Mr. Roger Wilson, a 32 year-old man who has a history of asthma and is currently a fitness instructor, complained to his GP of shortness in breath, fever, headaches, and a productive, cough for the past week.
The GP diagnosed Mr Wilson with a severe respiratory tract infection. He prescribed 150mg of roxithromycin (Rulide), twice daily (BD).
After two days of taking the antibiotic, Mr Wilson was feeling worse and has since returned to his GP.
A chest xray showed bilateral pneumonia. Mr Wilson was admitted to hospital via the emergency department.
Roger has mild asthma that he has suffered from since childhood.
For symptom relief, he uses a metered dose (MDI) salbutamol (Ventolin).
Roger and Matthew, their partner, have been renovating an old warehouse to make it a gym for the past several months.
Both suffered from ‘flu like’ symptoms, sore throats, chest infections, and other ailments.
Roger is anxious and breathless when he arrives at the ED.
Admission to the ED
Roger’s symptoms upon admission to the ED include sweating (diaphoretic), and flushing.
Roger is alert and orientated, but very breathless. He also has slight chest pain that he rates at a two out 10 on a numerical scale.
He has a productive and greenish-colored cough.
Roger is a social drinker and has not smoked.
Pathophysiology and Pharmacology Associated to The Case Patient
The clinical scenario was based on Mr. Roger Wilson (32 years old) who was admitted to the emergency room (ED) with symptoms such as chest pain, breathlessness and cough.
His chest xrays showed bilateral pneumonia. He was also diagnosed with respiratory infection (RTI).
It’s a severe form of acute lower-respiratory tract infection that affects both the lungs. This can cause symptoms like headache, sneezing or tightness in the chest, productive cough, and breathlessness. (Fabbri et. al., 2017).
Roger is also experiencing similar symptoms according to the review of his case study.
Roger’s most affected anatomical structures are the lungs, and the alveoli.
This causes the patient to experience mild chest pain, productive and persistent coughs, as well as breathlessness.
This is related to the anatomy of the disease. When bilateral pneumonia occurs, the alveoli become inflamed and then filled with pus. The patient experiences symptoms such as breathlessness and difficulty breathing (Craft & Gordon 2019).
The direct invasion of bacteria within the pleural area and the initiation of inflammatory events can lead to structural changes in lung structure (Quinton Walkey & Mizgerd 2018, 2018).
In this case study, the anatomy and physiology of bilateral pneumonia are also linked to the pathophysiology that caused the disease.
Understanding the pathophysiology behind the disease and the reasons behind Mr. Roger’s medication regimen is crucial.
Direct bacterial infection, inflammation in the lungs, pleural space, cascades of inflammatory episodes and bacteriologic virulence are all possible causes of the disease (Quinton Walkey & Mizgerd (2018).
Mr. Roger has experienced shortness-of- breath and productive cough episodes.
These episodes are due to bilateral pneumonia, a pathophysiological process.
Pneumonia is most often caused by bacterial or viral infections.
After infection by bacteria or virus, inflammation of the air sacs within the lung results in an immune response.
Fluid location is caused by an acceleration of the immune response.
This is due to the activation of the coagulation pathway and the migration of neutrophils, which results in fluid within the alveoli.
As the protein-rich fluid builds up in the alveoli the mucus plugs can reduce gas exchange efficiency in the lungs.
McCauley & Dean (2015) further indicate that the fluid in the alveoli causes impaired gas exchange and a risk of infection.
These pathophysiological modifications might explain Mr. Roger’s pneumonia. They are also related to the anatomical structures of pneumonia. Lung structures changes can trigger inflammatory events that cause fluid accumulation and initiate a cascade (Gon & Hashimo 2018).
The main treatment for bilateral pneumonia is pharmacological.
Treatment depends on the type of infection. The main goal of treatment is to reduce symptoms like impaired gas exchange and breathing difficulties for patients.
You can learn more about the effects of the medication by reviewing the prescription pharmacology for Roger.
For the treatment of pneumonia, antibiotics are the first line therapy.
Roger has received IV Benzylpencillin. This antibiotic is a narrow-spectrum antibiotic and is used primarily for the treatment of pneumonia.
It is administered intravenously because of poor oral absorption. The drug acts by binding to penicillin binding proteins in the bacterial cell wall.
This inhibits the last step of bacterial cell walls synthesis, which leads to cell lysis (Drug Bank 2018).
The evidence suggests that benzylpenicillin is a good pharmacological option in treating patients with pneumonia.
The benefits of early treatment include a lower demand for nursing care and the elimination of injectable medication.
Benzylpenicillin may be used to speed recovery, reduce the progression of infection, and prevent complications in Mr. Roger.
Doxycyline is another medication Roger was prescribed for the first day.
Doxycyline was prescribed to Roger for his first day because it prevents the growth of bacteria and treats infection.
