Press "Enter" to skip to content

Community –acquired pneumonia

Case: A 65-old female is diagnosed in the clinic with community-acquired pneumonia, and the plan is to begin a course of levofloxacin (Levaquin) 500 mg PO every day for 14 days. In deciding how to instruct her to take the Levaquin, her other health problems and medications requires consideration.

            Pneumonia is a leading cause of death from infections among the elderly and hospitalized persons. The diagnosis has a basis on the history, physical outcomes, and the chest X-ray S. Pneumoniae. It accounts for nearly half of community-acquired pneumonia as a result of bacteria.

The use of fluoroquinolones in the treatment of infections

            Fluoroquinolones drug are useful for the treatment of both complicated and uncomplicated skin and skin structure infections. Their general characteristics are being broad spectrum, with rapid bactericidal activity, have extensive tissue ***********, excellent bioavailability and ease of administration. Thus, the drugs are the best choice for many infectious diseases and skin infections. Research reveals that fluoroquinolones are effective for use as beta-lactam antibiotics in the management of several diseases. Among them are erysipelas, cellulitis, impetigo, surgical wounds and diabetic foot infections. The widespread use of the drugs is a major contributor to the resistance that continues to increase among the staphylococci, streptococci, Enterobacteriaceae and other essential Gram-negative bacilli. Many fluoroquinolone drugs are available for clinical use, and others are under development. The drugs treat infections in different body areas (Stahlmann & Lode, 2013).

            The drugs **** bacteria and hinder their growth in the areas administered. The major body parts in which fluoroquinolone drugs have a treatment effect are bone and joint, skin, and urinary tract infections, inflammation of the prostate, and chronic ear infections. The diseases treated using the drugs are bronchitis, pneumonia, tuberculosis, some STDS, and common infections that affect people with AIDS. The drugs can take the form of tablets or injectable forms. The common examples of the fluoroquinolones are Moxifloxacin, ciprofloxacin, ofloxacin, levofloxacin, lomefloxacin, and sparfloxacin among others (Stahlmann & Lode, 2013).

            The use of fluoroquinolones in treating infections requires strict observance of the recommended dosage to avoid their adverse effects. The dosage depends on the strength, the nature of infection, and type of the drug. Patients require using the drugs in their correct prescription to help in killing the bacteria or stopping their growth. The major precaution for the use of fluoroquinolones is that their abuse may lead to the development of drug-resistant strains of the bacteria. The overuse of the drugs is likely to reduce their effectiveness in the treatment of typhoid fever, and hospital-acquired pneumonia. The drugs also have side effects, and users should be aware of them.

            From the case presented, the 65-old female has community-acquired pneumonia and the physician prescribed levofloxacin (Levaquin) for two weeks. However, the patient also has other health problems that have their medications. They are Gerd, Osteoporosis, Dyslipidemia, and hypothyroidism.

Gastroesophageal Reflux Disease (GERD)

            It is a digestive disorder affecting the lower esophageal sphincter. The health problem makes people suffer from heartburn and acid indigestion. The heartburn can have relief through the use of diet and lifestyle change though some people require surgery and medication. The serious digestive disease takes place when the stomach acid and some stomach content flow back to the esophagus. The occurrence causes irritation to the lining of the food pipe causing GERD. A normal lower esophageal sphincter (LES) should open to allow the passage of food to the gut and close to prevent it flowing back. However, if it’s weak or has inappropriate relaxation; the contents of the stomach may flow back to the esophagus. The common symptoms in adults are heartburns and regurgitation. At present, the effective diagnostic method is esophageal PH monitoring. The common medications in use for the condition are proton pump inhibitors (PPIs) like omeprazole and H2 receptor blockers (Roberts, Aravapalli, Pohl, Freeman & Castell, 2012).

