Pathophysiology and Pharmacology: Pneumonia

Running Head: PATHOPHYSIOLOGY AND PHARMACOLOGY: PNEUMONIA
PATHOPHYSIOLOGY AND PHARMACOLOGY: PNEUMONIA
Name of the Student:
Name of the University:
Author Note:

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Detailed explanation of the pathophysiology in relation to the primary
illness/disease of the patient in the scenario:
Pneumonia is considered as one of the infection where the air sacs are found to be
inflamed in one or both of the lungs. The air sacs are observed to be filled with fluid or pus
(purulent material), which becomes the reason of coughs with pus or phlegm. The symptoms are
followed by rise in the body temperature accompanied by chills along with facing difficulties in
breathing. As per the case study, Mr. Roger Wilson, a 32-year-old man was observed to
complain regarding feeling shortness of breath, headaches followed by productive cough with
phlegm over the past few weeks before being admitted to the emergency department with
bilateral pneumonia. Mr. Wilson also had a history of mild asthma and usually whenever he felt
worse while doing exercise, took salbutamol (ventolin) (Sellers, 2017) to get symptomatic relief.
On his visit to the general practitioner, he was diagnosed with a respiratory tract infection and
was prescribed with roxithromycin (Rulide) 150 mg that was needed to be taken twice a day.
Post taking the medicine, Mr. Wilson was found reporting back to the general practitioner stating
about worsening his condition. On his second visit, Mr. Wilson was sent for a chest x-ray
(Torrealba et al, 2018), which confirmed the diagnosis to be bilateral pneumonia, following
which he was immediately administered to the emergency department in the hospital to undergo
further treatment. The diagnosis confirmed that Mr. Wilson was detected with bilateral
pneumonia, where the both the lungs of the patient gets affected and the condition is also coined
as the term double pneumonia. Here in the case study it has been mentioned, that Mr. Wilson and
his partner at the gym, Mathew were trying to rebuild a warehouse into gym and since then they
had been developing flu like syndromes. This can be considered as one of the major symptoms,
which indicated of Mr. Wilson developing bilateral pneumonia. They are found to be mainly

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caused by some types of streptococcal bacterial infections or respiratory syncytical virus (RSV).
Hike in body temperature accompanied by chills are another set of symptoms that helps in
determining the condition. Mr. Wilson was also observed to cough and produce mucus or
phlegm along with it. On being admitted to the ED, he complained of having chest pain as well
due to coughing, which was rated 2 out of 10 on the numerical scale of pain. The
pathophysiology of bilateral pneumonia can be described as when a bacteria, fungus or virus
causes the tiny sacs of the lungs, referred to as alveoli become inflamed. They are further
observed to be filled with pus, phlegm or mucus leading to the rise of a set of symptoms and
mainly causes shortness of breath. Before being administered into the emergency department,
Mr. Wilson was administered with roxithromycin, which are mainly used to treat respiratory
tract infections. However, post Mr. Wilson’s admission to the emergency department; he was
administered with IV Benzylpenicillin and Doxycycline (Ha et al, 2018) along with a regular
nebulization of salbutamol (ventolin). IV Benzylpenicillin (Kwong, Agweyu, English & Bejon,
2015) is mainly used to treat a number of bacterial infections and studies show that they are
found to be effective in case of pneumonia and strep throat. Doxycycline (Ha et al, 2018) is also
observed to be incorporated in the medicine chart of Mr. Wilson. Benzylpenicillin is considered
as one of he narrow pectrum antibiotic drug that are used to treat infections caused by bacteria.
The natural penicillin is observed to administered intravenously or via intramuscularly. Post
administration, the drug interferes and synthesizes the bacterial cell wall peptidoglycan. This acts
and forbids the biosynthesis of the cell wall peptidoglycan. Moreover, the biosynthesis leads to
rendering the cell wall and make them osmotically unstable. In term of pharmacodynamics,
Doxycycline helps in stopping the protein synthesis of the susceptible organisms. The synthesis
of protein is one of the important step that o the replication of genetic material that are needed by

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the organisms to grow and reproduce. Thereby, following this the reproduction is blocked,
making the drug being effective when applied to the patient. The human body is observed to
absorb almost all of doxycycline in about 2 hours and is found to be very effective while dealing
with infections.
Explanation of three (3) signs/symptoms the case presented. Discussion of
relevant signs and/or symptoms of the patient in the scenario.
The case study of MR. Wilson denotes that he had a history of asthma since he was small
and that his condition worsened along with the past few weeks. The signs or symptoms include
him complaining of feeling shortness of breath, accompanied with fever (Panjwani,
Shivaprakasha & Karnad, 2015) along with chills. These symptoms can be justified as the
symptoms that require immediate medical care. The symptoms of bacterial pneumonia are
observed to develop gradually or can develop suddenly. The fever can be recorded to rise as a
dangerous 105 degrees F accompanied by a feeling of getting chilled even at a normal weather
temperature. Mr. Wilson was also found to be profusely sweating and flushed while being
admitted to the emergency department. The rapidly increase in the breathing rate and the pulse
rate are considered as the main reason of this diaphoretic condition. The lips and nail beds are
also one of the most common symptoms that determine the lack of oxygen in the blood. In the
case study, it can be observed that Mr. Wilson had been suffering from a gradual cough and flu
like syndrome over a week. Due to the early symptoms being similar to the influenza, the
diagnosis for pneumonia becomes a little confusing. The most common sign or symptom for
detecting pneumonia include the producing cough with phlegm or mucus. The phlegm can be
defined as the type of mucus that is made in the chest. The phlegm is usually a sign that the body
is fighting with an infection and that the color is derived from the white blood cells. The change

