Medication Management for Various Health Conditions

QUESTION

T.J., an active 15 y/o high school soccer player, was brought into the ED with complaints of shortness of breath and severe expiratory wheezing. Medical history of asthma diagnosed at nine years of age. Asthma triggers include dander and pollen. As of recent, T.C. has been experiencing exercise-induced asthma exacerbation. T.C. admits that he has difficulty remembering to take his inhalers at home and forgets to administer his albuterol before the evening game.

Physical Exam:

Vital signs: BP: 140/80 P: 125 RR: 38 T: 99.0, SPO2: 86% ON ROOM AIR

Wt. 170 lbs BMI 26.5

ABG: pH: 7.31, PaCO2: 55, PaO2 77, HCO3: 25

General:

HEENT: Normocephalic, atraumatic.

Nasal mucosa boggy and inflamed without obvious purulent discharge.

Oropharynx moist, scrapable white film noted on his tongue.

Neck: Supple, no thyromegaly or lymphadenopathy.

Cardiac: Tachycardia, Regular rate, no murmurs, rubs, or gallops.

Pulmonary: Diffusely decreased breath sounds bilateral. Diffuse expiratory wheezes,particularly evident with forced expiration.

Extremities: No edema or skin changes noted.

Radial, posterior tibial and dorsalis pedis pulses 2+ bilaterally.

T.C. is diagnosed with acute asthma exacerbation.

1. What would you anticipate the provider to order to manage T.C.’s condition? (list themedication and purpose in managing the situation)T.C. has been stabilized and will be discharged on Albuterol, Fluticasone & fluconazole.

2. Describe the indication and mechanism of action for these medications.

3. Briefly outline how and when T.C. should administer these drugs and provide any additional patient teaching regarding administration.

4. T.C. does not understand why he has been prescribed fluconazole. Please explain why the provider ordered this drug.

Shrivatsa, a 45-year-old man, presents to urgent care with new-onset abdominal pain, nausea, bloating, and dark stools. Shrivatsa has struggled with back pain since a motor vehicle accident in 2016. The pain has recently been intolerable, making it difficult for him to work. Shrivatsa admits that she has been taking several ibuprofen tablets daily, usually in the morning, afternoon, and before bed; he is unsure of the dose but states he administers anywhere from 3-4 pills each time, and sometimes maybe even 5 tablets. He has been treating his back pain with this method for the last six months. The provider

draws labs to include:

CBC

Urea Breath Test

Fecal Occult Stool

The results come back with:

Hemoglobin: 9.0

Urea Breath Test: Negative for Helicobacter Pylori

Fecal Occult Stool: Positive

The provider consults the gastroenterologist and schedules Shrivatsa for an EGD/Colonoscopy

.a. What is most likely Shrivatsa’s diagnosis?The EGD/Colonoscopy notes erosion in the duodenum.

b. The provider orders Ondansetron. What is the purpose of the order, and what side effects may you expect?

c. Shrivatsa is started on Pantoprazole, antacid and sucralfate. Develop a teaching plan for Shrivatsa describing how these medications work differently to treat his condition and their administration consideration (NSAID induced Peptic Ulcer Disease).

Pantoprazole:

Cimetidine:

Sucralfate:

Antacid:

d. What medication options should Shrivatsa have been on to prevent the occurrence of NSAID-induced PUD?

e. Shrivatsa asks you if he can take all his pills at once. What is your response, and explain how he should administer them?Shrivatsa reports back to his PCP 2 weeks later with c/o profuse diarrhea after starting his regimen. The provider is concerned and places Shrivatsa on precautions.

2. What may cause his diarrhea, and what may it be related to?Sundance presents to the ED with constipation x 7 days status-post colon resection. Sundance has been on Hydrocodone for pain since the surgery. Sundance states that she continues to have pain from the surgery.