Osteoporosis

            Osteoporosis is a skeletal disorder having the characteristic of low bone strength due to the high rate of fractures. In adults, the daily removal of small quantities of bone mineral through resorption requires balancing by an equal deposition of new mineral. However, due to old age and other related factors, deposition of the new materials is slow. The understanding of the regulation of the bone remodeling is essential for prevention and treatment of osteoporosis. There are three major pathogenetic mechanisms linked to the disorder. They include; the failure of having optimum strength in the skeleton during growth, excessive bone resorption, and failure of replacing the lost bone. Calcium deficiency to the elderly is a major cause of osteoporosis. The medical management of osteoporosis involves the administration of calcium, Vitamin D, and other anti-osteoporotic medication. However, the preventive measures include the modifying the lifestyle factors and increasing calcium and Vitamin D intake (Raisz, 2005).

Dyslipidemia

            Dyslipidemia is a health problem involving the increase of the levels of plasma cholesterol, triglycerides (TGs) or having a low high-density lipoprotein level. The causes can be primary or secondary, and diagnosis involves the measurement of plasma levels. The common methods of treatment involve dietary changes, exercise, and the use of lipid-lowering drugs. The causes of dyslipidemia include the use of excessive intake of saturated fat, cholesterol, and the abnormalities of lipid metabolism. The mode of treatment depends on the particular lipid abnormality and requires having a lifestyle change, treatment of hypertension, and diabetes, smoking cessation. The high levels of TGs cause acute pancreatitis. Dyslipidemia disease has no known symptoms but has associated symptomatic vascular disease, coronary artery problems, ******, and other arterial diseases.

Hypothyroidism

            Hypothyroidism is an endocrine disorder that results from a deficiency of the thyroid hormone. In the United States, autoimmune thyroid disease is the major cause of hypothyroidism. The disease can be primary, secondary, or tertiary depending on the cause. The primary disease involves the failure of hormone release. The secondary disease entails the defective TSH signaling from the pituitary, and the tertiary occurs when the hypothalamus does not stimulate the thyroid hormone. The diagnosis depends on the laboratory testing for the thyroid-stimulating hormone (TSH). The major method of treatment is administering the thyroxine. The use of thyroxine for its treatment is effective, but there are differences in activity, stability, and bioavailability between different types of the drug. The disease can also be as a result of various drugs like the amiodarone, interferon, and lithium. Some anticancer drugs also may cause hypothyroidism. There are some clinical manifestations associated with hypothyroidism like congestive heart failure, intestinal obstruction, and coagulation disorders. The disease affects more women than men especially after the age of 50 (Carson, 2009).

Drug classifications

            The woman has a prescription of Levofloxacin for the treatment of community-acquired pneumonia. The drug falls under the classification of fluoroquinolones that help in the treatment of infections. The MOA of levofloxacin and other fluoroquinolones involves the inhibition of the bacterial topoisomerase IV and the DNA gyrase. In the process, it interferes with the bacterial DNA replication, transcription, repair, and recombination. The drug gets rapid absorption after oral taking. It takes one to two hours to attain the peak plasma concentrations. The pharmacokinetics of levofloxacin is linear and predictable. The major goal of using the drug is to **** the bacteria or halt the progression of their infection on the affected areas (Hurst, Lamb, Scott & Figgitt, 2012).

            The major side effects of the use of the drug are nausea and vomiting, diarrhea, headache, and constipation. Other users may experience insomnia, dizziness, abdominal pains, itching, and vaginal discharge.

            For a patient to get maximal benefit from the use of levofloxacin, they require taking the recommended dosage of 250-750 mg taken once daily for 5-60 days depending on the infection. The patient should not take more of it, more frequent, or for an extended period of the prescription. Another practice is taking it one hour before the meals, or two hours after the meal. It requires a full glass of water and additional glasses taken daily. The patient should also practice taking the drug the same time daily to ensure even distribution intervals (Langtry & Lamb, 2008).

