Case Study on medicines Assignment PDF

Case Study

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY..................................................................................................................................1
PART A...........................................................................................................................................1
1. Pathophysiology and aetiology and manifestations of Osteoarthritis......................................1
2. Paracetamol and Panadol Tablets............................................................................................2
3. Voltaren Rapid and its use in Osteoarthritis............................................................................2
4. Safety Consideration for NSAIDs...........................................................................................3
5. Negative and Positive interactions between the medications and herbal or nutritional
formulas.......................................................................................................................................3
PART B...........................................................................................................................................4
6) Use of corticosteroids in inflammatory joint disease..............................................................4
7) Explain 3 CNS drugs and adverse effects...............................................................................4
8) Discussion on altered pharmacokinetics in elderly.................................................................5
9) Drug monograph completed. (Appendix)...............................................................................5
10) Literature review of chosen drugs.........................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7
APPENDIX......................................................................................................................................7

INTRODUCTION
Osteoarthritis is an extreme level of arthritis and can impact a person both physically and
emotionally. In this report, the case study of Mrs F. has been discussed where in scenario one,
she is suffering from chronic moderate osteoarthritis and in scenario two, the osteoarthritis has
become more severe. This report will also highlight the various medicines that are being taken by
Mrs F. and they have been evaluated and a literature review has been conducted on the chosen
drugs in order to analyse the pharmacological treatment of Mrs F. in a better manner.
MAIN BODY
PART A
1. Pathophysiology and aetiology and manifestations of Osteoarthritis
As per the view of Ackerman, Bohensky, Zomer, Tacey, Gorelik, Brand and De Steiger,
(2019), it is normal to experience wear and tear in the cartilage surrounding the joints with the
passing age. In order to balance degradative enzymes in the cartilage formulation with that of
synthetic enzymes in the body, it is essential that tissue inhibitors are regulated. Ackerman and
et.al., (2019), has further stated that the major development in osteoarthritis pathophysiology is
recognizing the role that inflammatory cytokines has played and release of mediators like
synovial tissue which cause disruption in the balance. The author has also detailed the
endogenous and extrogenous factors that help in pathophysiological treatment of osteoarthritis.
The aetiology of the osteoarthritis can be traced back to Chondropenia which is the first
stage at which a person continuously loses the cartilage and can even be termed as an
intermediate stage when the initial stage in continuum i.e. loss of cartilage due to a chronic injury
and this process of cartilage loss culminates at the last stage which is osteoarthritis (Ackerman
and et.al., 2019). There are many research papers that have supported the fact that a major knee
injury ultimately leads to loss of cartilage i.e. osteoarthritis. Author, Zhu, Chang, Wang, Lu,
Han, Zheng, Meng, Wu, Jiang, Hannon and Hunter (2018), has researched that even a small
degree of misalignment can lead to increased pressure within a knee joint and this ultimately
leads to Chondropenia paving way for Osteoarthritis. Author has further stated that obesity is a
major contributor in osteoarthritis and Gap Junctions is another contributor in formulation of
cartilage degrading tissue.
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2. Paracetamol and Panadol Tablets
Paracetamol is a very commonly used drug, and is even recommended by clinical doctors
as a first time drug for treatment of osteoarthritis. The drug although is effective for reduction of
pain but cannot be concluded as a treatment since the pain reduced is at minimal levels and other
drugs specific for the treatment of osteoarthritis should be taken. However, the drug Paracetamol
poses minimal to no risks for patients inflicted with knee osteoarthritis. However, certain
precautions should be taken before intake of Paracetamol for osteoarthritis cure like avoiding
excessive intake of alcohol when taking Paracetamol etc.