3. What may the provider be concerned about, and what may the order be before drug therapy? (Consider complications and diagnostics)

4. What should Sundance be prescribed while on the opioid to prevent constipation?

5. The provider prescribes Docusate, MiraLAX, and Senna and one dose of Milk of Magnesia to treat constipation. Please describe how these medications work differently to treat constipation.provide side effects for each in patient teaching

ANSWER

Medication Management for Various Health Conditions

Introduction

This essay addresses medication management for three different patient scenarios: T.C., who has acute asthma exacerbation, Shrivatsa, who presents with NSAID-induced Peptic Ulcer Disease (PUD), and Sundance, who experiences constipation post-colon resection and opioid use. We will explore the medications prescribed for each condition, their indications, mechanisms of action, administration, and potential side effects, along with patient education.

Medication Management for T.C.’s Acute Asthma Exacerbation

Medications prescribed for T.C. include Albuterol, Fluticasone, and Fluconazole.

Albuterol: Indicated for the relief of acute bronchospasm in asthma. It is a short-acting beta-agonist that relaxes the airway muscles, leading to bronchodilation and improved breathing.

Fluticasone: A corticosteroid inhaler that reduces airway inflammation and prevents asthma symptoms.

Fluconazole: An antifungal medication, it is not directly related to asthma management. The provider may have prescribed it for another concurrent condition or infection.

Administration and Patient Teaching

T.C. should administer Albuterol as needed for acute symptoms, but it is crucial to remember to use it before physical activities. Fluticasone should be taken daily to manage inflammation, even if symptoms are not present. As for Fluconazole, T.C. should clarify with the provider the purpose and instructions for this medication.

Medication Management for Shrivatsa’s NSAID-induced Peptic Ulcer Disease

Medications prescribed for Shrivatsa include Ondansetron, Pantoprazole, Cimetidine, Sucralfate, and Antacids.

Ondansetron: Prescribed to manage nausea, a common symptom associated with Peptic Ulcer Disease (PUD). It blocks serotonin receptors in the brain and gastrointestinal tract, reducing the sensation of nausea.

Pantoprazole: A proton pump inhibitor (PPI) that reduces stomach acid production, promoting ulcer healing and preventing further damage.

Cimetidine: An H2 receptor antagonist that also reduces stomach acid production, similar to Pantoprazole.

Sucralfate: A cytoprotective agent that forms a protective barrier over the ulcer, shielding it from stomach acid and promoting healing.

Antacids: Provide quick relief by neutralizing stomach acid.

Administration and Patient Teaching:

Shrivatsa should take Ondansetron as needed for nausea. Pantoprazole and Cimetidine should be taken as directed by the provider, usually before meals. Sucralfate should be taken on an empty stomach, at least one hour before meals and at bedtime. Antacids can be taken as needed for immediate relief, but they should be spaced apart from other medications.

Medication Management for Sundance’s Constipation

Medications prescribed for Sundance include Docusate, MiraLAX, Senna, and Milk of Magnesia.

Docusate: A stool softener that helps prevent dry and hard stools by increasing water content in the stool.

MiraLAX: An osmotic laxative that draws water into the bowel, softening the stool and promoting bowel movements.

Senna: A stimulant laxative that stimulates bowel contractions, promoting bowel movements.

Milk of Magnesia: An antacid and laxative, it helps neutralize stomach acid and draws water into the bowel, softening the stool.

Administration and Patient Teaching

Sundance should take Docusate daily to maintain stool softness. MiraLAX should be taken with adequate fluids and as directed by the provider. Senna should be taken as needed for additional relief, but it is essential not to exceed the recommended dose. Milk of Magnesia should be taken as directed for immediate relief, but it should be spaced apart from other medications to avoid interactions.

Conclusion

Medication management is crucial for effectively treating various health conditions. It requires adherence to proper administration schedules and patient education on indications, mechanisms of action, and potential side effects. By following healthcare provider’s instructions and understanding their medications, patients like T.C., Shrivatsa, and Sundance can effectively manage their health conditions and achieve improved outcomes.