Advanced Pharmacology ID Homework Points: 23.5 Comments: Good Job! Name: Tracy Hill WU ID #: 20015608 E-mail: tracy.hill@washburn.edu TH_ I hereby certify that the work submitted is my own, and that I have not plagiarized or violated any terms of the WU School of Nursing s Classroom Integrity Policies. NOTE: You must insert your initials in the area of the line on the right Case Study NH is a 21 year old college student who presents to the student health clinic with a 2 day history of a sore throat. She rates her pain as moderate, but it has left her unable to sleep fitfully or to eat or drink very much. She says that he just got over a cold, but currently has no symptoms of nasal congestion or rhinorrhea. Her past medical history is unremarkable. Physical examination of the throat reveals an erythematous pharynx with a small amount of exudate covering the left tonsil. A rapid strep test is positive. You diagnose her with streptococcal pharyngitis and decide that a prescription for an antibiotic is appropriate. Question 1 - What information do you want to get from CS prior to writing the prescription for the antibiotic? Be brief! (3 points) Points: 3 Comments: Good! Esp. last point. Has NH been treated for strep throat in the past? If so, which antibiotics were prescribed and what was the result? Has NH been on any antibiotics in the last month? If so, which antibiotics and for what diagnosis? Does NH have any allergies or any adverse reactions to any medications, especially penicillins? If so, what is the reaction? Does NH take any other medications and if so, what is she taking and for what reason? Can NH swallow pills? Any chance of pregnancy? Last menstrual period? Consider doing urine pregnancy test to confirm negative pregnancy prior to prescribing certain antibiotics. Is it going to be feasible for NH to take 4 doses of the medication for the next 10 days? Can NH afford the medication? Consider offering the patient Bicillin L-A
1.2 million units I.M. x 1 dose to treat strep if patient unlikely to be adherent to treatment plan or unable to afford prescription antibiotics (Hamilton, 2011, p. 31)
Question 2 - Using the prescription blank below, write a prescription for an appropriate antibiotic for this condition. (10 points) Points: 9.5 Comments: BID dosing is probably sufficient. Drs. Boke and Tsukomi Manzai Primary Care Associates, Inc. 1020 Wellness Road Resume Speed, KS (913) 123-4567 Name Nana Hill DOB 3/15/1972 Date Jan. 30, 2011 Address 123 Front St. City/State/Zip Lawrence, KS 66044 Age/Wt / Rx Penicillin V 500mg Disp: 30 (thirty) tabs Sig: Take 1 tab po TID x 10 days for strep throat. T. Hill, ARNP Dispense as Written Substitution Permitted Refills none DEA # (Edmunds & Mayhew, 2009, p. 478); (Hamilton, 2011, p.31). Question 3 - What drug information will you provide to this patient? Be brief! (5 points) Points: 5 Comments: It is important to take the medicine 3 times a day and to take the antibiotic for the entire course of therapy, even if feeling better; do not skip doses, if you miss a dose, take as soon as possible, do not take 2 doses together. If pt taking birth control pills, should use back-up method of contraception (condoms, abstinence) while taking antibiotics. Women who are using estrogencontaining contraceptives should use alternative method of contraception because
oral contraceptive pills effectiveness is believed to be compromised during antibiotic usage (Edmunds & Mayhew, 2009, p. 640-643). Education on hypersensitivity reactions (anaphylaxis, laryngeal edema, with fever, rash and joint swelling, myocarditis) and potentially serious side effects of medication (>10% have GI effects nausea/vomiting/diarrhea; oral candidiasis (increase yogurt intake). (Edmunds & Mayhew, 2009, p. 640). Expect to see improvement in 1-2 days; if not improving in 3 days or get worse, return to clinic for re-evaluation. Drink plenty of fluids. Take medication on empty stomach if possible (1 hour before or 2 hours after a meal, as food decreases absorption rate). Return to clinic in 14 days for re-evaluation, sooner if worse. Do you have any questions? Question 4 What are you going to prescribe for pain relief? (3 points) Points: 3 Comments: How about a lower dose of motrin? Also, I d avoid narcotics until the patient demonstrates that OTC analgesics aren t cutting it. Tylenol 500mg tabs; 2 tabs every 4-6 hours as needed for pain/fever. OR AND AND Lortab Elixir (7.5/500 mg hydrocodone/acetaminophen/15ml). disp: 150ml; sig: 15ml q 6 hours as needed for throat pain. (Hamilton, 2011, p.10). Motrin 600mg by mouth 3-4 times a day as needed for pain. Chloroseptic throat spray as directed on bottle, as needed, for throat pain. Question 5 - CS questions why you aren t going to prescribe a Z-Pack? Her boyfriend had a similar episode of acute bronchitis with a sore throat a week ago and just recently finished a Z-pack, which, incidentally, really cut into his monthly beer money ---but, I digress). Explain to this patient why you feel that a Z-Pack is unnecessary (you DO believe that, don t you???). Be succinct, but convincing. (4 points) Points: 4 Comments: Good!
Penicillin V is the first choice treatment for strep throat (Edmunds & Mayhew, 2009, p.642). You and your and boyfriend are not being treated for the same illness. You have pharyngitis/strep throat, not bronchitis like your boyfriend. A Z-pack is a macrolide; Penicillin V is a natural penicillin. Oral penicillins are indicated for the treatment of mild to moderate infections like Strep throat. A Z-pack is used as an alternative to penicillin if someone is allergic to penicillin or those patients with penicillin sensitive adverse reactions. Generally, a z-pack is reserved for more complicated infections. You don t want to build up a resistance to first line therapies like penicillin. (Edmunds & Mayhew, p.642). Overuse and misuse of antibiotics leads to resistance to antibiotics. Lastly, Penicillin is cheaper than a Z-pack and thus less likely to cut into your beer money.
References Edmunds, M. W., & Mayhew, M. S. (2009). Pharmacology for the Primary Care Provider (3rd ed.). St.Louis, MO: Mosby. Gilbert, D. N., Moellering, R. C., Jr., Eliopoulos, G. M., Chambers, H. F., & Saag, M. S. (Eds.). (2010). The Sanford Guide to Antimicrobial Therapy 2010 (40th ed.). Sperryville,VA: Antimicrobial Therapy, Inc. Hamilton, R. J. (Ed.). (2011). Tarascon Pocket Pharmacopoeia: 2011 Classic Shirt- Pocket Edition (25th ed.). Sudbury, MA: Jones & Bartlett Learning, LLC. Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (Eds.). (2010). Drug Information Handbook for Advanced Practice Nursing (11th ed.). Hudson, OH: Lexi-Comp.