However, Panadol is an effective drug for reducing the impact of pain and getting instant
relief for longer number of hours. There are two variants of the drug i.e. Panadol Osteo and
Panadol. While Panadol is of 500 mg, Panadol Osteo is of 655 mg. it was summed that Panadol
Osteo gave pain relief for 3 more hours as compared to Panadol and for 6 more hours when
compared to Paracetamol. Pharmakonetic properties of Panadol Osteo involve a unique bi-layer
under which there is a sustained release forming a gel kind of layer and then the drug is released
at matrix periphery attaining plasma concentrations for upto 8 hours after the drug is
administered (Keays and et.al., 2015). Panadol also works in a similar manner except the fact
that its effect is only upto 5 hours. Since Mrs F. is suffering from osteoarthritis at a chronic
moderate level, the most appropriate drug would be Panadol over Panadol Osteo and
Paracetamol since Panadol Osteo is of increased mg which can be harmful for her and
Paracetamol has the similar mg i.e. 500 mg but the relief provided by Panadol is for a longer
time period.
3. Voltaren Rapid and its use in Osteoarthritis
Voltaren Rapid helps in giving quick relief from pain and reduces inflammation or
sensitivity in the patients. It is an NSAID and helps in reduction of the pain and is even
recommended as a gel for first stage treatment in osteoarthritis (Khurana and et.al., 2017).
However consumption of Voltaren Rapid by Mrs F. is extremely dangerous for her given her
other health issues and problems. Some of the major contraindication of the drugs are patients
with asthmatic attacks, Cardiac Failure, Renal Impairment, Pregnant women, Patients treated
with coronary artery bypass surgery, Gastrointestinal infections etc. and out of these, there are
many diseases which Mrs F. is currently facing like asthmatic tablet intake of Ventolin Puffer,
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indigestion treatment by intake of Mylanta liquid, prescription of Capoten for high BP or heart
failure etc. with regular intake of drugs.
4. Safety Consideration for NSAIDs
NSAIDs i.e. ‘non-steroidal anti-inflammatory drug’ is used for treatment of varied
symptoms and normally do not lead to any side effects. However, in some of the cases, this can
even lead to adverse effects if the intake of these medicines is not appropriate, the most common
side effect being excessive bleeding (Barton, 2017). Some of the major safety considerations that
patients should take involve, Gastrointestinal risk, cardiovascular risk, increased blood pressure,
patients who have been treated in past with some kind of heart diseases, renal risk etc. Although
the availability of NSAIDs is easy, they should be used only after proper analysis of the current
and previous medication intake of the patient and the side effects should be well versed.
5. Negative and Positive interactions between the medications and herbal or nutritional formulas
Various herbal medicines etc. like Black Cohosh, Coenzyme Q10, Echinacea, Evening
Primrose Oil, Valerian etc. can lead to a variety of drug interactions which can be positive or
negative (Ackerman and et.al., 2019). As per the current condition of Mrs F., some of the
positive interactions involve:
Black Cohosh does not pose a major risk and can be used with other drugs.
Echinacea also lacks any major risk while interacting with normal i.e. conventional drugs.
Garlic is also a minimal threat to the regular people taking normal medicines.
Green Tea used for antioxidant of the body is the least interactive herb with any of the drug
intake.
Apart from these some of the negative interactions can be categorised as:
 Ginseng who can impact treatment of blood pressure and serious interactions can occur.
 St. John’s Wart can lead to severe drug interactions putting life in danger like SSRIs,
TCAs, warfarin etc.
 Valerian is another sedative that cannot be used with pain killers or anti-depressants
leading to serious consequences.
 Saw Palmetto used for treating increased BP can also lead to thinning o blood and
warfarin etc.
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PART B
6) Use of corticosteroids in inflammatory joint disease.
Corticosteroids are both immunosuppressive and anti-inflammatory. These can be used to
treat the various types of joint disease of the patient that are unhealthy. It can also be used for
preventing organ rejection in the transplant of recepient. Further, there are various professionals
that recommend that, dose upto 15 mg in routine course can be used for the treatment of arthritis.
