Drug and Integrated Pharmacology: Case Study Analysis and Evaluation

This document presents a detailed analysis of a drug pharmacology case study, addressing various aspects of medication use and patient care. The assignment begins by exploring the pathophysiology, aetiology, and symptoms of tension headaches and migraines, setting the stage for a discussion of relevant medications. The solution then delves into the mechanisms of action, recommended dosages, and therapeutic uses of paracetamol, codeine, and Nurofen plus, including considerations for a specific patient case. It also examines over-the-counter medication safety, community concerns, and potential side effects. Further, it suggests natural medication and lifestyle changes for managing tension headaches, including dietary recommendations and physical therapies. The assignment also covers the mechanisms of action, routes of administration, safety considerations, and side effects of corticosteroids. A section on pharmacodynamics and drug interactions of Tramadol, Valium, and Efexor is also included. The document also addresses the use of these drugs during pregnancy, highlighting potential risks and precautions. Finally, it provides a drug monograph template for Prednisolone, covering its therapeutic uses, mechanism of action, side effects, warnings, pharmacokinetics, and drug interactions. The assignment integrates clinical knowledge, research methods, and evidence-based practices to provide a comprehensive overview of drug pharmacology and patient management.

Running head: DRUG PHARMACOLOGY
DRUG PHARMACOLOGY
Name of Student:
Name of University:
Author’s Note:

1DRUG PHARMACOLOGY
Answer no 1.
Illness Pathophysiology Aetiology Symptoms
Tension headache From the study of Bajwa
and Wootten (2017), it
was noted that tension
headache has muscular
origination. The pain
often tends to be dull
and, which lie on the
pathophysiology of the
transmission of signal
and impulse to the brain.
When there is an
increase in the excitation
of the central nervous
system, which is
stimulated by the
repetitive and input of
Pericranial Myofascial,
which leads to the
transformation of the
acute headache to the
chronic form. It is
1. Consumption
of alcohol
2. Dry eyes
3. Stress
4. Smoking
5. Poor posture
6. Tension and
anxiety
7. Hunger
1. Dull and
poor head
pain
2. Tightness
in the
forehead
or back of
the head.
3. Tenderness
on the
shoulder
and neck
(Gaul et
al., 2017).

2DRUG PHARMACOLOGY
evident from the
research that nitric oxide
and donor of it called
Glyceryl trinitrate is the
local mediator of tension
headache where it sends
the sensory transmission
to CNS and induces
strong headache.
Migraines The pathophysiology of
migraine is linked with
the pain generating
structure within
cranium. The genetic,
hormonal and
neurochemical factors
cause deregulation of
excitability of cortical
and brain where cortical
gets activated, which is
linked with activation of
nociceptive. There is a
release of
 Environmental
factors:
1. Drinking
alcohol
2. Stress
3. Lack of sleep
4. Change in
weather.
5. Sensory
impulses like
bright lights
and sun glare
 Hormonal
changes (Peres
1. Severe
head pain
usually at
one side
of the
head and
eye region
2. Nausea
3. Vomiting
(Burstein,
Noseda &
Borsook,
2015).

3DRUG PHARMACOLOGY
neurotransmitters, which
leads to central
sensitisation which then
spread via a trigeminal
pathway to the brain
stem causing an increase
in pain perception which
is regarded as migraine
(Goadsby et al., 2017).
et al., 2017).
Answer no 2.
Paracetamol:
Terms Migraine Tension headache
Mechanism of action Paracetamol is known to
have a negative effect on
the production of
prostaglandin as it tends to
inhibit the production of
prostaglandin when there is
a low level of Arachidonic
acid causing the resistance
of pain impulse (Mallet,
Eschalier & Daulhac,
It blocks the pathway of
nitric oxide, where the
sensory impulse is
transmitted to CNS
(Bhagyashree et al., 2017).

