Pharmacology: Multiple Medications for Mr. Smith's Case Study

This essay presents a detailed case study of Mr. Smith, a 76-year-old patient admitted to the hospital multiple times due to abdominal bleeding and complications from heart and lung diseases. The essay explores the various medications prescribed, including Amoxicillin, Movicol, Endone, Warfarin, and Heparin, analyzing their dosages, side effects, and the rationale behind their use. The essay also addresses the diagnostic procedures employed, such as CT scans and blood tests, to identify and manage Mr. Smith's conditions. It highlights the complexities of managing multiple medications, potential drug interactions, and the challenges posed by pre-existing conditions like asthma and COPD. The essay further discusses the importance of monitoring parameters like INR and the adjustments made to medication regimens to achieve therapeutic outcomes, such as preventing blood clotting and managing fluid buildup. The case study provides insights into the practical application of pharmacology principles in a complex clinical scenario, offering a comprehensive overview of Mr. Smith's treatment journey.

Running head: PHARMACOLOGY AND THERAPEUTICS 1
Pharmacology and Therapeutics
Student’s Name
University Affiliation

PHARMACOLOGY AND THERAPEUTICS 2
Introduction
This essay discusses the case of Mr. Smith, a 76-year old Caucasian who was admitted in
hospital two times on different accounts. During the first admission, the client had complained of
bruises around the naval region, but the physicist dismissed the claims saying that the condition
was normal for people on Warfarin (anticoagulant or blood thinner). The doctor assumed that the
patient had diverticulitis; a condition that occurs when pouches or the diverticula form on the
colon walls). A CT scan was done and showed that the patient had abdominal bleeding thus
calling for admission. In the following morning, MR. Smith found more bruises around the
abdomen extending to his back and was prescribed Heparin to prevent blood clotting.
On a different account; that is a week after the first admission, the client was readmitted
back in a local hospital on account that he had heart and lung diseases. These conditions manifest
in the first admission of the patient where it was noted that he had a history of Asthma and
chronic obstructive pulmonary disease (COPD). Following these conditions, a CT imaging was
done and showed fluids surrounding the lungs and heart. The previous history revealed that the
patient had aortic valve replacement and lung diseases. On the third day, the patient complained
of discomfort in the chest and throat, and Troponin levels indicated that he had a heart attack but
no heart damage. Ultimately, he was recommended other medication such as Frusemide and
Cephaxelin to eliminate the fluid build up in the lungs and heart. Specifically, this essay will
focus on the use of multiple medications for patients with heart and lung diseases and abdominal
bleeding. It will also focus on parameters for medication and tests dosage for different
medications, their side effects, precautions and diagnostics.

PHARMACOLOGY AND THERAPEUTICS 3
Bruises around the Naval Region
Bruises are discolouration or tenderness of the skin due to blood leakage as a result of
blood vessel injury (Garfinkel and Mangin, 2010). They are prevalent among the adults since
their skin, and blood vessels tend to become thinner with ageing and also due to increased use of
medications that affect the blood clotting agents. The use of asthma medications can lead to
increased bruising. According to Khan et al., (2012) anticoagulants or blood thinners,
particularly Warfarin and heparin can cause severe bruising. Bruising around the abdomen can
be an indication of internal bleeding. Although bruising is a minor issue that does not call for a
formal medical diagnosis, bruises in some parts of the body would require a number of blood
tests or a computed tomography (CT) scan if the region of the bruise is hard (Khan et al., 2012).
Eventually, the doctor dismisses Mr. Smiths’ complain of bruises around the naval region on the
account that he is on Warfarin medication. The formal results then showed that the patient had
abdominal bleeding. Lawrence et al., (2010) asserts that internal bleeding can cause shock, organ
failure or death. In cases where there is uncontrolled bleeding in the abdomen, the body may lose
a lot of RBCs thus hindering supply of oxygen in the body.
Diagnosis of Abdominal Bleeding
Diagnosis can be done by a gastroenterologist, a primary care officer or an emergency
room physician (Ng et al., 2013). If the abdominal bleeding is suspected, a doctor can conduct a
blood test or CT imaging to confirm the diagnosis. Laboratory tests are commonly used in
diagnosing internal bleeding. As Ng et al., (2013) asserts, a blood test is done to confirm
infection or blood count, where the test showing a high white blood cell count is an indication of
infection. The tests can also reveal the presence of anaemia or inflammation.

