Free «Case Study: MN553 Advanced Pharmacology» Essay Sample

Introduction

Low back pain is among the fast rising medical conditions in the world. It is a significant cause of disability that affects work and the general health of population. Low back pain is a result of obesity, certain height and age, depressive moods, and occupational posture among other factors. World Health Organization estimates the prevalence of common low back pain at 62% to 70% in the developed countries (Phillips, Slosar, Youssef, Andersson, & Papatheofanis, 2013). Prevalence among the adults is higher in comparison to children. Low back pain patients are increasingly adopting complementary and alternative medicine (CAM) regimes, moving away from the conventional choices (Murthy, Sibbritt, & Adams, 2015). This paper addresses pharmacological management plan as well as follow-up evaluations with consideration to the prescribed drugs with CAM by looking at a case study of Mr. NX.

Pharmacological Management Plan

CAMs Contraindicated with Current Prescriptions

Mr. NX uses drugs for regulating diabetes type II and his high blood pressure, and he also consumes medicine for his recurrent DVTs. Furthermore, he takes creatine and coenzyme Q 10. Creatine is contraindicating when taken with lisinopril. Creatine supplementation for a workout is beneficial in cases where the individual has low creatine levels in the body. In cases where the patient is hypertensive, creatine supplementation may present an imminent danger. High levels of creatinine, a by-product of creatine, have a potential of causing hypertension. It happens through kidneys — creatine causes the retention of water in the muscles, which makes the urine concentrated. Concentrated urine causes elevated blood pressure as the kidney functions start to slow (Kizhakkeveettil, Rose & Kadar 2014). A significant amount of risks exists when Mr. NX uses creatine while he has hypertension.

Mr. NX takes kava to manage his anxiety. Anxiety is closely related to high blood pressure, but it is not among the causes of it. In cases of sustained anxiousness, the heart muscles and kidneys are damaged. It may be a subject for concern because of the function the kidneys play in managing fluid balance, meaning that it also affects the blood pressure. Among the many uses of kava, the herb is effective for controlling anxiety, and therefore, this role makes kava maintain high blood pressure.

Coenzyme Q-10 is an antioxidant found naturally in foods, and it also works as a supplement. It is important for metabolic reactions for energy generation, and this it is highly concentrated in organs with high energy requirements. Apart from helping to maintain the health of the heart, it also supports the health of blood vessels (Kizhakkeveettil, Rose & Kadar 2014). Furthermore, coenzyme Q-10 improves glycemic control by cutting down oxidative stress and other mechanisms.

Coenzyme Q-10 is contraindicated if taken with Coumadin. CoQ10 causes bleeding, and the risk increases with an anticoagulant. Coumadin — in other words, warfarin, is an anticoagulant that inhibits clot formation (Enthoven, Roelofs, Deyo, van Tulder, & Koes 2016). In terms of this case study, the drug is prescribed for Mr. NX with the aim of stopping the appearance of clots in his veins and arteries, which is essential, considering that historically, he has a diagnosis of recurrent DVTs. Warfarin acts as an anticoagulant by inhibiting vitamin K, which is a coagulation factor.

CAMs Contraindicated with Diagnoses

In the regarded case study, the patient Mr. NX has a history of recurrent DVTs. It is the formation of blood clots (thrombus) in the veins, especially in those situated in the lower limbs. The clots can cause blockage in the veins, leading to pain, swelling, discoloration, and making the skin warm to touch.  Pulmonary embolism can result from DVTs — it happens when a portion of the clot breaks free and travels to the heart and then to the lungs. Pulmonary embolism is life-threatening (Kizhakkeveettil, Rose & Kadar 2014), and for this reason, patients with recurrent DVTs receive prescriptions for anticoagulant drugs.

Complementary and alternative medications prescribed to patient NX are forbidden in regard to his diagnosis. The usage of Coenzyme Q-10 decreases the efficiency of anticoagulants that are necessary for DVT patients (Murthy, Sibbritt, & Adams, 2015). Using CoQ-10 would then require an increase in the dosage of the anticoagulants. It should be done under strict supervision of the doctor since side effects of Coumadin are adverse. They include bleeding from the nose, wounds, and needle injections, which takes a long time to stop, as well as bloody stool and urine, swelling, and bruising.

