Introduction
Among the many respiratory diseases, asthma is the most demanding to fulfill all the conditions prescribed by the doctor. Since healthcare professionals cannot completely cure this disease, it is necessary to carefully approach the formation of one’s lifestyle, avoid various triggers, and take all prescribed medications in a specified manner (Mayo Clinic, 2020). However, even the most vigilant control does not guarantee the occurrence of an emergency in which the already prescribed treatment will no longer be relevant. In such cases, it is essential to repeat a pharmacological analysis and form a new course of treatment. This study aims to review the pediatric case study of A. R., a nine-year-old Hispanic female with a history of mild persistent asthma and identified left lower lobe community-acquired pneumonia (CAP). Pharmacological analysis of the prescriptions currently taken and researchers will carry out the need to change or add new drugs. In addition, individuals will study particular interventions and possible next steps in treatment.
Background
The history of R. has two main factors that need to be considered in the context of a pharmacological analysis. First, the girl has a five-year history of mild persistent asthma, which she has successfully managed to date with prescribed medication. Thus, there was no need to change the medicines since they fulfilled their function. Secondly, R. now has community-acquired pneumonia (CAP), which significantly exacerbates her asthma and any new symptoms. According to the available information, the medications taken do not help in the situation, and therefore there is an urgent need to add some new prescriptions.
Therefore, learners should first pay attention to treating these symptoms as part of the fight against CAP. The points indicated in the case study coincide with commonly observed signs of pneumonia: fever, low energy, loss of appetite (National Library of Medicine, 2022). However, it is necessary to decide what kind of pneumonia the girl has: viral or bacterial. Studies show that the symptoms of these two variations are the same: poor appetite, high fever, cough with green sputum (Chase, 2018). With tachypnea, fever, and lobular consolidation, individuals can state that the patient has bacterial pneumonia (Bickley, 2021).
However, students should note that it is necessary to conduct several additional tests to make a more solid decision. Individua may obtain additional clinical information from a chest X-ray, blood sample analysis, or sputum (Chase, 2018). At the moment, the pharmacological analysis will be based on empirical data, taking into account the need to eliminate current symptoms. In addition, when prescribing new drugs, it will be necessary to consider their compatibility with already used drugs.
Discussion
Medication Analysis
Analyzing the medications taken, it is worth noting the use of epinephrine. This medicine is an effective neurotransmitter that interacts with alpha and beta-adrenergic receptors (DrugBank Online, 2022b). It is prescribed R. as an emergency treatment for exposure to peanuts due to the girl’s allergy. Since this tool is used only in a crisis, its practical effectiveness far exceeds all possible adverse effects. For the same reason, researchers can calculate neither the appointment schedule nor the total monthly price for the two drugs mentioned, i.e., dosages of the drug is 500-1000 mg per tablet and are taken 1-3 times a day for a month. The average price for a 60-tablet pack ranges from $13.58 to $30.86, and 90 tablet packs seem to range at 850 per month. Evaluation of interactions with other drugs shows that epinephrine may worsen hypokalemia when interacting with mometasone furoate. Since this condition is not observed, the prescription is safe for the patient. Therefore, it can be considered necessary for the patient’s safety, and there is no need to make any changes in the principle of its administration.
Asmanex HFA, which has mometasone furoate as its main active ingredient, is a prescription for daily use in cases of asthma. This type of medication, referred to as corticosteroids, acts on the airways to prevent symptoms caused by the release of certain substances (Mayo Clinic, 2022). Its constant use reduces the frequency and intensity of asthma attacks. However, specific side effects include the development of yeast and other infections (ORGANON, 2021). Therefore, when taking mometasone furoate, it is necessary to check possible signs of diseases and carefully monitor the environment.
The dosage depends on the patient’s condition and age. As a result, it varies from 50 mg for children of 5-12 years old to 100-200 mg for patients older than 12. According to the, the drug should be used twice a day: 2 puffs in the morning and evening when feeling abnormal (“ASMANEX® HFA,” n.d.). Given that there are 120 doses in an inhaler, one inhaler is designed for one month, forming an approximate monthly cost of $209.28- $219.07 (Drugs.com, 2022c). Due to the absence of interactions with other medications and the ability to constantly keep the patient stable, this drug is highly effective and necessary for treating asthma. Per guidelines, she is at max dose; therefore, the currently prescribed drugs will be left.
Unlike the previous drug, Ventolin HFA is used only in certain situations and not on an ongoing basis. Its main component is albuterol sulfate, a bronchodilator that increases airflow to the lungs by relaxing airway muscles (Durbin, 2021). This prescription helps prevent bronchospasm caused by both asthma complications and physical exertion. However, care must be taken to avoid serious side effects such as heart problems, coughing, wheezing, muscle and chest pain (GSK, 2021). In addition, there are contraindications to the use of albuterol: other inhalers and beta-blockers and antidepressants should be used with caution.
