What are the recommended medications to start this specific patient on?
Expectations
Length: A minimum of 180 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years
Q1. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and the initial starting dose.
The patient has been seen in the clinic and presented with symptoms such as fever and productive cough. Unless the patient is having shortness of breath and difficulty breathing, in which case, I would refer to the Emergency Department to get treated. In this scenario, I would prescribe the following combination therapy to an otherwise healthy patient to treat both Pneumonia and Chlamydia at the same time in an outpatient clinic setting:
Macrolide – Azithromycin Zithromax 1000mg on first day then 500mg the next two days PO for Pneumonia and Chlamydia. Local resistance patterns should be used, when available, to guide CAP treatment. A macrolide antibiotic like azithromycin that targets the most prevalent causative pathogen S. pneumoniae is indicated as first-line treatment for previously healthy patients who are suitable for outpatient treatment (Grief & Loza, 2018). Certain bacterial infections, including bronchitis, pneumonia, sexually transmitted diseases (STDs), and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs are treated with azithromycin. It acts by preventing bacterial growth.
Tetracycline Antibiotics – Doxycycline Hyclate Vibramycin-D 100mg PO daily for Pneumonia and Chlamydia for 7 days. One study shows that patients receiving this combination therapy (Azithromycin and Doxycycline) had significantly better treatment outcomes than those receiving Azithromycin alone (Lu et al., 2020). Additionally, the combination group experienced significantly shorter times for symptom relief, medication durations, recurrence rates within one year of discontinuation, and serum IL-6 levels than the azithromycin group (Lu et al., 2020). Patients in the combination group had a considerably higher quality of life than those in the azithromycin group (Lu et al., 2020).
Antipyretics (Fever Reducer) – Acetaminophen Tylenol 650mg PO Q6H as needed for fever.
Antihistamine, Second Generation – Cetirizine Zyrtec 5mg (starting dose) PO daily for seasonal allergies. Cetirizine is suggested for treating seasonal allergies in adults and children two years of age and older (Naqvi & Gerriets, 2023). It is safe to use in the treatment of perennial allergic rhinitis and urticaria in adults and children over the age of six months (Naqvi & Gerriets, 2023). Cetirizine has been demonstrated in studies using the Environmental Exposure Unit (EEU) to be more effective than loratadine and astemizole (Hossenbaccus et al., 2020). Similar to loratadine, cetirizine greatly lessens symptoms when compared to both of those drugs’ placebo and the beginning of effect is 60 minutes (Hossenbaccus et al., 2020). Additionally, cetirizine’s action lasted longer than fexofenadine’s (Hossenbaccus et al., 2020).
Q2. Please discuss the mechanism of action of each of the drugs you listed.
Azithromycin. The primary goal of AZM, like other macrolide antibiotics, is to stop the production of bacterial proteins by concentrating on the delicate bacterial ribosome’s 50S component (Heidary et al., 2022). The decrease in protein synthesis and the rise in macrolide concentration are connected. The unionized form of AZM has a greater membrane transit rate, which may account for the improved antibacterial action of AZM at alkaline pH (Heidary et al., 2022). On the 23S rRNA, AZM binds to and partially occludes a region known as the nascent peptide exit tunnel that is close to the peptidyl transferase core (Heidary et al., 2022).
Doxycycline Hyclate. Tetracyclines, like doxycycline hyclate, have bacteriostatic properties that are meant to halt bacterial growth by allosterically attaching to the 30S prokaryotic ribosomal unit during protein synthesis. (Patel & Parmar, 2020). Doxycycline hyclate stops the charged aminoacyl-tRNA (aa-tRNA) from interacting with the ribosomal A site, stalling the elongation phase and resulting in an unsuccessful cycle of protein synthesis Patel & Parmar, 2020). The ternary complex, which consists of the elongation factor Tu (EF-Tu), GTP, and aa-tRNA, binds to the ribosome at a different rate when treated with doxycycline (Patel & Parmar, 2020).
Acetaminophen. In any case, acetaminophen is hypothesized to have analgesic and antipyretic effects by reducing the activity of the COX pathway, which in turn prevents the manufacture of prostaglandins in the central nervous system (Gerriets & Nappe, 2019). A stimulating influence on the descending serotonergic pathways in the central nervous system (CNS) may be the cause of the analgesic properties (Garriets & Nappe, 2019).
Cetirizine. Cetirizine successfully counteracts many of the effects of histamine due to its antagonistic actions on histamine H1-receptors (Naqvi & Gerriets, 2023). Similar to other second-generation antihistamines, cetirizine reduces vascular permeability, which reduces fluid leakage from capillaries into tissues (Naqvi & Gerriets, 2023). Cetirizine also prevents bronchospasm brought on by histamine (Naqvi & Gerriets, 2023).
Q3. Please discuss the side effect profile of each medication you listed.
Azithromycin. The most common side effects associated with AZM include heart arrhythmias, headaches, nausea, and upset stomach (Heidary et al., 2022). Hepatotoxicity has been documented in rare instances (Heidary et al., 2022). When administering AZM, care should be taken in patients with a prolonged QT interval, impaired hepatic function, and renal GFR of less than 10 ml/min (Heidary et al., 2022).
