely performs. For instance, she can take her drugs when she wakes up, and when she is going to bed in the evening. She can equally organize her medication to make it easier for her to identify which medication to take at specific times of the day.
References
López-Campos, J. L., Carrasco Hernández, L., Ruiz-Duque, B., Reinoso-Arija, R., & Caballero-Eraso, C. (2021). Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies. International journal of chronic obstructive pulmonary disease, 16, 2065–2076. https://doi.org/10.2147/COPD.S275943.
Pinal-Fernandez, I., Casal-Dominguez, M., & Mammen, A. L. (2018). Statins: pros and cons. Medicina clinica, 150(10), 398–402. https://doi.org/10.1016/j.medcli.2017.11.030.
Module 2 Discussion
This post should discuss the medication‘s classification, pharmacodynamics, pharmacokinetics, neurotransmitters and receptor sites involved. Be sure to discuss if your medication is an agonist, antagonist, etc., and how it will affect the receptors involved. Discuss side effects, be sure to explain why the side effects may be occurring (remember to use neuroscience and your knowledge of receptor sites). In your discussion of pharmacokinetics be sure to include the CYP 450 system. Lastly, include FDA approval and off label use for these medications. You may include any additional information you find interesting. It is expected that you will have sources for this discussion.
Expert Answer and Explanation
Understanding Celexa Medication
Classification
Celexa is classified under antidepressant medications. This class is commonly referred to as SSRIs which is an abbreviation for selective serotonin reuptake inhibitors and they are commonly prescribed for various anxiety disorders and depression (Drugbank, 2022).
Pharmacodynamics
Celexa works by inhibiting the reuptake of the neurotransmitter serotonin in the brain by attaching to the serotonin transporter responsible for reabsorbing serotonin in the presynaptic neuron following its release into the synaptic cleft (Edinoff et al., 2021). As a result, Celexa increases the concentration of serotonin in the synaptic cleft, leading to improved serotonergic neurotransmission which eases symptoms of anxiety and depression.
Pharmacokinetics
Celexa goes through hepatic metabolism through the CYP2C19 and CYP3A4 in the CYP450 system (Melaragno, 2021). The genetic variations present in CYP2C19 usually affect the metabolism of Celexa in people. For poor metabolizers, this leads to higher drug levels in their system hence increasing the risk of side effects. Celexa can be given as a once-daily dosage as the elimination of its half-life is 35 hours.
Neurotransmitters and Receptor Sites Involved
As earlier stated the main target of Celexa is the serotonin system by increasing the concentration of serotonin in the synaptic cleft. Serotonin plays a primary role in mood regulation, by blocking the reuptake of serotonin (Edinoff et al., 2021). Celexa ensures mood stabilization by activating the 5-HTIA and 5-HT2 receptors.
Agonist/Antagonist Effects
Celexa acts as a serotonin reuptake inhibitor, indicating that it is an antagonist at the serotonin transporter. This action reduces depression and anxiety in the patient.
Side Effects And Their Mechanism
Some of the common side effects of the drugs include nausea caused by the stimulation of 5-HT3 receptors in the gut. Other side effects include sexual dysfunction, sleepiness, and weight changes all caused by the changes in serotonin levels which impact the body’s activities (Edinoff et al., 2021)
FDA Approval And Off-Label Use
Celexa has been approved by the FDA for treating major depressive disorders (Drugbank, 2022). Physicians also prescribe it for other conditions that are categorized as anxiety disorders.
References
Drugbank. (2022). Citalopram. Go.drugbank.com. https://go.drugbank.com/drugs/DB00215
Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038
Melaragno, A. J. (2021). Pharmacotherapy for Anxiety Disorders: From First-Line Options to Treatment Resistance. FOCUS, 19(2), 145–160. https://doi.org/10.1176/appi.focus.20200048
Module 3 Discussion
- Do you think that clindamycin was an appropriate initial antibiotic choice for JC, what advantages or disadvantages does it have over other options?
- Of the available alternative antibiotic agents which agent would you prescribe JC?
- What information should be provided to the patient to enhance compliance, ensure successful therapy, and minimize adverse effects?