4DRUG PHARMACOLOGY
2017).
Recommend dosage An adult over 50 kg-
1000mg three times per
day
An adult over 50 kg- 500g
three time per day
Codeine
Terms Migraine Tension headache
Mechanism of action It binds with the opioid
receptors in the brain and
causes blockage of pain
signal transmission to the
brain (Tong & Atkinson,
2017).
The mechanism of action
of codeine is same in every
kind of headache
(Peechakara & Gupta,
2018).
Recommend dosage 15-60 mg in every 4 to 6
hours
15-40 mg in every 4 to 6
hours
Answer no 3.
Nurofen plus contains two most active ingredients which include Ibuprofen and Codeine
Phosphate. The two of them belongs to the non-steroidal anti-inflammatory drugs and opioid
analgesic, respectively. Hence, they are effective and appropriate for treating the pain of tension,
headache and migraine (Waldock, 2017).

5DRUG PHARMACOLOGY
Reviewing the case study of Melanie, it can be said that it is suitable for her to treat her
head pain. Those following facts can validate it. Firstly, she is an adult person of 37 years of age,
so there is the least chance of any metabolic changes in her body. Second, she is not a pregnant
woman as it is stated by Price and Collier (2017) that Nurofen plus should be taken by pregnant
and breastfeeding women. Thirdly, she is not allergic to NSAIDs. Fourthly, she is not having any
of the medical condition like liver, kidney or heart disease.
Answer no 4.
Over the counter medication of NSAID is given without the prescription by the doctors.
These drugs are known to reduce inflammations and pain. They are effective and work quickly in
relieving pain. However, before purchasing the medicine, people should be aware of its potential
side effects and its interaction with other drugs. It is necessary for the people to evaluate the
conditions in which such drugs should not be taken. They should be aware of the situation in
which it can cause a side effect on the body.
Additionally, for taking NSAIDs, the accurate and recommend dosage is very important
to be known by the people. People should be aware of its dosage and time in which medication
should be taken. People need to apply safety consideration regarding the availability of NSAIDs
OTC (Moore, Pollack & Butkerait, 2015). One of the specific community safety concern related
to the use of Nurofen plus formulation is its size of the dosage. The primary reason is that it
constitutes both NSAIDs and opioid formulation. Hence, it is hard to determine its recommended
and appropriate dose size. It is the community safety concern as an overdose of such medication
can cause stomach problems, vomiting, gastric irritation, laboured breathing and drowsiness
(Van Hout & Norman, 2016).

6DRUG PHARMACOLOGY
Answer no 5.
As the neuropathy, I would suggest some natural medication for Melanie for the
management of her ongoing tension headache. I would recommend her to avoid the following
foods which are potent to cause migraine and headache:
 Cow milk
 Egg
 Chocolate
 Cheese
 Tomato
 Benzoic acid
I will suggest her following nutritional supplement to get relief from migraine:
 Wobenzyme
 Magnesium citrate
 Vitamin B6
 5 hydroxytryptophan (Roth, 2016).
I would suggest her to follow physical medicine for treating her migraine and tension
headache, which are outlined below:
 I would instruct her to submerge her feet in hot water followed by the ice massage to the
back of the neck.
 Acupressure should be taken

7DRUG PHARMACOLOGY
 For prevention of headache, chiropractic adjustment and spinal alignment will be
effective.
Additionally, I will also recommend her biofeedback therapy and intravenous magnesium
for low-grade magnesium deficiencies (Papadopoulos, 2017).
Answer no 6.
Mechanism of action Corticosteroid binds with the cytosolic glucocorticoid
receptor and activates various gene and inflammatory
transcription factors. It in turn, cause suppression of
inflammatory gene expression known as transrepression.
Additionally, it is also known to induce the expression of
the anti-inflammatory gene (Wang et al., 2015).
Routes of administration Oral and intramuscular injection (Lowe et al., 2017).
Consideration around safety Taking corticosteroid in overdose form may cause
cloudiness of the lens of eyes.
Diabetic patient need to avoid intake of corticosteroid
Taking more than prescribed dosage can cause skin
infection, slower the healing of wound and muscle
weakness, hence, the right dose is very important (Tan et
al., 2016).
Side effects  Mood swings
 Blurred vision
 Bruising

