[Solved] Sarah Johnson is a 32-year-old pregnant female at 24 weeks gestation. PMH consists of hypertension x 3 years and acne treated with isotretinoin and spironolactone 50 mg po daily – Fast, Quality and Affordable Assignment Expert

Sarah Johnson is a 32-year-old pregnant female at 24 weeks gestation. PMH consists of hypertension x 3 years and acne treated with isotretinoin and spironolactone 50 mg po daily

Adults health, ears, eyes, case study

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For your week 9 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

To Prepare:

• Review assignment rubric and case studies. Be sure to thoroughly answer ALL questions.
• Explain the problem and discuss how you would address the problem.
• When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, indication for use, quantity and # of refills. An example: lisinopril 10mg #30 tabs, take 1 tab PO once daily for high blood pressure, refills: 2.
• Also state if you would continue, discontinue or taper the patient’s current medications.
• Answer questions using your required learning resources, clinical practice guidelines, Medscape, etc.
• Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

Scenario 1 – Sarah Johnson

Sarah Johnson is a 32-year-old pregnant female at 24 weeks gestation. PMH consists of hypertension x 3 years and acne treated with isotretinoin and spironolactone 50 mg po daily. She denies smoking and alcohol but drinks 3 cups of coffee per day. Lisinopril 10mg daily was discontinued due to pregnancy. She presents for a routine prenatal visit. Labs include Hgb 12.8, HCT 39.9, K 4.7, glucose 78, BUN 12, Cr 0.78. Her blood pressure is 150/95 mmHg, measured twice with a 5-minute interval. What treatment plan would you implement for Sarah? How would you treat her hypertension (include a complete medication order)? How would you monitor drug therapy and what is her goal blood pressure?

Scenario 2 – Lydia

Lydia is a 24-year-old single female presenting with vaginal discharge for 1 week. She is sexually active and has had unprotected sex with a new male partner for the last month. Her gonorrhea culture is positive. This patient is allergic to sulfa drugs. What is the first line treatment for this patient? What other organism should you consider covering and why? What medication would you prescribe to cover this organism (include complete medication orders)? How long should Lydia abstain from sexual activity to prevent reinfection? What patient education would you provide?

Scenario 3 – Edgar

Edgar is a 6-year-old boy seen in the clinic today. His mother states he woke up this morning with his right eye red and swollen with a crusty yellow discharge. He has been diagnosed with bacterial conjunctivitis of the right eye. The mother asks if this is the same as “pink eye”? Edgar is allergic to sulfa drugs, amoxicillin and penicillin. His current medications include montelukast 10mg chewable tablet qhs. What treatment plan would you implement for Edgar (include complete medication orders)? What education would you provide to the patient’s mother regarding his treatment?

Scenario 4 – JT

JT is a 3-year-old male that was seen 3 days ago for acute otitis media. He weights 15 kg. Utilizing the dosage calculator in Medscape, write a prescription for liquid amoxicillin. If the patient develops a rash and is presumed to have an allergy, what alternative antibiotic would you prescribe to treat his acute otitis media? What education would you provide his mother during this visit?

Expert Answer and Explanation

Adults health, ears, eyes, case study

Scenario 1: Sarah Johnson, A 32-Year-Old Pregnant Female

Treatment Plan

High blood pressure during pregnancy is risky and might lead to stroke, eclampsia, placental abruption, and preeclampsia (Bohiltea et al., 2020). Sarah’s blood pressure is slightly high at 150/95 mmHg. Therefore, I would start antihypertensive therapy on her to avoid complications related to high blood pressure. Labetalol is preferable in this case, given the patient’s health history and pregnancy status.  Riddle et al. (2022) noted that labetalol is a safe medication that can be used to manage high blood pressure in patients who are pregnant. They found that the medication did not affect the mother or baby when administered during pregnancy. She should be observed for any side effects, and her blood pressure should be checked regularly.

Hypertension Treatment:

I would recommend that the patient begin labetalol, 100 mg orally in the morning and evening. The medication should be taken eight hours apart. The dose increments maybe 400 mg/day, depending on the level of BP control. Riddle et al. (2022) found in their study that increasing the dosage of the medication to 400mg/day in pregnant women is safe. They did not find any significant side effects on the mother or fetus on pregnant patients who took labetalol, 400mg/day. For side effects including bradycardia and dizziness. I would also advise the patient to take a lot of water and rest.