This can be used to treat long term disease like inflammatory diseases etc Wagner (2018). They
have widespread endocrine as well as non-endocrine impacts through direct and indirect impacts
on the body.
The direct impact of this on Mrs. F may be acute and it generally happens at high doses
like decreased permeability. Anti-inflammatory effects are promotion of apoptosis, monocytes,
inhibition of phospholipase etc. The major limitation of using Corticosteroids is regarding safety
along with difficulty of substituting patients of the treatment. It is widely used in medicines
today. It is helpful in minimizing the number of swollen joints Magnuson, Wang and Schork,
(2016).
7) Explain 3 CNS drugs and adverse effects.
Losec is the combination of two active enantiomers that helps to reduce acid secretion
with the help of mechanism of actions. It is a particular substance of acid pump Wagner (2018).
If, Mrs F will consume Losec for more than the period of three months then there are chances
that, the level of magnesium in the blood may decline. Low level of magnesium will cause
involuntary muscle contradictions, fatigue etc. Taking Temaze drug may cause addiction.
Taking the medication will reduce the chances of addiction. There are some side effects
of this drug: it can lead to short term memory loss. So it is essential to have sleep for at least 7 to
8 hours after consuming a dose of Temaze drug. Prozac can be defined as the selective serotonin
reuptake inhibitor (SSRI) and it is commonly used to treat compulsive disorder, anxiety and
treating depression van Weeren and Back (2016). If, different drugs are taken together in that
case, it will lead to various side effects such as drowsiness, slow breathing, severe drowsiness
etc. Therefore, interactions may cause several problems. Further, one drug can decrease or
increase the absorption of either of the drug Kinoshita, Ishimura & Ishihara (2018).
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8) Discussion on altered pharmacokinetics in elderly.
In normal absorption of the drugs, distribution in metabolism, activity and excretion etc.
all leads to change due to the reason of ageing. The elder patients have lower level of
physiological reserves in most of the organs as compared with young age adult patients. With
increase in age it will negatively impact homeostatic mechanism. In combination with the
alterations in pharmacokinetics it will increase the chance of risk of ADR's. It is general for
various medical conditions to be happened in older patients that can lead to increase in potential
for problems related with medication problems due to poly pharmacy Kinoshita, Ishimura. and
Ishihara, (2018). Tablets are developed to allow full release of the drug over a particular period.
Absorption of drug is minimized in old people due to the loss of mucosal intestinal surface,
reduction in gastrointestinal flow of blood and reduces the gastric acidity. Once the drug comes
in the body it is carried around the body in the stream of blood. There are various age related
changes that impact the function of liver. It involves reduction in the flow of blood in liver etc.
9) Drug monograph completed. (Appendix)
10) Literature review of chosen drugs.
Losec drug -
According to the author Wagner (2018) proton pump inhibitors that is PPI's are
commonly used for treatment of reflux diseases such as acid related diseases including
gastrosophageal reflux disease. It is very important to know the negative impacts of the drug just
as with other drugs. Thus this drug is considered as safe those are not generally observed during
and after the administration. This have become frequently administered to the patients that h it
will increase the chance of risk of ADR'sas gastroduodenal disease. The drug has been given for
the conditions that has not been fully confirmed.
Cockburn and et.al (2017) said that, Although various cases related with negative impact
has been reported but, there is no clinical evidence for this. For treating acid related disease there
are various inhibitors of acid secretion that has been developed. However, the impact of those
acid inhibition are limited and the use of drug has adverse impact . It includes diarrhoea and
constipation. Further, if this acid neutralizing drug come in contact with other drugs it will
change the bioavailability of co-administered medication. The drug is mostly used medication
for inhibition of gastric acid inhibition in the world. Since, all the available PPI's have similar
molecular structure, they also have common pharmacological features. There are various side
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effects of Losec drug on elderly people such as it may lead to blurred vision, diarrhoea, joint
pain, muscle ache, pain or burning in throat etc.