It belongs to the drug group tetracycline antibiotics and is used to treat different types bacterial infection.
It acts in a similar way to benzylpencillin. By binding to the 30S of the ribosomal units, it inhibits protein formation.
This inhibits bactetial development and results in improvement of symptoms (Nightingale & Bishai 2016, 2016).
Roger has mild asthma and takes salbutamol via a metered-dose inhaler (MDI).
Salbutamol is an asthma treatment that works by short acting beta2adgrenergic receptor antagonists.
Evidence suggests that glucocorticoids, b2?Adrenoceptor receptor agonists, and salbutamol are the best options for treating inflammation in the airways.
It is used as a first line treatment for asthma.
b2?Adrenoceptor Anagonists are the most essential drug class to treat asthma.
For long-term treatment, short-acting preparations such as salbutamol are used. A long-acting preparation is combined with glucocorticoid (Amrani & Bradding 2017.
This pharmacological treatment can be linked to Mr. Roger’s treatment of bronchocontriction. Because this class of drugs has bronchodilator effects and plays a role in alleviating breathlessness, it is also connected to Mr. Roger’s treatment of bronchocontriction.
The Cases Study: Explanation of the Three Symptoms
Mr. Roger experienced the three most common symptoms of bilateral pneumonia: chest pain, productive cough, breathlessness.
These symptoms are also common clinical signs of pneumonia.
These symptoms are related to bilateral pneumonia pathophysiology. The pathophysiology is affected by bacterial invasion. Inflammation contributes to the appearance of these symptoms (Fabbri et.al., 2017).
In patients with bilateral pneumonia, the most common symptoms are mucous and productive cough.
Roger had productive cough. This was a sign that he may have suffered from bilateral pneumonia.
It is an indication of severe allergic reactions and acute bacterial infections.
This causes thick mucus plugs to block the airway (Begic, et al. 2017, 2017).
Upon admission to the ED by Mr. Roger, he had a productive and green-colored cough.
This is a sign of hypersecretion of mucus in the airways due to pathophysiological manifestations.
Normal mucous functions are to moisten the airway and protect it from infection.
Anaerobic infections of the lungs can lead to purulent cough (Shen, et al.
Roger is a pneumona patient. This can reduce airflow.
Mr. Roger had dyspnea and breathlessness.
A case study showed that Mr. Roger had been experiencing shortness in breath over the past week.
This is also directly connected to the pathophysiology for pneumonia.
After bacterial infection, pneumonia can cause breathlessness. This is because the inflammatory cascade leads to the release of macrophage as well as filling the alveolar space’s inner linings with fibrin-rich exudates.
This causes the alveolar spaces to become less airy and results in impaired lung expansion and pulmonary embolism.
The common causes of oxygen deprivation are decreased gaseous exchange and increased work of respiration (Regunath & Oba (2018)). This can lead to symptomatic breathlessness as an increase in airflow obstruction.
(2016) explained that breathing becomes more difficult or less efficient when certain pathways are activated.
The most common symptoms are tightness and an increased respiratory work effort.
Review of the clinical case of Mr. Roger showed that he also experienced mild chest pain with breathing difficulties.
The patient’s response to the pain questionnaire was two out ten. This resulted in a low intensity of pain.
This was due to muscle strain from excessive coughing or acute inflammation in the inner tissues of the lungs.
The progression of inflammation in the airways may cause chest pain.
Inflammation of the parietal and pleural spaces triggers pain receptors, and pleural chest pain can be mainly caused by inflammation.
Trauma to the rib cage, intercostals or intercostal nerves can lead to pain in the cutaneous nerve distribution (Reamy Williams & Odom 2017).
These pulmonary embolisms can occur for many reasons, including bilateral pneumonia in Roger.
Discussion of three Medications Related to the Pathophysiology And The Patient:
Salbutamol via nebulizer and IV benzylpenicillin are the three medications prescribed to Mr. Roger as a treatment for asthma symptoms.
Salbutamol must be prescribed to Mr. Roger in order to treat his symptoms of bilateral pneumonia.
A review of the pharmacokinetics as well as the pharmcodynamics of Salbutamol will help you understand why Salbutamol is given to patients.
Knowing the effects of Salbutamol on absorption, distribution and metabolism (ADME) will help you to determine how fast your medication can be used to relieve Mr. Roger.
Salbutamol’s pharmacodynamics review can be helpful in understanding its mechanism of action.
It acts by inducing bronchodilator action by activating the adrenergic receptors.
It triggers a cascade that results in AMP release, and calcium ion concention. This causes symptom relief (Neame et.al., 2015).
Additionally, the pharmacokinetics describes the time taken for above mentioned actions (Bryant & Knights 2019).
The half-life of salbutamol ranges from 4 to 6 hours.