Monitoring and Goal BP:

I would check Sarah’s blood pressure every time she comes for a check-up and may also organize home blood pressure checkups. I would also conduct regular lab tests such as routine monitoring to check renal function and electrolytes. The target blood pressure is below 140/90 mmHg to help prevent incidents such as preeclampsia and other dangers to the health of the mother and baby (Garovic et al., 2022).

Scenario 2: Lydia, A 24-Year-Old Single Female

First-line Treatment:

The lab test has confirmed that the patient has gonorrhea, and thus ceftriaxone should be recommended. Center for Disease Control recommends ceftriaxone as the first line treatment for gonorrhea (Zhu, 2024). The agency recommended that the medication can be given as an intramuscular injection, single dose (Zhu, 2024). This medication is safe for the patient, especially since she is allergic to sulfa.

Additional Organism to Consider:

Chlamydia trachomatis should also be included, since it often coexists with gonorrhea. Chlamydia if untreated can cause complications and as such requires dual therapy (Mitchell et a., 2021).

Medication for Chlamydia:

Treatment should be started with doxycycline 100 mg orally twice per day for three weeks (Grant et al., 2020). Lydia should take the medication as prescribed to ensure that it is effective.

Abstinence Duration:

The patient should cease sexual activity for 7 days following the treatment to make sure that both she and her partner are treated to avoid being re-infected.

Patient Education:

One of the focus of patient education should be about safe sexual activities. The patient should be educated to use protection when having sex to prevent being re-infected. She should also be educated to avoid having sex with many partners. It is advisable to engage in sexual activities with only a single partner. The second focus should be about medication. She should be advised to take the drugs as prescribed and ensure that she has completed the dosage. She should come for testing in two weeks to determine whether the infection has cleared.

Scenario 3: Edgar, A 6-Year-Old Boy

Treatment Plan:

Indeed, bacterial conjunctivitis is referred to as ‘pink eye’ in most cases. For Edgar, I would recommend an antibiotic eye drop, which is not made of sulfa. An ideal medication would be moxifloxacin ophthalmic solution 0.5% eye drops, which are safe for use in children (Celebi et al., 2021). The dosage for the medication is one drop three times a day in the infected eye for seven days. The drug will help clear the infection from the affected eye without exposing the child to penicillin, amoxicillin, or sulfa. The medication should be applied properly to ensure it effectiveness.

Medication Order:

The correct medication order is Moxifloxacin 0.5 % 0.5% ophthalmic solution, one eye drop in the affected eye, three times a day for seven days (Gentili et al., 2024). It is effective in clearing against bacterial conjunctivitis and has no contraindications against the use in children.

Patient Education:

At this point, I should educate Edgar’s mother on how to use the eye drops. She should be advised to clean her hands before and after administering the drops to avoid spreading the infections. Before each application, any secretion, particularly in Edgar’s eye, should be wiped gently with a clean, damp cloth (Mahoney et al., 2023). She should not touch the tip of the dropper on the eye or any surface to prevent contamination when instilling the drop.

Also, the child’s mother should be told that bacterial conjunctivitis is easily spread, and thus, measures should be taken to prevent its spread. One of the prevention measures is staying home from school for at least 24 hours after the onset of treatment. This strategy can help prevent spread of the disease at school. Other prevention strategies include washing their hands, not rubbing their eyes, having separate towels, and ensuring they do not share items such as a pillow or washcloth with other children (Mahoney et al., 2023). These measures will assist in avoiding the further spread of the infection.

Scenario 4: JT, A 3-Year-Old Male

Prescription for Liquid Amoxicillin:

Amoxicillin 250 mg/5 mL suspension. The required dosage is 5mL orally twice a day for seven days (Dharmapalan et al., 2023). The dispensed medication is 150mL. The medication should be shaken well before use. The medication should be given in a span of 12 hours.

Alternative Antibiotic for Allergy:

If JT comes down with a rash, he will be presumed to have an allergy to amoxicillin; thus, the medication should be changed. An appropriate substitute would be cefdinir. The suggested doses include cefdinir 125 mg/5 mL suspension, which is 7 mg/kg/dose given twice daily (Molloy et al., 2020). In JT’s case, this equates to 5 mL (75 mg) orally every 12 hrs for seven days. Cefdinir actively treats acute otitis media and is safe for most children with mild or moderate penicillin hypersensitivity (Molloy et al., 2020; Ajmal et al., 2023). This medication will help to eradicate the infection. It will help the patient feel better after taking the first dose of the medicine.