PHARMACOLOGY AND THERAPEUTICS 4
A CT scan is another commonly used method to diagnose abdominal bleeding.
According to the World Gastroenterology Organisation (WGO), the tomography scan offers
benefits of evaluating bowel and mesentery with a sensitivity of 67% to 97% and specificity of
76% to 100%. Computed tomography findings show bowel wall thickening, periodic fat
stranding, free fluid and an abscess (Robertson et al., 2014). Moreover, an inflamed pouch can
show overhead sign where an iodinated contrast represents an overhead configuration at the foot
of the inflamed pouch. The primary reason why the scan will show a thick bowel wall is that
when inflammation occurs, free air, as well as abscess formation will be present. However,
correct diagnosis of the bleeding ranges from 60 to 97% as per the facility evaluated. As of late,
a vast number of physicians order a CT scan over Barium enema, which is usually ordered when
the diagnosis from the CT scan is not conclusive (Walker and Harris et al., 2017). After
performing an abdominal CT scan from the patient, the result showed that Mr. Smith had an
internal bleeding and needed to be admitted. Earlier on, the doctor had suspected diverticulosis
and prescribed three medications; Amoxicillin 500mg, Movical to help with constipation, and
Endone 2.5 mg to relieve pain.
Medications for internal bleeding
1. Amoxicillin
This is an antibiotic used to treat bacterial infections. Doctors prescribe amoxicillin to
treat different infections such as urinary tract infection, lungs, stomach and skin infections. It is
important to finish a prescribed medication even if a person feels better in the course of taking
the drug. Although amoxicillin could interfere with some birth control pills for the women,
elderly adults like the case of Mr. Smith needs to take a lower dosage of the drug. Also using the

PHARMACOLOGY AND THERAPEUTICS 5
drug can be risky for certain conditions such diarrhoea and asthma. Although it is not mentioned
whether the patient is allergic to penicillin, it is vital to note that existing use of asthma
medications could control symptoms in asthmatic patients, and over continued use of antibiotics
like amoxicillin can lead to more problems with the development of drug-resistance bacteria
(Vonbach et al., 2007). Antibiotics like amoxicillin can cause signs such as loose stools and
frequent bowel movements. For the case of Mr. Smith, this condition is likely to prevail not only
because of diverticulitis but also due to continued use of asthmatic drugs like prednisone.
Dosage; A dose of amoxicillin depends on two things; how severe the infection is and
the type of disease a patient is having. The drug comes in tablets and capsules form. For the
adults, they should take the drug as prescribed by their doctor. A common dose of the drug for
adults with mild to moderate infection is 500mg/12hours or 250mg/8 hours until a prescription is
completed. For severe infections, a dose of 875mg/12 hours is recommended or 500mg/8hours.
Mr. Smith had been recommended an amoxicillin dosage of 500mg for five days
Side effects; According to Tolosana et al., (2009), some of the common side effects of
amoxicillin include diarrhoea, vomiting and stomach upset. Other side effects are chest pain,
difficulty in breathing, unusual bruising /bleeding, severe or bloody diarrhoea, severe rash e.t.c.
Mr Smith had a history of COPD, and Asthma which causes breathlessness and bleeding/bruises
hence this drug would have adverse effect on his condition.
2. Movicol
This is a laxative medication used to treat constipation in adults and the elderly
(Yachimski and Friedman, 2008). It is not recommended for persons under the age of 12 years.