Inhalation of salbutamol causes the medication to act on the bronchial smooth muscles. The drug’s concentration decreases within 2-3 hours.
The drug is absorbed in the gut.
After this, the drug is absorbed by the body.
A blood concentration of 5-20ng/ml is sufficient to produce bronchodilatory effects.
The majority of the medication is delivered to the lungs in unmetabolised form. The rest are stored in the oropharynx.
Salbutamol doesn’t get metabolized in your lungs. It is however converted to salbutamol 4-O-sulfate.
Salbutamol, along with its metabolites, are excreted in urine.
Therefore, the elimination half-life is 5.5 hours after inhaled or oral administration.
The method of administration will determine the extent of renal clearance.
Oral administration results in renal clearance of 38 ml/min. Intravenous administration is 70ml/min (Drug Bank 2018.
This helps to explain the pharmacokinetics of Salbutamol as well as how quickly Salbutamol will relieve Mr. Roger.
As it is prescribed to treat bronchoconstriction caused by asthma patients’ airway inflammation, the drug has been linked to pathophysiology.
Mr. Roger received IV Benzylpenicillin as his second medication.
Because Mr. Roger had increased breathing effort and breathlessness, Benzylpenicillin prescriptions were made to him.
Benzylpenicillin, an antibiotic, is used to treat a wide range of bacterial infections.
Because of its poor oral absorption, this antibiotic is intravenously administered.
It is a penicillin beta lactum antibiotic that is used in the treatment of infections caused by gram-positive bacteria.
The drug’s ability to inhibit cell wall synthesis, and the binding of penicillin binding protein to the drug causes a bactericidal reaction (Waller & Sampson 2017, 2017).
It binds to the cell wall and causes cell lysis.
The most common antibiotic given to patients suffering from bilateral pneumonia is antibiotics.
Mr. Roger has received Benzylpenicillin as a treatment for his malodorous sputum and productive cough.
Rapid absorption is what makes Benzylpenicillin so effective.
After the drug has been distributed to the lungs, it is metabolized to penicilloidic acid, which is an inactive compound.
The drug is eliminated by the kidneys and its half-life is approximately 0.4 to 0.9 hour (Ajavon & Takt, 2016).
This drug has links to pathophysiology. It works to address the issue mucus hypersecretion during bacterial infections or lung inflammation.
Review of Roger’s medical records revealed that Doxycycline had been prescribed to him.
Doxycycline, an antibiotic that can be used to treat many types of infection, is also available.
Doxycycline is an antibiotic that suppresses the immune system. Mr. Roger was prescribed it.
According to Bhattacharyya and colleagues (2017), long-term use of the drug improves symptoms and the obstructive characteristics of pneumonia.
Roger was therefore prescribed this medication in order to promote lung function, and reduce chronic respiratory obstruction. This is part of the pathophysiology behind bilateral pneumonia.
Doxycycline pharmacodynamics review can be used to identify the drug’s properties that have the potential to provide therapeutic effect.
It inhibits the binding of bacteria protein synthesis to the 30S-ribosomal subunit, which is responsible for its bactericidal activity.
It prevents the replication of bacteria by inhibiting protein synthesis (Xing et.al., 2015).
ADME reviews indicate why Mr. Roger is being prescribed a fixed dose.
It is quickly absorbed by the stomach and metabolized in gastrointestinal tract.
The drug is mainly excreted by urine and faeces. The half-life of the drug is approximately 16.33 hours.
The kidneys are responsible for the drug’s clearance.
Roger will experience relief from his symptoms if he takes three of the drugs (Drug Bank 2018).
Oral amoxicillin and benzylpenicillin for severe pneumonia in kenyan kids: A pragmatic controlled, noninferiority pilot study.
Preclinical Drug Development.
Asthma and b2-Adrenoceptor Function.
Advances in immunology Vol.
View from Primary Health Care System. Productive Cough in Children & Adolescents.
Long term effects of doxycycline for asthma: A real-world observation.
(2019) Pharmacology for healthcare professionals (5th edition.
Dyspnoea – Pathophysiology and a Clinical Approach.
SAMJ South African Medical Journal, (106(1)), 32-36.
Understanding pathophysiology, ANZ 3rd.ed.
A rare form of pneumonia: The golden diagnostic.
Pneumonia & empyema: Causal, casual, or unknown.
Journal of thoracic diseases, 7(6), 992.
The Role of Macrolides for Community-Acquired Respiratory Infections.
Community-Acquired Respiratory Incidents (pp.
Integrative physiology and pneumonia.
Understanding Pleuritic chest pain: Sorting through the Differential Diagnosis.
Chinese expert consensus (English version): Management of airway mucus oversecretion in chronic obstructive pulmonary disease.
E-Book Medical Pharmacology and Therapeutics.
Antibacterial properties of doxycycline coated dental abutment surface surfaces.