Clinical Case Of Recovery Pharmacology

Clinical Case of Recovery Pharmacology

Pharmacokinetic parameters:

Omeprazole is absorbed orally. The maximum plasma concentration appears at 30 minutes if administered in suspension and in 1 or 3 hours if it is in the form of capsules or tablets. It can also be administered intravenously. It binds to plasma proteins in 95% and its half -life is short, around 1 hour, although its antisecretor effect is maintained for 2 or 3 days. They suffer liver biotransformation, giving active metabolites, through cytochrome P450. Finally, they are eliminated by urine by 80% and by feces by 20%.

Alprazolam is a benzodiazepine of intermediate action so, administering orally, it will be maximum in plasma in less than 2 hours. His half -life varies between 6 and 20 hours. It presents a distribution volume of 0.6-0.8 l / kg. It binds to plasma proteins by 70% and has a bioavailability of 80% in addition to a liposolubility of 0.54 so it can cross the placental barrier and reach breast milk. It is metabolized in the liver and is mainly eliminated by urine inactively. Its elimination semi -surrounding is around 12 – 15 hours. 

The effect of salmeterol appears in 1 or 2 hours from its administration and can last up to 12 hours. It is preferably administered by inhaled, although there are also prepared for oral or parenteral route. Inhaled, only 5-20% of the dose reaches the distal and oral bronchi, only 10%. It reaches systemic circulation in small quantity and binds to plasma proteins in 94-98% regardless of the route of administration.

It presents liver and renal metabolism and is excreted through feces and urine. It crosses hematoencephalic and placental barriers. 

Dexamethasone is rapidly absorbed orally, although it can be administered by many other routes such as intravenous, intramuscular, intra -articular, intralesional, inhaled, nasal, topical … Topic … A 70% plasma proteins are 70%. It suffers liver biotransformation and inactive metabolites are eliminated by urine with a removal of approximately 3.5 hours elimination. It crosses the placental barrier and reaches breast milk, being its distribution volume of 2 l / kg. 

Clindamycin can be administered parenterally. It joins more than 90% to plasma proteins and is distributed wide and quickly, including bone tissue, but does not reach the CSF in sufficient concentrations to have therapeutic action. It crosses the placental barrier and is excreted by milk. It disappears from plasma quickly, being its 6 -minute biological semivide, although its plasma removal of elimination is 3 hours. It suffers liver biotransformation, giving rise to active and inactive metabolites. 

Paracetamol has rapid absorption orally and a bioavailability of 75-85%. The maximum plasma concentration is reached between 30 minutes to 2 hours and its hard action between 3 to 4 hours. It joins plasma proteins by 10-20%. It crosses the hematoencephalic and placental barrier. It presents a mainly liver metabolism by conjugation with glucuronic and N-acetylcysteine. It is eliminated by urine in a metabolized form being its elimination semi -removida of 1.5 to 3 hours. 

Methylprednisolone can administer orally or parenterally. Its oral bioavailability is around 80%, reaching the maximum concentration in 90 minutes. It has a distribution volume of 1.2-1.5 l / kg, so it diffuses well throughout the body, even reaching the fetus and breast milk. Binds to albumin 62%. It presents a liver metabolism and is eliminated by urine having a total clearance of 4-8 ml / min / kg. Its elimination semi -surrounding is around 4 and 8 am.

Drapping has good absorption orally, appearing the effect at 15 or 30 and finding the highest concentrations at 3 hours. Its bioavailability is reduced to 50% due to the phenomenon of the first hepatic step it presents. It is widely distributed by the tissues, but being an antihistamine of 3rd generation does not cross the blood brain barrier. Its elimination semivid is 27 hours and binds to plasma proteins between 83-87%. Is eliminated by feces and urine. 

Cephalosporins can be administered orally or parenterally depending on each. They are distributed throughout the organism, being in the synovial fluid, the pericardial fluid, in the placenta and in high concentrations, at the ocular level. It does not cross the blood brain barrier. They metabolize in the liver and all are excreted by the kidney.

Clindamycin administration can be intravenously or intramuscularly.

Intravenously, it must be previously diluted and administered in intermittent perfusion, in a time not less than 10 minutes and up to 1 hour. The concentration of the drug in the solution should not exceed 12 mg/ml. It is not recommended to administer more than 1200 mg in a single infusion. Alternatively, we must know that we can administer a first dose in the form of rapid infusion (10 minutes) followed by continuous infusion to maintain serum levels.

For dilution, we must use compatible intravenous solutions such as 5% dextrose, 0.9% sodium chloride or ringer lactate.