            Esomeprazole falls under the classification of proton pump inhibitors. The drug suppresses the gastric acid secretion by specific inhibition of the Hydrogen and Potassium ion-AT Pase in the gastric parietal cell. The proton pump is the stage for gastric acid secretion and responsible for the secretion of the hydrogen ions. The proton pump inhibitors are in an inactive form and ********* t o the acidic environments. It then protonates and rearranges into the active form. The active form binds to the gastric proton pump thereby deactivating it. The major side effects of the use of esomeprazole are a headache, diarrhea, and abdominal pain. The patient taking the drug should adhere to the doctor’s prescription and follow the correct dosage. The medication requires taking at least one hour before a meal. Also, the patient should swallow the capsules whole without chewing or crushing. If she misses a dose, she can take it but not near the scheduled time for next dose since it becomes a double dose (Weintraub, 2013).

            Sucralfate drugs fall under Carafate drugs used in the treatment of active duodenal ulcers, and GERD. Sucralfate causes an ulcer-adherent complex with proteinaceous exudates like albumin and fibrinogen. The actions occur at the ulcer site thereby protecting it from further acid attack. The drug binds the bile salts from the liver thus protecting the injury of the stomach lining. The major side effects of sucralfate drugs are allergic reactions like hives, difficulty in breathing, swelling of the face, lips, and throat. Other lesser side effects are nausea, vomiting, stomach pains, skin rash, drowsiness, and insomnia. For maximal benefits from the drug, the patient should take the medicine on an empty stomach at least 60 minutes prior to a meal or two hours after the meal. The patient should also avoid taking other medication two hours before or after taking sucralfate. She should also take it for the full prescription.

            Alendronate falls under the classification of bisphosphonates. The mode of action involves the inhibition of osteoclastic bone resorption. The drug attaches to the hydroxyapatite binding sites on the surface of the bone.  The osteoclasts begin to resorb the bone having the bisphosphonate and the bisphosphonate released in the resorption hinders the ability of osteoclasts to act on the bony surface. Alendronate drug reduces the osteoclast activity thereby hindering the progression of osteoporosis. The common side effects include abdominal pains, heartburn, muscle pains, and irritation. However, some of the side effects do not require medical attention. The patient should use the medication as prescribed by the doctor and should consult the health care provider of any occurrences. The tablets require swallowing with a full glass of water and should be after getting out of bed in the morning. The patient should take it whole and after taking should not eat, drink, or take other medications within half an hour (Drake, Clarke, Khosla, 2008)

            Citracal drugs have a vitamin and mineral that acts as a calcium supplement in the reduction of osteoporosis. The mode of action involves the moderation of the nerve and muscle performance through the process of action potential excitation threshold regulation. The major use of the drugs is to prevent low blood calcium levels and treatment of osteoporosis. The major side effects of taking citracal drugs are tooth staining, increased urination, uneven heart rate, and muscle weakness (Carne, 2015).

            For maximal benefit, the patient should not take the medicine with milk, and other dairy products, calcium supplements or antacids with calcium.

            Atorvastatin falls under statins and helps to lower the level of cholesterol in the blood. The mode of action involves the prevention of the production of cholesterol in the liver by blocking reductase. Statins reduce total cholesterol thereby reversing Dyslipidemia. The major side effects of the drugs are muscle pains, weakness, memory problems, tiredness, weight gain, and dark colored ***** among others. For maximal benefits, the patient should use the drug with diet, and weight loss mechanisms to suppress the risk of heart attack and ******. The patient should also follow the given prescription.

            Levothyroxine drugs help in the treatment of hypothyroidism by suppressing the thyroid hormone release from thyroid nodules hindering the growth of goiter.  The mechanism of action involves working as the endogenous thyroid hormone thyroxine (T4). In the liver, conversion of T4 to T3 occurs leading to the active metabolite. The thyroid hormones attach to the binding proteins, thyroxin-binding globulin, and transthyretin. Next are the transport and binding of the thyroid hormone receptors in the cytoplasm and nucleus. The replacement of the natural thyroxine relieves the symptoms of thyroxine deficiency (Carson, 2009).