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in color appears along with the severity of pneumonia. It helps in detecting the progression of the
disease from viral infection to bacterial infection. This condition only arises when there is an
active infection occurring in the chest. The phlegm may appear green, yellow or bloody and are
considered as the major sign of developing pneumonia.
Explanation of three (3) pharmacological (medication) interventions,
including the ADME principles of each medication of the patient in the
scenario along with a discussion of how they would improve the condition of
the patient in the clinical scenario.
Before getting admitted to the hospital, Mr. Wilson was administered with
Roxithromycin, which is a semi-synthetic macrolide antibiotic, specifically used to treat any
respiratory tract infection. The drug helps to exert the antibacterial action by binding to the bacterial
ribosome and forbidding the bacterial protein synthesis. The absorption rate of this particular drug
has been found to be very high and is rapidly absorbed as well as diffused to most of the tissues and
phagocytes. The metabolism is mainly performed by the hepatic system and is found mainly
eliminated from the body through the kidney. The medications that are administered to cope up
with pneumonia include the administration of IV benzylpenicillin, which helps in to treat infections
caused by any kind of susceptible bacteria. They act as the first line or the second line of agents
against the susceptible bacteria. The treatment includes in vitro activity where the synthesis of the
cell walls are stopped and is mediated through penicillin G and are bound to the penicillin binding
protein (PBPs). The binding is specific to the proteins located inside the bacterial cell wall and
ultimate helps in stopping the synthesis of the total bacterial cell. The bacterial cell wall lysis take
place with the autolytic enzymes known as the autolysins. The drug is administered by intramuscular
and subcutaneous injection. The initial blood levels administration are found to be high but also

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transient. The drugs are found to be distributed with about 0.53- 0.67 L/Kg in adults with a perfect
and normal renal function. 16-30 percent of the intramuscular dose is metabolized to the penicilloic
acid that acts as an inactive metabolite. A small amount of 6-aminopenicillanic have been found to be
recovered from the urine of the patients. Moreover, a small percentage of drug appears to be
hydroxylated into more than ne etabolites, which shall be excreted through urine. The rote for
elimination of the particular drug is done by the kidneys. The parts of the drugs that are not
eliminated are mainly metabolized by the hepatic system and the lesser extent with the help of biliary
excretion. The second drug that can be observed on the medical observation sheet include
Doxycycline. Doxycycline is a broad spectrum antibiotic that are derived from the oxytetracycline.
They are used to treat a wide range of bacterial infections. They are mainly responsible for the
treatment of various kinds of infections caused by the gram negative and the gram-positive bacteria.
The inhibition of the protein synthesis in the bacteria helps in the exertion of the bacterial effects.
The growth of the bacteria is suppressed and is kept at a stationary phase. The drug is also observed
to show favorable intra-cellular penetration. Doxycycline are found to be readily absorbed and are
bound to the proteins present in the plasma. The drug is found to be highly soluble in lipids and has a
lower affinity to binding with the calcium. The drug is also found to readily diffuse into almost all
the body tissues, cavities and the distribution is measured as 0.7L/kg14. Metabolism of this drug
mainly happens in the liver and the gastrointestinal tract and remains concentrated in the bile. The
route for elimination of this particular drug is mainly done through active feces and urine in the form
of active and unchanged drug. The 40 % to 60 % of an administrated dosages of the drugs are found
to be present in the urine uptil1 92 hours.

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Critical thinking and use of clinical rationale. Explains the links between
pathophysiology and pharmacology context and theory.
Pneumonia has been coined as the infection of the lungs and the health care professionals
look over the disease as a single disease rather than considering it as group of syndromes. It can
be observed that there is a presence of an intricate balance in between the organisms that reside
in the lower respiratory tract along with the systematic and local defense mechanisms. Any
disturbance caused to this may give rise to the inflammation of the lung parenchyma, and
ultimately leading to pneumonia. The resident macrophages present help in protecting the lungs
from the foreign pathogens. The inflammatory reactions are triggered by these macrophages. The
macrophages present helps in engulfing the pathogens, trigger cytokines, and help in triggering
signal molecules (Adegunsoye et al, 2017). These further help in presenting the antigens to the
Tcells, which in turn trigger both the cellular and humoral defense mechanisms and help in
forming antibodies against the attacking organisms. The inflammation of the lung parenchyma is
caused due to this, thereby making the linear capillaries leak and further leads to the exudative
congestion. The treatment of pneumonia starts with the curing of the infection, also aim to
prevent the further degradation in these symptoms. The administration of antibiotics for treating
bacterial pneumonia are one of the main step involved that act as intervention. Identifying the
type of bacteria that is responsible for the pneumonia can help in choosing the best type of
antibiotic to treat it. The fever reducers or cough medicine can also be implemented as a part of
intervention, depending on the condition of the patient. Despite major changes implemented in
the management of pneumonia, the mortality and morbidity rate are still on the higher range. The
paper by, (Prina, Ceccato & Torres, 2016) states that despite the initial treatment provided by the
incorporation of the appropriate antibiotics, there are two aspects observed that happen to be

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worse. They are mainly caused due to inadequate immune response along with the uncontrolled
inflammatory reaction. The paper discusses about the use of corticosteroids (Nedel, Nora, Salluh,
Lisboa & Póvoa, 2016) on the patients and this might help in reducing the time of clinical
stability and the risk of the disease deteriorate to acute respiratory distress syndrome. The paper
critically analyzes the administration of intravenous immunoglobulin and helps in the
reinforcement of the immune response.

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