Patient Education:

JT’s mother should be informed on how to measure and administer the liquid medication correctly. She should be advised to shake the bottle well before each dose and give the child the whole bottle even if the symptoms subside. In case JT experiences an allergic reaction, including rash, itching, or swelling while using the medication. Then, she has to discontinue the product and consult a healthcare provider. Besides, she should be told to look for signs like fever or ear pain and attend the clinic if they do not subside or become severe.

References

Ajmal, M., Zamir, A., Rehman, A. U., Imran, I., Saeed, H., Majeed, A., & Rasool, M. F. (2023). Clinical pharmacokinetics of cefixime: A systematic review. Xenobiotica, 53(3), 149-162. https://doi.org/10.1080/00498254.2023.2217265

Bohiltea, R. E., Zugravu, C. A., Nemescu, D., Turcan, N., Paulet, F. P., Gherghiceanu, F., & Cirstoiu, M. M. (2020). Impact of obesity on the prognosis of hypertensive disorders in pregnancy. Experimental and Therapeutic Medicine, 20(3), 2423-2428. https://doi.org/10.3892/etm.2020.8783

Celebi, A. R. C., & Onerci Celebi, O. (2021). The effect of topical ocular moxifloxacin on conjunctival and nasal mucosal flora. Scientific Reports, 11(1), 13782. https://doi.org/10.1038/s41598-021-93233-5

Dharmapalan, D., Bielicki, J., & Sharland, M. (2023). Harmonization of amoxicillin dose, duration, and formulation for acute childhood respiratory infections. Antibiotics, 12(7), 1138. https://doi.org/10.3390/antibiotics12071138

Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., McMurtry Baird, S., Magee, L. A., & August, P. (2022). Hypertension in pregnancy: diagnosis, blood pressure goals, and pharmacotherapy: A scientific statement from the American Heart Association. Hypertension, 79(2), e21-e41. https://doi.org/10.1161/HYP.0000000000000208

Gentili, V., Strazzabosco, G., Spena, R., Rizzo, S., Beltrami, S., Schiuma, G., & Rizzo, R. (2024). Comparison between Moxifloxacin and Chloramphenicol for the treatment of bacterial eye infections. Current Therapeutic Research, 100, 100740. https://doi.org/10.1016/j.curtheres.2024.100740

Grant, J. S., Stafylis, C., Celum, C., Grennan, T., Haire, B., Kaldor, J., & Klausner, J. D. (2020). Doxycycline prophylaxis for bacterial sexually transmitted infections. Clinical Infectious Diseases, 70(6), 1247-1253. https://doi.org/10.1093/cid/ciz866

Mahoney, M. J., Bekibele, R., Notermann, S. L., Reuter, T. G., & Borman-Shoap, E. C. (2023). Pediatric conjunctivitis: a review of clinical manifestations, diagnosis, and management. Children, 10(5), 808. https://doi.org/10.3390/children10050808

Mitchell, C. M., Anyalechi, G. E., Cohen, C. R., Haggerty, C. L., Manhart, L. E., & Hillier, S. L. (2021). Etiology and diagnosis of pelvic inflammatory disease: Looking beyond gonorrhea and chlamydia. The Journal of Infectious Diseases, 224(Supplement_2), S29-S35. https://doi.org/10.1093/infdis/jiab067

Molloy, L., Barron, S., Khan, N., Abrass, E., Ang, J., & Abdel-Haq, N. (2020). Oral β-Lactam antibiotics for pediatric otitis media, rhinosinusitis, and pneumonia. Journal of Pediatric Health Care, 34(3), 291-300. https://doi.org/10.1016/j.pedhc.2019.11.001

Riddle, K. M., Green, P. M., Williams, J. A., & Hecht, J. P. (2022). The safety of high dose labetalol in the pregnant population. Archives of Obstetrics and Gynaecology, 3(2), 66-70. https://doi.org/10.33696/Gynaecology.3.032

Zhu, X. (2024). Ceftriaxone-Resistant Gonorrhea—China, 2022. MMWR. Morbidity and Mortality Weekly Report, 73. https://www.cdc.gov/mmwr/volumes/73/wr/mm7312a2.htm

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