Doxycycline Hyclate. Common adverse reactions include mild diarrhea, photosensitivity, nausea, vomiting, skin rash/itching, headaches, and tooth discoloration. In rare instances, severe reactions may include bloody diarrhea, leukopenia, migraines, hemolytic anemia, throat irritation or trouble swallowing, chest pain, exacerbation of systemic lupus erythematosus, shortness of breath, irregular or fast heart rate, dysuria, intracranial hypertension, esophagitis/esophageal ulcerations if taken without water (Patel & Parmar, 2020).
Acetaminophen. Adverse effects of acetaminophen administered orally or rectally may include the following skin rash, hypersensitivity reactions, nephrotoxicity (elevations in BUN, creatinine), hematological: anemia, leukopenia, neutropenia, pancytopenia, metabolic and electrolyte including decreased serum bicarbonate, decreased concentrations of sodium and calcium, hyperammonemia, hyperchloremia, hyperuricemia, increased serum glucose and increased bilirubin and alkaline phosphatase (Gerriets & Nappe, 2019).
Cetirizine. Adults who take this medication frequently report sleepiness, lethargy, pharyngitis, dizziness, and dry mouth (Naqvi & Gerriets, 2023).
Q4. Are there any interactions between any of the medications you prescribed?
According to Drugs.com (2019), there are no interactions with the medications I listed above. However, though, it is very important to know that Cetirizine’s adverse effects on the neurological system, such as sleepiness, confusion, and dizziness, might be exacerbated by alcohol (Drugs.com, 2019). Additionally, some people might have thought or judgment issues. While taking cetirizine, you should minimize or avoid drinking alcohol. Use cetirizine just as directed, and until you are familiar with how it affects you, refrain from performing tasks that call for mental alertness like operating potentially dangerous machinery or driving. If you have any inquiries or worries, speak with your physician or pharmacist (Drugs.com, 2019).
Q5. What other non-pharmacological interventions would be suggested?
One common approach to improve and expand patients’ lungs and help them breathe more deeply and fully is through the use of an incentive spirometer or IS. Our research looked at whether a regular IS routine improved lung function in an outpatient setting and whether patients could use IS as a signal to let their primary care doctor know when their goals weren’t being met or when related symptoms started (Toor et al., 2021). I would also educate the patient on sexual activities. It should be strongly recommended to all patients who are receiving therapy for chlamydia or gonorrhea to avoid sexual activity for 7 days following treatment and until all partners have received treatment (Van Ommen et al., 2023). To lower the rates of recurrent or persistent infection, sexual partners from the past 60 days should be tested and treated, or expedited partner therapy should be offered (i.e., clinicians can give the patient’s partner empiric treatment) (Van Ommen et al., 2023). Lastly, I would recommend using car filters and air purifiers at home to prevent seasonal allergies and exposure to allergens.
References
Drugs.com. (2019). Drug Interactions Checker. Drugs.com; Drugs.com. https://www.drugs.com/drug_interactions.html
Gerriets, V., & Nappe, T. M. (2019). Acetaminophen. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482369/
Grief, S. N., & Loza, J. K. (2018). Guidelines for the Evaluation and Treatment of Pneumonia. Primary Care: Clinics in Office Practice, 45(3), 485–503. https://doi.org/10.1016/j.pop.2018.04.001
Heidary, M., Ebrahimi Samangani, A., Kargari, A., Kiani Nejad, A., Yashmi, I., Motahar, M., Taki, E., & Khoshnood, S. (2022). Mechanism of action, resistance, synergism, and clinical implications of azithromycin. Journal of clinical laboratory analysis, 36(6), e24427. https://doi.org/10.1002/jcla.24427
Hossenbaccus, L., Linton, S., Garvey, S., & Ellis, A. K. (2020). Towards definitive management of allergic rhinitis: best use of new and established therapies. Allergy, asthma, and clinical immunology: official journal of the Canadian Society of Allergy and Clinical Immunology, 16, 39. https://doi.org/10.1186/s13223-020-00436-y
Lu, Z., Hou, M., Li, D., Cheng, J., Deng, H., & Yan, J. (2020). Azithromycin combined with doxycycline in non‑gonococcal urethritis. Experimental and Therapeutic Medicine. https://doi.org/10.3892/etm.2020.9125
Naqvi, A., & Gerriets, V. (2020). Cetirizine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549776/
Patel, R. S., & Parmar, M. (2020). Doxycycline Hyclate. In www.ncbi.nlm.nih.gov. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555888/
Toor, H., Kashyap, S., Yau, A., Simoni, M., Farr, S., Savla, P., Kounang, R., & Miulli, D. E. (2021). Efficacy of Incentive Spirometer in Increasing Maximum Inspiratory Volume in an Out-Patient Setting. Cureus, 13(10), e18483. https://doi.org/10.7759/cureus.18483
Van Ommen, C. E., Malleson, S., & Grennan, T. (2023). A practical approach to the diagnosis and management of chlamydia and gonorrhea. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 195(24), E844–E849. https://doi.org/10.1503/cmaj.221849
Requirements: 180
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