            The use of levothyroxine therapy has a good tolerance, but symptoms may occur due to toxic levels of the thyroid hormone. Hair loss may occur temporarily for the first few months. Other adverse effects are irregular heartbeat, chest pain, leg cramps, and headache. The patient should take the drugs on an empty stomach at least 30 minutes before taking breakfast. The patient should not take the drugs within four hours of taking calcium and iron supplements and antacids (Carson, 2009).

            The medications described have effects on a course of therapy with Levaquin. The use of Levaquin with proton pump inhibitor produces a synergy effect leading to effective eradication of the infection. Taking bisphosphates together with antibiotics is likely to decrease the amount of antibiotic absorbed. Thus, patients should take Levaquin 4 to 6 hours after the calcium supplements. There is a high possibility of the thyroid hormone replacement drug like levothyroxine to interact with quinolone antibiotics. The interaction affects the absorption of the thyroid drugs. Thus, the patient may become more hypothyroid (Holtorf Medical Group, 2015).

            It is essential for the patient to adhere to the daily schedule to ensure maximal benefit from the drugs and avoid adverse interactions. The time schedule helps the patient observe the prescription as required and have minimal instances of adverse effects from the drugs. Levothyroxine and levofloxacin should have 4-6-hour intervals.

The table below shows the schedule for the first week that should be similar to the second week of the Levaquin therapy to other medication.

Medication Time Frequency
Levofloxacin 12:00 Noon Daily up to  14 days
Esomeprazole 11: 00 am and I hour before meals Daily
Sucralfate 5: 30 am and 5: 30 pm on empty stomach Twice daily
Alendronate 6: 00 am in the morning after waking up Once a week (Any preferred day)
Citracal 2: 00 PM Daily
Atorvastatin 1: 00 pm with diet Daily
Levothyroxine 6: 00 am before breakfast Daily

Bibliography

Bone metabolism, osteoporosis. (2015). Clinical Chemistry & Laboratory Medicine, 53s435-         s451. doi:10.1515/cclm-2015-5011

Carne, K. (2015). Osteoporosis and fractures: diagnosis and management. Practice Nurse, 45(5), 42-46.

Carson, M. (2009). Assessment and management of patients with hypothyroidism. Nursing           Standard, 23(18), 48-56.

Drake MT, Clarke BL, Khosla S.  (2008) Bisphosphonates: mechanism of action and role in          clinical practice. Mayo Clin Proc; 83:1032

Holtorf Medical Group (2015) Thyroid Drugs and Antibiotics: A Warning,

Hurst, M., Lamb, H., Scott, L., & Figgitt, D. (2012). Levofloxacin: An Updated Review of Its       Use in the Treatment of Bacterial Infections. Drugs, 62(14), 2127-2167.

Langtry, H., & Lamb, H. (2008). Levofloxacin: Its Use in Infections of the Respiratory Tract,      Skin, Soft Tissues and Urinary Tract. Drugs, 56(3), 487-515.

Raisz, L. G. (2005). Pathogenesis of osteoporosis: concepts, conflicts, and prospects. Journal of   Clinical Investigation, 115(12), 3318–3325. doi:10.1172/JCI27071

Roberts, J. R., Aravapalli, A., Pohl, D., Freeman, J., & Castell, D. O. (2012). Extraesophageal       gastroesophageal reflux disease (GERD) symptoms are not more frequently associated          with proximal esophageal reflux than typical GERD symptoms. Diseases Of The    Esophagus, 25(8), 678-681. doi:10.1111/j.1442-2050.2011.01305.x

Stahlmann, R., & Lode, H. (2013). Fluoroquinolones in the Elderly: Safety Considerations.          Drugs & Aging, 20(4), 289-302.

Weintraub, H. (2013). Update on marine omega-3 fatty acids: Management of dyslipidemia and   current omega-3 treatment options. Atherosclerosis (00219150), 230(2), 381-389.      doi:10.1016/j.atherosclerosis.2013.07.041

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in custom essay paper writing if you need a similar paper you can place your order from custom research paper services.

Be First to Comment

Leave a Reply