Prescription for Back Pain

The case study regards a patient that has been suffering from dull lower back pain for ten years. He has not had any specific injuries, which rules out any other symptoms and signs that could signify other conditions. The cause of the chronic back pain in the regarded patient might be attributed to many factors. Spraining can be a reason for the back pain, as well as other factors already mentioned above, such as obesity, physiological stress, and occupational posture, which can lead to back pain or intensify it. There are various prescriptions for chronic back pain, including physical exercises highlighted below.

Cyclo-Oxygenase-2 Inhibitors (COX-2)

COX-2 is a class of bigger non-steroidal anti-inflammatory drugs commonly known as NSAID. They work by explicitly inhibiting COX-2 enzymes. COX enzymes exist in two forms — COX-1 and COX-2, and they both release prostaglandins (Enthoven et al., 2016). The primary function of COX-1 enzymes is the production of prostaglandins that activate platelets and protect the lining of gastrointestinal tract. COX-2 enzymes, on the other hand, release prostaglandins in response to an injury or infection. Prostaglandins regulate inflammation, while blocking COX-2 enzymes and COX-2 inhibitors reduce inflammation and pain. The examples of them include Bextra and Celebrex.

Anti-Depressants

Anti-depressants, apart from being a part of the treatment of depression, can be prescribed as a first-line treatment for chronic pain. It is explained by the fact of the shared neuro-biology and neuro-anatomy that both chronic pain and depression have. Classes of anti-depressants for pain relieve are tricyclic anti-depressants (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). They share the ability to control the neurotransmission of both serotonin and norepinephrine (Janakiraman, Hamilton, & Wan 2016). They reduce pain by affecting its circulation at the cerebral and the spinal levels. They also control the working of dorsolateral prefrontal cortex, hippocampus, insular cortex, and amygdala (Enthoven et al., 2016). Similarly, these are the regions of the brain that are altered due to depression of the patients. Hence, the reason for using anti-depressants such as Celexa, Paxil, and Zoloft can be found in both of the aforementioned facts.

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Changes in Prescribed Drugs

Mr. NX had been prescribed medication for his type II diabetes, lisinopril to control his high blood pressure, and Coumadin for his recurrent DVTs. This prescription will stay as it is, the only change will be the additional CAMs that clash with his prescribed medicines. Murthy, Sibbritt, and Adams (2015) elaborate that this will eradicate creatine and co-enzyme Q-10 supplements. Also, Mr. NX ought to change his training partner and include a physiotherapist in his training. It will help to focus his exercises not on building muscles, but rather on healing his back.

Follow up Evaluations

Time Frame

High blood pressure drugs are taken for regulation purposes, and as such, the time frame will be as extensive as required by the regulation. Similarly, type II diabetes drugs will be used by the patient for regulation of the condition for a lifetime, for as long as the condition persists (Moon & Oh, 2016). An anti-depressant will be used as the primary drug. The antidepressant drug of choice is celaxa, citalopram HBr. Drug administration is 20 mg once a day, and the duration for taking this drug should not exceed one week.

Strategies for Evaluating Side/Adverse Effects

To evaluate side effects of a drug, the benefits of the drug must offset the risks. For instance, some drugs, when taken, have an adverse impact on the liver or the nervous system. When such medication is administered to young children, it poses a higher risk than if administered to older people. A general principle is therefore that drugs with adverse side effects should not be administered to young ones. The choice of the drug should also be determined by the side effects caused by it (Moon & Oh, 2016). Though a given class of drug will have more or less the same side effects, some of them are more pronounced in one drug than they are in another. The adverse effects should be short lived and not contribute to the appearance of another medical problem.

Strategies for Evaluating Effectiveness

Physicians provide information to their clients about the new drugs in the market. The effectiveness of a drug is seen in the manner in which it maximizes the benefits of the patient health-wise. In the case study, the effectiveness of celexa, the anti-depressant drug prescribed for chronic low back pain, will be deemed appropriate if the patient gets well. New therapies must have such key factors of an effective drug administration as safety, personal tolerance, affordability, and straightforwardness.

Conclusion

Pharmacological management for Mr. NX, who has chronic low back pain, will entail the use of anti-depressants. The anti-depressants serve as first-line treatment for chronic pain of the back. Lisinopril will be used to control his blood pressure, and Coumadin prescribed for his recurrent DVTs will remain. Enzyme Q-10 and creatine are CAMs that clash with prescribed medicines, meaning that they should be withdrawn from the patient’s pharmacological management plan. The only CAMs regime for this management is exercising with a physiotherapist. It shows that low back pain patients can use the complimentary alternative medication in the treatment of their conditions. It is also worth mentioning that not all CAMs regimes are appropriate when coupled with certain medications.