Introduction
The assignment will focus on case study of Mr Roger Wilson who is a patient of 32-year-old man with chronic pneumonia and he is a gym instructor by profession. The patient was admitted to hospital due to fever, breathlessness and chest pain. This assignment will focus on the pharmacological interventions with proper reference of pathophysiology. The person was diagnosed with bilateral pneumonia due to infection. The main three pharmacological interventions or medications which are given to the patient, are; IV benzylpenicillin, Doxycycline 200mg and Salbutamol (Ventolin). Pharmacological interventions and pathophysiology will help tom understand patient’s condition in a better way.
Discussion
Pathophysiology and patient scenario
Mr Roger Wilson is suffered from the bilateral pneumonia which is also known as double pneumonia. In this condition, both lungs are infected by virus, fungus and bacteria. Inflammation, filling of pus and mucous cause different symptoms such as shortness of breath and difficulties in respiration. Different types of pneumonia can be occurred by various process of acquiring; such as community acquired, hospital acquired and ventilator associated pneumonia. In community acquired pneumonia, virus, bacteria and fungus affect the lungs. The pathogens cause infection in the lungs and fluids are accumulated in the alveolar. The bacteria can be spread by various ways into the body such as through the bloodstream and the breathing air (Zambare & Thalkari, 2019). The bacteria enter into the body and passes to the bloodstream of lungs. After the entrance of bacteria, infection spreads in different organs of the body especially the parts of lungs get highly affected. Fluids are accumulated in the alveoli or the air sacs of lungs due to infection. Therefore the accumulation of pus and mucous or purulent material causes coughing, fever, chills and respiratory abnormalities. The infection in the lungs gives rise to green cough with foul smell and bad –tasting sputum. The systematic defence mechanisms like humoral and complement regulated immunity is compromised in this condition (Kalil & Thomas, 2019). The impaired cell mediated immunity depositors predispose the individual infection by intracellular organisms and low level of virulence occurred by the help of different bacteria and fungus. Condition of bilateral pneumonia gives rise to the infected sputum in the lobes of lung and the oxygen production rate will drop. Due low oxygen production, dyspnoea can be observed in lungs with shortness of breath. Dyspnoea is occurred due the infection on lungs and gives rise to tachypnoea which increases the breathing rate. As a result, respiratory rate will increase more than 20 breath per minute. Respiratory obstruction leads to the condition of high heart rate or tachycardia for beating in a faster rate. Due to shortness breath, the heart beats faster than the usual rate and as a result the high heart rate can be seen in the patient. On the contrary, due to severe infection blood pressure becomes low. High heart rate will decrease the blood pressure in human body (Di Pasquale et al., 2019). Tachycardia is responsible for blood pressure in human. As in human body heart rate increases to collect more blood in Atrium by pumping. Blood pressure drops automatically with the force of plant moving in the veins. In this case heart rate and low blood pressure is associated with infection of lungs. The person has a history of mild asthma from childhood and they sometimes become worse during physical training. In this case study it has been shown that Rodger and Matthew are suffering from flu like symptoms after shifting their gym to an old warehouse place. As Roger was suffering from bilateral pneumonia his lungs are not functioning well. Due to abnormal ladies in respiratory functions Rodger is facing difficulties in breathing and high heart rate which is 128 BPM. He is suffering from fever with 38.8 degree Celsius. His respiratory rate was 31 breeds per minute which was quite higher than the normal rate. Due to infection in lungs the diastolic blood pressure was quite low compared to the normal rate. Diastolic blood pressure depends on the blood exertion within the arteries between two consecutive heartbeats. Due to lung action blood pressure is low. After admitting to the emergency department Rodger Ford some diaphoretic symptoms and he felt slight chest pain with rate of 2 by 10 on numerical pain scale.
Relevant symptoms
Three most significant symptoms for pneumonia are:
Infection in lungs: Malodorous sputum is one of the most prevalent symptoms in the context of this case study. Pneumonia is occurred due to inhalation of bio aerosol containing pneumonia causing bacteria (such as Streptococcus pneumoniae). The infection reduces the capacity of oxygen production in the alveoli for accumulation of pus and mucus. As discussed before, bacteria related to pneumonia are transmitted by air and enter into the patient (Méndez et al., 2018). Mr Roger and his partner are affected by air borne infection as they have shifted to an old warehouse and transformed that place into gym. Lack of dissemination of that place infection might affect both of them with respiratory problem or infection in lungs.
Shortness of breathing and respiratory problem: Roger was a chronic asthma patient as a result infection can worsen his lungs’ condition. The patient is a gym instructor so heavy work is a part of his occupation. His condition get worse after performing different physical exercise. Roger’s lungs get infected and shortness of breath and anxiety will be observed for having chronic asthma.
Fever and chills: Fever and chill are some definite symptoms of bacteria–infected pneumonia. Pneumonia will increase heart rate and reduce the blood pressure. As enough oxygen is not produced by the lungs, elevation of heart rate or tachycardia will be observed (Brooks, 2020). The heart rate will increase sweating as the condition of diaphoretic.
Pharmacological interventions
The main three pharmacological interventions or medications which are given to the patient, are; IV benzylpenicillin, Doxycycline 200mg and Salbutamol (Ventolin).