PHARMACOLOGY AND THERAPEUTICS 6
The drug should not be taken by people with a blockage in the intestine, serious bowel
inflammatory diseases and perforated gut wall. When taking the medication, it is recommended
to take plenty of fluids. It is also important for the patient to inform a doctor of other medications
he might be using since not all drugs work effectively with Movicol.
Dosage; The drug can be taken anytime with/without food. The content of the sachet is
dissolved in 125 ml of fluid like water. For constipation, the medication is one to three times a
day depending on the severity of constipation. A dose of eight sachets of Movicol a day is the
recommended dose for treatment of faecal impaction. The sachets (each 13.8g) should be taken
within six hours up to three days if necessary. For the case heart condition, do not exceed two
sachets in one hour. This is witnessed in the case of Mr. Smith who is having heart attack hence;
he should stick to the recommended dose by the doctor.
Side effects; Allergic reactions that cause breathlessness and swelling of the throat face
and lips are common side effects of Movicol. Other allergic reactions may include mild
diarrhoea at the start of the dose, reddening of the skin, soreness of the anus and stomach ache.
These conditions get better when the amount of Movicol intake is reduced.
3. Endone
According to Skandarajah (2005), endone is a medication used to relieve pain. It is
prescribed by a pharmacologist or a doctor for long term or short term and in the case of Mr.
Smith, it is used to reduce the abdominal pain. Special care needs to be taken when on Endone
prescription because it is known to interact with ojther medications such as Movicol (for bowel
disorder), warfarin and Heparin (anticoagulants) and asthma/ COPD medications. The client
goes through a vast number of these conditions hence it would be advisable to inform the doctor
of current medications

PHARMACOLOGY AND THERAPEUTICS 7
Dosage; A pharmacology or doctor will recommend the right dose depending on nature
as well as the extent of the pain. The drug is taken orally where each tablet contains 5mg of
oxycodone hydrochloride, an ingredient used to relieve pain. The usual dose of Endone is 4 to 6
hours after meals. Robertson et al., (2014) holds that a doctor can adjust the dose depending on
the severity and nature of the pain as well as effectiveness of the drug. The drug takes up to 15
minutes to start working and can be effective for up to six hours. To relieve abdominal pain, Mr.
Smith is recommended 2.5 mg of Endone every 6 to 24 hours
Side effects; Endone has common and uncommon side effects. Some of the common
side effects include constipation (for the case of the client), urinary retention, dry mouth and
unusual tiredness or weakness. Other uncommon side effects of Endone include breathlessness,
restlessness, mood changes and muscle rigidity to mention just a few (Robertson etal., 2014).
Although the patient feels weak, breathlessness is common since he suffers from chronic
obstructive pulmonary disease
Medications for Abdominal Bleeding, Heart and Lung Diseases
After a CT scan of the abdomen was conducted, the results showed that Mr. Smith had
internal bleeding. A CT of the abdomen is a diagnostic imaging test used to detect diseases of the
large intestine, small bowel as well as other internal organs (Vonbach et al., 2007). The
following morning the client found that the bruises had extended to the back and the doctor
concluded that the INR was 5 despite the fact that he was on warfarin. Warfarin is an
anticoagulant that decreases the body’s ability to form clotting factors via blocking the formation
of vitamin k-dependent clotting factor (Vonbach et al., 2007). People on warfarin should have a
basic international normalised ratio (INR) of 2 to 3. Since the INR for the client was 5 which is

PHARMACOLOGY AND THERAPEUTICS 8
very high, the doctor reversed the warfarin with vitamin K injection to clot the blood since the
patient was bleeding excessively. Since it is hard to maintain a balance between the bleeding and
clotting, heparin was introduced and then Warfarin reintroduced back on different doses until the
INR became stable and the bleeding stopped.
Warfarin and Heparin
Warfarin is an oral anticoagulant which reduces the formation of blood clots in the
arteries or veins while Heparin is an alternative for warfarin only that it is administered
intravenously in dilution form (Garfinkel and Mangin, 2010). Since the patient had a history of
aortic valve replacement, it can be suggested that aorta had ruptured hence the need for an
anticoagulant. Warfarin should be taken by people with the bleeding disorder, blood in the stool,
stomach bleeding or infection in the stomach lining (Garfinkel and Mangin, 2010). This is
evident in the case where the patients had chest pain. Most importantly, the drug increases the
chances of blood clotting; hence it would be advisable not to take the medication for a person
who has a bleeding disorder, infections on the lining of the heart, stomach/intestinal bleeding.
These are some of the signs Mr. Smith had hence the reason the bleeding cloud not stop. Since
Warfin was not effective for the blood clot, the doctor opted for heparin and then reintroduced
warfarin back in different portions thus balancing the bleeding and formation of blood clot.
According to research, warfarin/Heparin can make a person bleed more especially if he/she has
bleeding disorders, severe heart disease, history of internal bleeding and for people aged 65 years
and over. (Lawrence et al., 2010) This shows that Mr. Smith was vulnerable of the bleeding.
Dosage; Warfarin should be taken as prescribed by the doctor. While taking the
medication, it is nice to have INR tests taken to measure how long the blood takes to clot. This