- What recommendations would you make to JC in regards to COVID-19 vaccination?
Expert Answer and Explanation
Analysis of a Clinical Case
Appropriateness of Clindamycin Including Advantages and Disadvantages
Considering the gradual increase in pain linked to the SSTI, the clindamycin was the right antibiotic choice for JC because it treats various forms of bacterial infections including those that are caused by Staphylococcus aureus. Prescribing the clindamycin was necessary because the boil is severe and it affects sensitive part of JC’s body. As an antibiotic medication, clindamycin has minor side effects, hampers Staphylococcus aureus’ toxin production, and can work where other antibiotics have failed (Luchian et al., 2021).
Although drugs such as cephalexin can treat an SSTI, some bacterial infections are resistant to this medication. Therefore, using the clindamycin can help address this problem. Furthermore, it has an edge over other medications because it penetrates into the tissue, altering the activities of the pathogens in the boil (Armengol Álvarez et al., 2022). However, the use of clindamycin can alter the functioning of one’s gastrointestinal system, leading to complications such as diarrhea.
The Alternative Antibiotic Agent to Prescribe
A wide range of antibiotic agents including Mupirocin, Linezolid, Vancomycin and Cephalexin can help manage SSTI. While these medications provide antibiotic therapies for the SSTI, I would prescribe the cephalexin because of the numerous benefits it provides. Like the clindamycin, cephalexin provides a suitable pharmacological intervention considering that it can treat a wide range of bacterial infections. This means that the risk of antibiotic resistance is low if one uses this drug to treat a boil (Haynes et al., 2022).
It is also associated with reduced risk of side effects, and when taken, it starts to work fast. Thus, JC would not have to worry about the pain if he takes cephalexin. Additionally, it targets various bacterial infections, improving the intervention outcomes.
The Information to Provide to the Patient to enhance Compliance
To ensure the patient complies with treatment, the therapy is successful, and the side effects reduce, provider should provide the patient with information such as the benefits of complying with treatment. If JC becomes aware of the benefits associated with adhering to the prescribed medications, he is likely to adhere to treatment. Still, providing him with details of the side effects of the clindamycin can help prepare him to deal with the side effects.
Recommendations in Regard to Covid-19 Vaccination
Regarding the Covid-19 vaccination, I would recommend that JC seek urgent medical attention because the side effects associated with the vaccine can affect aspects of his life. I would also recommend that he stays aware of updates on covid-19 because such information can help him learn how to cope with the side effects. I would equally recommend that JC take adequate rest, and hydrate to improve the recovery of his body. Furthermore, I would recommend the resources that can help him learn how to cope with the side effects of the vaccine (Fajardo et al., 2019).
References
Armengol Álvarez, L., Van de Sijpe, G., Desmet, S., Metsemakers, W. J., Spriet, I., Allegaert, K., & Rozenski, J. (2022). Ways to Improve Insights into Clindamycin Pharmacology and Pharmacokinetics Tailored to Practice. Antibiotics (Basel, Switzerland), 11(5), 701. https://doi.org/10.3390/antibiotics11050701.
Fajardo, M. A., Weir, K. R., Bonner, C., Gnjidic, D., & Jansen, J. (2019). Availability and readability of patient education materials for deprescribing: An environmental scan. British journal of clinical pharmacology, 85(7), 1396–1406. https://doi.org/10.1111/bcp.13912.
Haynes, A. S., Prinzi, A., Silveira, L. J., Parker, S. K., Lampe, J. N., Kavanaugh, J. S., Horswill, A. R., & Fish, D. (2022). Cefadroxil Comparable to Cephalexin: Minimum Inhibitory Concentrations among Methicillin-Susceptible Staphylococcus aureus Isolates from Pediatric Musculoskeletal Infections. Microbiology spectrum, 10(4), e0103922. https://doi.org/10.1128/spectrum.01039-22.
Luchian, I., Goriuc, A., Martu, M. A., & Covasa, M. (2021). Clindamycin as an Alternative Option in Optimizing Periodontal Therapy. Antibiotics (Basel, Switzerland), 10(7), 814. https://doi.org/10.3390/antibiotics10070814.
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