Case Study#26 DY is a 78-year-old Asian woman who was admitted to the hospital b
ID: 254547 • Letter: C
Question
Case Study#26 DY is a 78-year-old Asian woman who was admitted to the hospital because she needs to have hip-replacement surgery because she fell in her house recently. Her significant medical history includes chronic renal failure (creatine clearance, 14 mL/min), osteoarthritis, hypert failure. Her current medication list includes furosemide 20 mg po daily, spironolactone 12.5 mg po daily, imidapril 2.5 mg po bid, and celecoxib 200 mg po bid. Unfractionated heparin therapy at a subcutaneous dosage of 5,000 units tid was initiated after surgery for deep vein thrombosis prophylaxis. Five days after surgery, DY complained of pain and swelling in her left leg. A compression ultrasound reading demonstrated superficial femoral and ension, and congestive heart popliteal vein thrombosis. A laboratory evaluation for heparin- induced thrombocytopenia (serotonin release assay) was ordered and yielded a positive result. Her physician wants to change her unfractionated heparin to a different anticoagulant and asks your opinion of the choices 1-3 e Fondat arinex 1. Conduct a thorough and mechanistic SAR analysis of the three therapeutic options in the case. 2. Apply the chemical understanding gained from the SAR analysis to this patient's specific needs to make a therapeutic recommendationExplanation / Answer
Three therapeutic interventions include:
I)1) SAR (structure-function relationship analysis) of the effect of anti-coagulant drugs used for curing deep vein thrombosis. It includes the medicines like warfarin and heparin(fondaparinux) which act as anticoagulants and prevent the clotting of the blood by blocking the synthesis of vitamin K which activates the synthesis of blood clotting factors. The chemical structure of the drugs are specific and they bind to particular receptors on the cell membranes and exert their action. The drug argatobran inhibits the thrombin which helps in the coagulation of blood inside the blood vessels.
2)Furosemide drug is used to treat heart failure and kidney disease. It blocks the sodium, potassium and chloride channels in the membrane of the ascending limb and loops of Henle. Spironolactone is used to treat high blood pressure.It is an inhibitor of the androgen and estrogen receptors in the body.
3)Imidapril drug is used for treating chronic heart failure. It is an inhbitor of the enzyme acetylcholinesterase.
4)celecoxib is a COX-2 (cyclo-oxigenase enzyme) inhibitor which reduces pain and swelling in the body.
II) These drugs are effective for the treatment of the various diseases of the patients like renal failure, hypertension, coronary heart disease, and osteoarthritis as they effectively bind to the receptors present on the cell membrane and block the cell signaling mechanisms present inside the cell.