Intramuscularly, an administration of more than 600 mg is not recommended in a single injection.The dose that should be administered would be around 1.2 and 1.8 g/day fractional in 3 or 4 shots for moderate infections and between 2.4 to 2.7 g/day for serious infections. Clindamycin must be administered with caution and determine during treatment any sign of hypersensitivity or gastrointestinal symptom. It must also be taken into account that this drug is incompatible with ampicillin, sodium phenytine, barbiturates, aminophiline, calcium gluconate and magnetic sulfate. 

Other adverse reactions, apart from hypersensitivity, which may appear due to clindamycin treatment are especially of the gastrointestinal type, such as pseudomembranous colitis or a common gastrointestinal syndrome (including diarrhea, nausea, vomiting, abdominal pain, flatulence …). We can also find blood alterations (neutropenia, eosinophilia, agranulocytosis, thrombocytopenia …), increased transaminases, neuromuscular blockages, thrombophlebitis, etc.

All described adverse reactions are presented rarely or frequently not known, except diarrhea, which is more common in clindamycin treatment. 

The 4th generation cephalosporin that would be indicated in the case of Alberto is the Cephepima.

This antibiotic is sensitive to many microorganisms causing pneumonia, such as the Staphylococcus aureus, Pseudomra aeruginosa, pneumococcus, streptococcus, haemophilus influenzae, etc. Therefore, it would be indicated in this case, in addition, it is very stable in front of beta -lactamases and has a broader action spectrum than 3rd generation cephalosporins.

The Cephepima, acts by inhibiting the synthesis of the bacterial wall of the microorganism by joining the PBPs, 1, 3 and especially those of type 2, being more related to those of the gram -negative bacteria. Your action is time dependent. The disadvantage of this drug is that it can only be administered parenterally, so the treatment should be completed and the infection before giving the domicile.

It is distributed very well by all the tissues and fluids of the organism, varying its volume between 13 and 22 l/kg. We find high concentrations of the drug in the bronchial mucosa in 4.8 hours. Plasma protein union is 16.4%. Cephepima is little metabolized. More than 85% is excreted by urine unalterada. The removal of elimination is approximately 2 hours, the total clearance is 120 ml/min and the renal of 110 ml/min, so it is almost completely excreted by the urinary tract.

It is vitally important to adjust the dose in patients with renal pathologies. Some of the most frequent adverse reactions of this cephalosporin are gastrointestinal symptoms and hypersensitivity reactions. In addition, we can find other less frequent paintings, secondary to this treatment such as anemia, eosinophilia, headache, thrombophlebitis, diarrhea, cutaneous eruption and alterations in analytics (positive coombs test, increased alkaline phosphatase, increased bilirubinemia, prolongation ofprothrombin and thromboplastin time …).

The letter B of teratogenicity level is associated in pregnancy. It is excreted by breast milk in small quantity so it must be cautious. At the time when Alberto is discharged, he receives his individualized nursing recommendations in relation to medication, which are composed of:

  serious or not related reactions to your treatment.

Conclusion:

As for other recommendations not related to medication we could influence:

• Consume a varied and balanced diet, avoiding spicy foods, very seasoned, fat, chocolate, coffee, mints, tomato, alcohol … to minimize gastric reflux.
• Keep healthy habits, avoid tobacco consumption and perform physical exercise.
• Keep relaxation, meditation and music therapy techniques to combat stress.
• Eliminate or reduce stressful stimuli.
• Maintain adequate body hygiene and perform frequent hand washing.
• Avoid exposure to cold temperatures without shelter clothes.
• You can notice tiredness or decrease in appetite at the beginning, it is normal.
• Drink a lot of liquid, preferably water.
• Go to the review with your pneumologist in the planned appointment.
• Keep proper rest.
• · Find out of the flu and pneumococcal vaccination calendar.

BIBLIOGRAPHY

• 1 Alprazolam technical fiction [Internet]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;2018 June.
• Enrique Pacheco del Cerro. Pharmacology and Nursing Practice. 1st ed. Barcelona: Masson S.A.;2003
• Salmeterol: antiasmatic, bronchodilators, adrenergic. Academic Vademécum of Medicines: Accessmedicina. McGraw-Hill Medical [Internet]. 
• Dexamethasone Technical Card [Internet]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;2017 December [cited June 11, 2020].
• Technical sheet Clindamycin [Internet]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;2014 July [cited June 11, 2020].
• TECHNICAL SHEET PARACETAMOL [INTERNET]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;2019 June [cited June 11, 2020].
• Methylprednisolone Technical Card [Internet]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;February 2020 [cited June 11, 2020].
• Drapported Technical Card [Internet]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;2017 December [cited June 11, 2020].
• Ecured collaborators. Cefepime [Internet]. Ecured: April 8, 2019.
• Cephepima Technical Card [Internet]. Madrid: Ministry of Health, Social Policy and Equality. AEMPS online medication information center;2018 January [cited June 11, 2020].