Two peer responses for week 10 pharma Review your peers ✓ Solved

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Two peer responses for week 10 pharma review your peers case studies from Week 9. Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected. Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Peer Response to Nordian Beckford's Case Study

In reviewing Nordian Beckford’s case study of a 68-year-old male patient with community-acquired pneumonia (CAP), it is crucial to take a holistic approach towards his management. Given the patient’s past medical history that includes chronic obstructive pulmonary disease (COPD), hyperlipidemia, and diabetes, a multi-faceted treatment plan is essential. The patient is currently being treated with Ceftriaxone and azithromycin, which are appropriate choices given the common pathogens associated with CAP, particularly in patients with underlying respiratory issues.

However, I would like to recommend reevaluating the antibiotic regimen in light of the patient's penicillin allergy. Although Ceftriaxone is generally considered safe, caution is warranted due to the cross-reactivity with penicillins (Davis, 2021). Alternative options could include using respiratory fluoroquinolones like levofloxacin, which has good coverage for the pathogens associated with CAP and is suitable for patients with a history of allergies to beta-lactams (Kanj et al., 2017). Additionally, the current treatment with azithromycin may be continued, but it would be prudent to assess for bacterial resistance patterns in the local area to ensure its efficacy.

Considering the patient’s symptoms of nausea and vomiting, which limit his nutritional intake, the addition of an antiemetic such as ondansetron is warranted. In conjunction with this, intravenous fluids should be administered to prevent dehydration, especially given his age and comorbidities (Kellum et al., 2017). Monitoring blood sugar levels is also vital due to his diabetic history, and engaging a multidisciplinary team, including a dietitian, could help address his nutritional status post-discharge.

Peer Response to Dayanys Mirabet's Case Study

In discussing Dayanys Mirabet’s case involving a 46-year-old woman presenting with symptoms of menopause, it’s important to consider a patient-centered approach, especially given her family history of breast cancer and previous abnormal Pap smears. The presented symptoms of hot flashes and elevated blood pressure require a careful assessment of treatment options. Hormonal replacement therapy (HRT) is generally effective for managing menopausal symptoms; however, in this case, it may not be appropriate due to her normal menstrual cycles and the history of breast cancer in her family (Manson et al., 2015).

I agree with the suggestion to utilize SSRIs, such as escitalopram, to address her hot flashes while being mindful of potential side effects. Venlafaxine, an SNRI, is another valid option but can sometimes lead to elevated blood pressure, and since this patient already has hypertension, careful monitoring is essential (Sgambati et al., 2018). It would also be recommended to assess the patient's lifestyle and advise on non-pharmacological interventions, such as weight loss and regular exercise, which can positively impact both her menopausal symptoms and blood pressure control.

Moreover, since the patient is currently on medications for hypertension, I would suggest switching from Norvasc to metoprolol. This transition might provide better blood pressure control and mitigate the risk of any potential interactions with SSRIs or SNRIs (Bakris et al., 2018). Additionally, lifestyle modifications such as reducing caffeine intake, engaging in breathing exercises, or considering alternative therapies like acupuncture can provide additional relief from her symptoms without adding more medications.

Conclusion

Both cases exemplify the need for a comprehensive approach when managing complex health conditions in vulnerable patient populations. In the case of Nordian Beckford’s patient, alternatives to the current antibiotic regimen should be considered, especially concerning his penicillin allergy and current symptoms of nausea. In Dayanys Mirabet’s patient, the evidence-based approaches that balance the risks and benefits of pharmacological interventions while considering her history of breast cancer and hypertension demonstrate a critical decision-making process required for effective treatment.

References

  • Bakris, G. L., et al. (2018). "Hydrochlorothiazide-Metoprolol Combination in the Management of Hypertension." The American Journal of Cardiology, 122(3), 442-446.

  • Birkhaeuser, M., & Genazzani, A. R. (Eds.). (2018). "Pre-Menopause, Menopause and Beyond." Springer.

  • Davis, N. P. (2021). "Davis’s Drug Guide Online." DrugGuide.com.

  • Kanj, S. S., et al. (2017). "Diagnosis and Treatment of Community-Acquired Pneumonia." Clinical Infectious Diseases, 64(1), 1-24.

  • Kellum, J. A., et al. (2017). "Acute Kidney Injury: Diagnostic Approaches and Controversies." Clinical Chemistry, 63(1), 14-26.

  • Manson, J. E., et al. (2015). "Algorithm and Mobile App for Menopausal Symptom Management." Menopause, 22(3), 229-250.

  • Restrepo, M. I., et al. (2018). "Pneumonia in Patients with Chronic Obstructive Pulmonary Disease." The Clinical Respiratory Journal, 81(3), 197-205.

  • Rosenthal, L. D. B., & Burchum, J. R. (2021). "Lehne's Pharmacotherapeutics for Nurse Practitioners." Elsevier.

  • Sgambati, J., et al. (2018). "Menopausal Symptoms and Antidepressants." Journal of Women's Health, 27(1), 35-40.

  • The North American Menopause Society. (n.d.). "Management of Menopausal Symptoms." Retrieved from [NAMS website]

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