Pharmacology case study

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Summary

The patient is a 75 year old male with a past medical history of CHF, COPD, hypertension, diabetes mellitus-type 2, gout, and chronic renal insufficiency. He was admitted through the Emergency Room with symptoms of cough, SOB, and fever, and a chest x-ray revealed left lower lobe pneumonia. He is currently taking Avandia, Glucophage, Lasix, Potassium supplements, Lopressor, Prinivil, Allopurinol, and Advair. He is being treated with IV Zithromax and Albuterol via nebulizer treatment. The drugs listed above were classified and their mechanisms of action were briefly described. The laboratory parameters that need to be monitored for each drug were identified. Zithromax was chosen to treat this patient due to its broader range of coverage for both gram (+) and gram (-) bacteria and because the patient is allergic to penicillin. The patient’s risk for gout was discussed, and it was noted that the patient is taking Lasix, which significantly increases his risk for gout due to the concentration of uric acid in the blood. Allopurinol is used to prevent recurrent gout in this patient, and the standard dose is 300 mg daily; however, this patient is only on 100 mg daily due to his chronic renal insufficiency and because the drug is used for maintenance therapy and not for acute attacks.

Table of Content

Your patient is a 75 year old male admitted through the Emergency Room w/ cough, SOB and fever, Chest x-ray revealed left lower lobe pneumonia.

Past Medical History: Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), hypertension, Diabetes Mellitus –Type 2, Gout, chronic renal insufficiency.

Allergies: PCN

Current medications:
Avandia (rosiglitazone) 2mg BID
Glucophage (metformin) 500mg OD
Lasix (furosemide) 40 mg daily
Potassium supplements (KCl) 20 meq daily
Lopressor (metoprolol) 25 mg BID
Prinivil (lisinopril) 5 mg daily
Allopurinol (zyloprim) 100mg daily
Advair 1 inhalation BID

He is started on IV Zithromax (azithromycin) and Albuterol via nebulizer treatment.

Questions:

· Identify the drug classification and briefly describe the mechanism of action for each of the drugs listed above.

· What laboratory parameters would be routinely monitored in the above patient

– Lasix: BUN, creatinine & electrolytes (specifically potassium) loop diuretic therapy – Avandia: monitor LFT’s (increase sensitivity at of insulin at the receptor site) – Metformin: use cautiously with renal insufficiency patients—monitor BUN and creatinine (if levels are too high, not a candidate for biguinides) – Potassium supplements: potassium levels
– Metaprolol: monitor blood glucose can mask signs of hypoglycemia – Prinivil: monitor potassium levels (has a tendency to increase), – Allopurinol: monitor BUN, creatinine

· Why was Zithromax chosen to treat this patient?

– Zithromax was chosen to treat this patient because it doesn’t interact with liver function and it has a broader range of coverage for both gram (+) and gram (-) bacteria that can treat the pneumonia that is possibly causing the fever. This patient is also allergic to penicillin.

· What factor increases this patient’s risk for gout?

– This patient is taking a loop diuretic, Lasix, which significantly increases the risk for gout due to the concentration of uric acid in the blood. – Hypertension
– Diabetes can cause renal insufficiency which can lead to uric acid build up

· Allopurinol is used to prevent recurrent gout in this patient. The standard dose is 300 mg daily. Why is this patient only on 100 mg daily?

– This patient has chronic renal insufficiency and therefor the drug needs to be adjusted, this drug is also used to for maintenance therapy and not for acute attacks

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