PHARMACOLOGY AND THERAPEUTICS 9
will help a doctor prescribe the best dose. The initial dose for adults is 2 to 5 mg once a day and
then adjusts the dose as per the results of the INR. The doctor should dictate the dosage. On the
other hand, heparin is introduced intravenously after dilution. The dosage of heparin needs to be
adjusted following the patient INR results (Ng et al., 2013). The dosage is considered adequate
when the activated partial thromboplastin time is either 1.5 or 2.0 times normal.
Side effects; the most severe side effects of warfarin are bleeding. Signs and symptoms
of bleeding include bruising, trouble breathing, blood in the spit and abdominal or stomach pain.
According to research, such medication can affect a person’s clotting factors hence the risk of
continued bleeding. Haemorrhage is a complication that can result from heparin infusion.
Hypersensitivity accompanied by fever and chills is another heparin side effect that might
manifest over the continued use of heparin (Ng et al., 2013).
Clexane 40mg sub cut injections; this is an anticoagulant made to prevent blood clot
especially in the legs. It goes hand in hand with warfarin to prevent blood clots. Some of the
common side effects of clexane injections include back pain, fast heart beat, bleeding at the
injections sites and dizziness to mention just a few. For the dosage, Mr. Smith was receiving
clexane sub cut injections twice a week following the discharge from hospital.
Another drug that was prescribed to the patient is aspirin. This is a drug used to reduce
fever /inflammation and treat pain. At times, it can be used to prevent cardiac arrest, angina and
strokes. Some of the side effects of include mild headache, drowsiness and heartburn. The
patient was prescribed this medication to prevent such complications.
On the second admission in a local hospital, Mr. Smith complained of difficulties in
breathing and Felt weak. It should be noted that the client had a previous history of lung diseases
(COPD and asthma) and aortic valve replacement. After a CT scan, it was found that fluid was

PHARMACOLOGY AND THERAPEUTICS 10
surrounding his lungs and heart and prescribed Frusemide. After the client was admitted to a
coronary care unit, no signs of heart damage were found hence more emphasis was put on the
lungs. Frusemide was prescribed to treat fluid build up in the lungs and cephalexin for infections.
Frusemide or Furosemide is a diuretic drug that can be used to treat different conditions such as
hypertension, Edema (build up of fluids in the lungs) and kidney diseases (Lawrence et al.,
2013). The drug causes severe effects such as diarrhoea, constipation, vertigo and blurred vision.
The dosage of the medication ranges from 10mg to 80mg three times a day. The dosage is
dependent on the severity of the disease. From the case study, the patient is prescribed 40gm to
treat edema.
Ultimately, the patient was prescribed cephalexin to help fight bacteria in the body, and
after adhering to the prescribed medication, the patient’s condition started to improve, and on the
13th day after the second admission, the patient was discharged from the hospital.
Conclusion
Abdominal bleeding is a condition that calls for quick and thorough medication.
Although the condition has adverse complications which may call for surgery, it is advisable to
adhere to a prescribed dosage for quick treatment. For patients who are on medications or had a
history of certain illnesses or condition, it is vital for them to notify their doctor on the current
medication they are using to prevent reaction with other drugs which may end up worsening the
condition of a disease instead of bringing an end to the illness. Also, it should be noted that body
system reacts differently to different medications; hence it is essential to be aware of the
alternatives and also have knowledge of how drugs react to each other.

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