CONCLUSION
The above Report has been concluded that, Voltaren Rapid drug assist in providing quick
relief from any pain and minimizes inflammation or sensitivity in the patients. Consumption of
Voltaren Rapid by Mrs F. is dangerous due to other health issues and problems. Some major
indicationCockburn, N., Pradhan, A., Taing, M.W., Kisely, S. and Ford, P.J., 2017. Oral health
impacts of medications used to treat mental illness.The Report has also described that,
Corticosteroids can be used to treat long term disease. It has been concluded that if, Losec drug
is taken for more than the period of three months then there are possibilities that, the level of
magnesium in the blood may reduced to a certain level. Further, it has been concluded that, the
patients of old age have lower level of physiological reserves in their different organs as
compared with patients of young age. Moreover, there are various side effects of Losec drug on
older patients like diarrhoea and constipation etc. Due to interaction between various types of
drugs the chance of risk of ADR's will high. Therefore, interactions between drugs may cause
various problems.
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REFERENCES
Books and Journals -
Cockburn & et.al, 2017. Oral health impacts of medications used to treat mental illness. Journal
of affective disorders. 223. pp.184-193.
Kinoshita, Y., Ishimura, N. & Ishihara, S. (2018). Advantages and disadvantages of long-term
proton pump inhibitor use. Journal of neurogastroenterology and motility. 24(2). p.182.
Magnuson, V., Wang, Y. and Schork, N. ((2016). Normalizing sleep quality disturbed by
psychiatric polypharmacy: a single patient open trial (SPOT). F1000Research. 5.
van Weeren, P.R. and Back, W. (2016). Musculoskeletal disease in aged horses and its
management. Veterinary Clinics: Equine Practice. 32(2). pp.229-247.
Wagner, J.G., 2018. Pharmacokinetics for the pharmaceutical scientist. Routledge.
Watanabe and et.al, (2018). The analgesic effects of buprenorphine (Vetergesic or Simbadol) in
combination with carprofen in dogs undergoing ovariohysterectomy: a randomized, blinded,
clinical trial. BMC veterinary research 14(1). p.304.
Ackerman, I.N., Bohensky, M.A., Zomer, E., Tacey, M., Gorelik, A., Brand, C.A. and De
Steiger, R., 2019. The projected burden of primary total knee and hip replacement for
osteoarthritis in Australia to the year 2030. BMC musculoskeletal disorders, 20(1), p.90.
Barton, C. (2017). Knee osteoarthritis: Put the knife down and embrace exercise therapy. Sport
Health. 35(2). 38.
Khurana, L., and et.al., (2017). Osteoarthritis patient preference for using technology to
communicate with physicians. Osteoarthritis and Cartilage. 25. S222-S223.
Keays, S. L., and et.al., (2015). Early osteoarthritis following conservatively treated anterior
cruciate ligament injuries. Physiotherapy. 101. e737-e738.
Zhu, Z., Chang, J., Wang, G., Lu, M., Han, W., Zheng, S., Meng, T., Wu, F., Jiang, D., Hannon,
M.J. and Hunter, D.J., 2018. The morphological parameters of proximal tibiofibular joint predict
incident radiographic osteoarthritis: data from osteoarthritis initiative. Osteoarthritis and
Cartilage, 26, p.S443.
Online -
Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use. 2018.
APPENDIX
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Drug- Losec Drug name- Omeprazole
Therapeutic uses/Indications- It is used to prevent and treat ulcers that are caused by
infection.
Mechanism of Action: (how and where does it work) - It is irreversible proton that pump
inhibitor. It suppresses acid secretion in stomach.
Side effects: - blurred vision, diarrhea
Warnings/Contraindications: - diarrhea from infection.
Pharmacokinetics (how is it absorbed/metabolised/cleared) – The absorption takes place in
small intestine.
Drug Interactions: There may be interaction between azole, amphetamines etc.
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