Pharmacology Case Study: Asthma, GERD, and Depression

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Pharmacology Case Study
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PHARMACOLOGY CASE STUDY 2
Introduction
Different disease processes demand different considerations in clinical assessment and
drug administration. The treatment of these diseases requires a choice of drugs that are
efficacious in combating the ailments while minimizing harmful outcomes. The current paper is
a discussion on drug pharmacology in reference to a case study of a patient requiring therapeutic
intervention. The patient, Sally Smith is a 36-year-old patient with a history of asthma and
GERD on albuterol inhaler prn, loratadine 10 mg PO daily, omeprazole 20 mg PO twice daily
and Yasmin. She also reports using St John’s Wort 1 tablet PO daily for episodes of depression.
The paper will outline the pathophysiology of her disorders, Asthma, GERD, and depression, to
better understand the relevance of the chosen medications and their pharmacodynamics.
Concerning herbal preparations, the paper will outline current research on its
pharmacodynamics, efficacy, potential risks and advantages of using them. The
pharmacokinetics, adverse effects, prescriber considerations and patient education for each drug
will be outlined.
Pathophysiology.
Asthma
Asthma is a chronic airway disease. The main features are bronchoconstriction, airway
remodeling and symptoms of wheezing and cough. This is usually as a response to
environmental stimuli and allergens such as animal dander, pollen, dust, food among others
(Kumar, Abbas & Aster, 2015). Exposure to an allergen leads to a Th2 mediated immune
response with the production of IgE antibodies, the classic type 1 hypersensitivity reaction. Re-
exposure to the antigen leads to antibody crosslinking on mast cells and mast cell degranulation

PHARMACOLOGY CASE STUDY 3
releasing inflammatory mediators, cytokines, and histamine. Loratadine is an antihistamine drug
that works to block the effects of histamine in the disease process. Mast cell degranulation drives
the early phase causing excess mucus production due to mucosal hyperstimulation, dilatation of
vessels and a direct effect on vagal receptor causing bronchoconstriction (Kim, Kim, Jeon, &
Kim, 2013). Albuterol is a selective beta agonist that acts on bronchial smooth muscle to cause
bronchodilation hence reversing the pathologic bronchoconstriction and wheeze. The late phase
includes the recruitment of polymorphonuclear lymphocytes that drive a chronic inflammation
leading to smooth muscle hypertrophy, deposition of collagen and mucosal gland hypertrophy
(Kumar, Abbas & Aster, 2015). This is termed airway remodeling.
Gastro-esophageal reflux disease
GERD is a condition characterized by the reflux of gastric contents into the esophagus
due to incompetent lower esophageal sphincters. The disease predisposes the patient to irritative
acidic contents of the stomach (Kumar, Abbas & Aster, 2015). Unlike the gastric mucosa, the
mucosa of the esophagus is stratified squamous epithelium which is not adapted to contact with
acidic contents (Kumar, Abbas & Aster, 2015). The reflux occurs when the lower esophageal
pressures are lower than the intragastric pressure such as in transient relaxation of the sphincter
or a hiatal hernia. Treatment modalities are aimed at preventing further reflux, preventing erosive
esophagitis and reducing other complications (Katz, Gerson, & Vela, 2013). The patient is on
omeprazole, a proton pump inhibitor which aids in symptomatic relief by controlling acid
production from gastric glands.
Depression.