Typically, Ventolin HFA is used with a cough, wheeze, and before physical activity to suppress possible bronchospasms. The usual dosage is two puffs every 4-6 in the first case and two inhalations half an hour before exercise (Durbin, 2021). The calculation of the average price per month is complex in this case since albuterol is usually taken irregularly. If one follows the indicated plan of taking four inhalations every four hours, the cost of the drug will increase significantly. In this case, the patient will take up to 24 inhalations per day, with a maximum inhaler resource of 200 times. Thus, in this most expensive scenario, three inhalers per month would cost approximately $207 (Drugs.com, 2022f). However, according to the examination, taking this medication removes some of the symptoms and increases SpO2. Thus, albuterol in this situation is reasonable and highly effective. It allows eliminating some of the signs associated with asthma and allows focusing on the treatment of pneumonia.
As the analysis shows, the patient does not have any prescriptions that could remove the symptoms of bacterial pneumonia. Her condition is not severe enough to stay in the hospital; she can be treated in an outpatient setting using additional medications (Messinger et al., 2017). Based on the type of pneumonia, the most rational solution would be to prescribe amoxicillin, which inhibits cell wall synthesis (DrugBank Online, 2022). The most special warning to the use of the drug is an allergy to penicillin or its derivatives. In addition, diarrhea and food allergies are common side effects (Durbin, 2022). However, when monitoring the current state and controlling the disease, this medication can be an effective solution in this situation.
Since amoxicillin is only a common active ingredient, many different preparations are based on it. It is not easy to establish a general pattern of admission and schedule. Hence, the course should last 7-10 days; for children weighing less than 40 kg, a dose of 90 mg per kilogram of body weight, two doses a day, is recommended (Mayo Clinic, 2021a). The clinicians should take medications regularly until the complete cure, and the doctor cancels the antibiotic. Since many drugs are based on amoxicillin, and the course of antibiotics rarely lasts a whole month, it is difficult to calculate the average monthly price. However, amoxicillin is a cheap prescription that costs no more than $13.72 in the course of maximum ten days (Drugs.com, 2022b). It is an effective antibiotic with very few interactions with other medications (Messinger et al., 2017). Therefore, its purpose and use in this situation are entirely reasonable. Taking amoxicillin and adding Tylenol will help the body fight bacteria. The girl’s condition should improve within 48-72 hours.
Tylenol
Tylenol is any drug that treats moderate or mild pains and fever. For this case, acetaminophen can be utilized as the key Tylenol. The medication’s mechanism makes it the best for use among individuals. The drug is small hence easily swallowed by the patient. Contextually, they exhibit a COX pathway in the CNS of an individual, unlike others which press more into the peripheral tissues. Some, such as ibuprofen, are coated with red pigments to reduce its bitterness. The side effects include nausea, stomach pains, headache, dark urine, rash, itching of the skin, and clay-colored stools. However, the side effects may be reduced by maintaining some precautions, such as not taking more than one product that carries acetaminophen at a time.
The dosage is always a single tablet three times a day, implying that the patient will take three tablets of the drug daily. For instance, ibuprofen taken by a patient for 30 days should be 90 tablets. The cost of acetaminophen medication in 30 days can be equated to $50. The critical evidence behind the drug’s effectiveness is pain and fever relief. Tylenol interacts with carbamazepine, isoniazid, rifampin, cholestyramine, warfarin, and alcohol. However, since the child does not take these prescriptions and is too young to consume alcohol, the use of Tylenol is reasonable for fever. The only changes can include a smaller dosage of 2, 2.5 tablets a day and can be avoided when the fever is gone.
Patient Analysis
Since the case involves a child, healthcare practitioners should forward much information regarding patient care and medication to the parents. However, the girl needs to be taught the importance of keeping her inhalers on schedule, as they, especially albuterol, are an essential part of her treatment. On the other hand, parents should be instructed regarding pediatric dosages, possible side effects, symptoms, and caring for and monitoring their daughter’s condition. No special considerations have been found regarding the patient population other than age. As such, doctors can calculate the dosage by adding a proper inhaler tech and the use of a spacer.
Since the usual duration of antibiotic treatment is seven days, it is suggested that the patient be seen three days after her new treatment to monitor changes in her condition. There should be significant changes in the positive direction by this time, a decrease in fever and sputum. However, for these changes to be more widespread, non-pharmacological interventions need to be included: increased rest time and fluid intake, limited physical activity. In combination with medication, rest and care for the child will allow the patient to cope with the disease faster and more efficiently.
Conclusion
Thus, the pharmacological study showed that the patient’s use of Asmanex HFA is not reasonable for either pneumonia or asthma. Dosages and frequency of administration do not correspond to the recommended ones, which could lead to the development of CAP. Therefore, it will be necessary to review the intake of this drug following the norms in the future. On the other hand, taking Ventolin HFA, based on albuterol sulfate, can slightly improve the patient’s condition by increasing saturation and reducing breathing. However, this medication cannot fight bacterial pneumonia, so antibiotic amoxicillin is proposed. In combination with albuterol and non-pharmacological interventions such as increased rest and drinking, this drug should positively affect the patient’s health by reducing bacterial activity and allowing recovery. A follow-up appointment is suggested 3 and 7 days after the start of treatment to follow up on progress and prescribe additional medications or tests.
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