8DRUG PHARMACOLOGY
 Weight gain and loss
Complication Administration of corticosteroid in inflammatory
disorder if taken for more extended time disrupt the
metabolism and create complication of pain signal and
stomach issue (Dominguez, Tibbetts & Simpson, 2017).
Answer no 7.
Medicines Pharmacodynamics
Tramadol Tramadol blocks the pain pathway at a spinal
level as it inhibits the release of
neurotransmitter towards the transmission of
pain in CNS. It blocks potassium channels
and assumed to increase the activity of the
endogenous inhibitory control (Vazzana et al.,
2015).
Valium It is benzodiazepine that causes an anxiolytic
and amnestic effect. Such an effect is caused
by the action of gamma-aminobutyric acid in
the central nervous system, which is an
inhibitory neurotransmitter. It bound to the
receptor in the brain and spinal cord and

9DRUG PHARMACOLOGY
control the symptoms (Bond & Lader, 2016).
Efexor It has antidepressant effects as it inhibits the
reuptake of norepinephrine, dopamine and
serotonin with potency more for the 5-HT.
Thus, they are related to control anxiety and
lower the stress level (Magalhães et al.,
2015).
Interaction of Valium and Efexor has high potential as they both are associated with the
transmission of neurotransmitter. It causes dizziness, drowsiness, confusion and problem in
concentrating. It is often recommended to avoid drinking alcohol when a person is taking such
medication (Smith, 2016).
The interaction of Valium and tramadol may cause depression of the central nervous
system. In association with this, it also leads to distress or even a person can go to coma. Both
medicines has a different formulation which interferes with the signal transmission of the central
nervous system. It is often recommended to avoid drinking alcohol while taking such medication
(Miotto et al., 2017).
Answer no 8.
Tramadol
During pregnancy in women, there are many hormonal changes which can lead to a
variety of physiological pains due to which they opt to take a painkiller. Tramadol being an

10DRUG PHARMACOLOGY
opioid drug is addictive in nature , so it should be used with cautions during pregnancy. It is
evident from the research that the uses of tramadol during pregnancy cause health risk to both
mother and unborn baby. FDA categorizes tramadol under category C, which reflects that there
is limited data to assess the safety of the drug during pregnancy (Källén & Reis, 2015). Hence, if
Melanie was to fall pregnant, she should consult her physician before taking tramadol
medication.
Valium
From the study of Akinadenekan et al. (2015), it is evident that consumption of valium
during pregnancy causes teratogenesis, decrease the incidence of pregnancy and even death of
the foetus. Therefore, if Melanie was to fall pregnant, she should be apprised of the harm that can
cause to the foetus. She should be monitored for any irregularities in heart rate of the growing
foetus, any sign of respiratory depression and hypothermia. For precaution, she should stop
taking valium before being pregnant.
Efexor
It is evident from the research that, venlafaxine takes almost two days to get expelled
from the body. Hence Melanie needs to stop consuming Eflexor before being pregnant.
However, if she continues to take medicine, there is a high chance of miscarriage or premature
delivery (Kirsch et al., 2019). Melanie need to visit the doctor when there is any sign of
complication.
Answer no 9.
Drug monograph template
Drug name: Prednisolone Brand name: Prelone

11DRUG PHARMACOLOGY
Therapeutic uses/ indication
It is a synthetic drug which is naturally produced by the adrenal gland. It is the potent
anti-inflammatory and immunosuppressive agent. It is known to be used to treat the condition
of arthritis, a disorder of the immune system, breathing issues, blood problems and various
allergic reaction. It lowers the immune system response to illness in order to reduce pains and
to swell (Hosseini et al., 2016).
Mechanism of action
Prednisolone is glucocorticoid which inhibits infiltration of leukocyte at the site of
inflammation and interferes with humoral immune response. Such action involves
phospholipase A2 which limit the secretion of an inflammatory mediator like leukotrienes and
prostaglandin. The drug reduces the dilation of capillary and accumulation of leukocytes and
WBC. It also works as an agonist of glucocorticoid receptor and binds with the GRE where it
can repress the expression of the inflammatory gene, in addition with suppression of IL2
(Vandewalle et al., 2018).
Side effects
 Nausea
 Headache
 Irregular menstrual period
 Insomnia
 Sweating
 Acne
 Dizziness