IV benzylpenicillin is administered by the physicians to reduce the infection rate in lungs of patients. This antibiotic is penicillin by nature and acts on the gram positive bacteria such as Streptococcus pneumoniae, groups A, B, C and G, nonenterococcal group D and other viridians groups (Edwards, Khalfan, Jacobson, Pirie & Raidal, 2017). This medication is prescribed for septicaemia, pericarditis, meningitis and severe pneumonia. This medication interferes in peptidoglycan cell wall by biosynthesis of peptidoglycan and renders the cell wall with unstable osmosis. Cell wall synthesis is carried out with the effect reactions due to binding of penicillin G with penicillin binding protein present in cell of bacteria. Specific enzymes are attached with bacterial cell wall and synthesis of cell is mediated by some autolytic cell wall enzymes (Bijleveld et al.,2018 ). Therefore benzyl penicillin is given to the patient for reducing number of bacteria in patient’s body. This medication should be introduced as an intravenous dose to patient as parenteral administration is highly transient, the oral absorption of the medication is not as effective to acting upon the cell wall of the responsible bacteria. This medication is distributed throughout the body whereas the concentration of the medication is various in different tissues and fluids. The approximate volume of distribution is about 0.35 litres/kg and 60% of penicillin G is converted to albumin in plasma (Lonsdale, 2018). After administrating the drug as IV dose, 16-30% of the medicine will be converted into peniciloic acid (inactive metabolites). The medicine is metabolised in 6-aminopenicillanic acid which is excreted through the urine by the process of hydroxylation. The medication is given to patient as this will be excreted by kidneys with inclusion of hepatic metabolism and biliary excretion.
Doxycycline is a widely used antibiotic and prevents the synthesis of bacterial protein by binding with the 30S ribosomal subunit which is unique in bacteria. The medications stop the binding of transfer RNA with the messenger RNA. The amino acid cannot be added to polypeptide chains for the effect of the medication. Therefore, new proteins cannot be produced and the bacterial growth will be stopped. The medication was administered as an initial dosage of 200mg to reduce the effect of bacteria in human body (Zhang, Mao, Li, Huang, Gu, Shen & Ding, 2019). The dosage will be reduced into 100mg after submerging effect of the drug. The drug was administered to the patient for its resistance to any type of staphylococcus infection and various streptococcal infection. This tetracycline was administered to the patient for its antiparasitic effects and anti-inflammatory actions of bacteria. Tetracyclines are bound to the plasma protein easily in different degrees. The drug is soluble in lipid and has low affinity for the calcium affinity. The medication is easily diffused by into most of tissues and fluids in the volume of 0.7L/ kg in body(Hopkins et al., 2017). The medication is metabolised in the liver and GI and absorbed in bile. By urination and faecal excretion, the medication is eliminated from the body. After 92 hours of administration of the medication, 40 to 60% of the drug is excreted and 30% of the mediation will be eliminated as faeces.
Salbutamol (Ventolin) is a selective beta 2 adrenergic receptors which are used in the treatment of asthma. The medication is used in decreasing the negative impact of the asthma as it has specific pulmonary beta receptors of lungs (Jacobson et al., 2017). The medication is used for acute episodes of bronchial asthma, other chronic broncho pulmonary disorders and chronic bronchitis. The medication can reduce the impact of exercise-induced asthma. Therefore the medication is appropriate for the patient as he is a gym trainer by profession. This medication is administered to the patient with the help of nebuliser. The medication was diluted with normal saline to smoothen the muscle of all airways of trachea up to the terminal bronchioles(Kruizinga et al., 2019). The medication can help to reduce the respiratory obstruction with cardiovascular effects. Therefore tachycardia in the patient will be reduced as an effect of declining respiratory rate. Within 5 to 15 minutes of administration of the drug, the effect on the restrictive respiration can be observed. Most of the effects can be observed after 50 to 90m minutes of drug administration. Normal saline helps the drug to dissolve in patient’s body rapidly and a bronchodilator activity has been observed in patient. This medication is inhaled by patients with nebuliser and acts topically on the respiratory muscles. As per the records the volume of distribution of the medication is 156 +/- 38 L. This medication is bound to the plasma protein within the interval of 7 days. The medication does not metabolise in lungs and converted into liver in the form of salbutamol 4′-O-sulfate ester with negligible pharmacological activity. The medication metabolises with the help of oxidative deamination and conjugation with glucuronide. After the administration of this drug, 58-78% of dosage is eliminated by urine within 24 hours. On the contrary, small fraction of the dosage is excreted by the faeces.
Patient was administered with oxygen in an amount of 4L by nasal specs. After the admittance to the ED, blood and sputum were sent for culture. Tests will be arranged for analysing the body fluids and the results would be helpful for assessing the condition of the patient. The patient was prescribed Roxithromycin 150mg twice per day for respiratory tract infection. The administered drugs were prescribed to chest congestion and respiratory obstructions. The prescribed drugs will reduce the prominent respiratory abnormalities in the patient. Doctors provided drugs to reduce infection and obstruction of oxygen production as both elevated heart rate and reduced blood pressure are interrelated with the respiratory difficulties.
Conclusion
Mr Roger Wilson is suffered from the bilateral pneumonia which is also known as double pneumonia. The essay has described the effectiveness of drugs with mentioning their absorption, distribution, metabolism and elimination. The administered drugs were prescribed to chest congestion and respiratory obstructions.
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