Pharmacology Case: Jessica White

Answer :

                                                                 Introduction

The report analysis includes a very short description of the case in order to introduce who Jessica white was, and pharmacological intervention to focus upon the signs and pertaining to Pharmacology .  

Jessica white was a 5 year old child who used to stay with her grandmother in the north of the country with two dogs and one cat.  She loved to play with children in the park and enjoyed their company a lot. Jessica was diagnosed with Eczema  and seasonal asthma which used to strike her in the winters.  Since Jessica was unwell the last couple of days and her mother used to give her salbutamol as required for her relief. But unfortunately, one night Jessica felt very ill and had difficulty in breathing along with coughing and wheezing.  She was rushed to the hospital where the doctor diagnosed her health condition and found heightened dose of salbutamol-90%,  RR 30 per minute pulse 136 per minute. Thus, the consultant diagnosed her with severe moderate Asthma. 

Asthma-

Asthma is common disease, which is long-term inflammatory disease. It is related to airways. The symptoms include chest tightness, cough and shortness of breath. The effective asthma treatment includes identification and avoidance of allergen,  effective drugs and emergency action plan. There are occupational Asthma and  exercise induced asthma. If patient feels asthma only at workplace, it is called occupational asthma whereas if physical exertion make it difficult to breath, it is called exercise asthma.

Asthma is a condition in which airways of person become inflamed and narrow. These airways become swallow and start producing extra mucus which makes it difficult for patient to breath. Asthma causes chest pain, wheezing, coughing and wheezing (Möller, et.al., 2017).

Asthma normally can be treated from rescue and controller inhalers. Rescue inhalers are salbutamol whereas controller inhalers are given to prevent asthma symptoms (Prednisone).

Pharmacology

 We are aware of the fact that Jessica who was just 5 years of age was suffering from asthma, she had allergies to  pollens  and during the season of winter  used to have cold and cough with eczema.  After giving her salbutamol over the night she was very relieved for a short duration but, her condition  was going back to worse  and was admitted to emergency in the middle of the night.  An ED consultant had prescribed her drug salbutamol inhaler  2.5 MG 6 puffs of 3 doses,  ipratropium 250 mcg 4 puffs 3 dosses and PO prednisolone 22 mg as that goes with high flow of oxygen . 

Furthermore, I shall be discussing all these medicines in detail and why these medicines were prescribed by the ED to Jessica for calming her down and help her  relax. These medicines  usually open up the lungs and help the child to breathe. However, the findings were not very impressive as there was a continuous low air pressure in her bilateral and she was wheezing. Her respiratory rate had dropped to 36 breaths per minute and her pulse was 136/ min with a bp of 100/60.

Salbutamol

A quick onset medicine known as Salbutamol, was prescribed to Jessica and is a selective form of beta-2 adrenergic receptive agonist, which is broadly used to treat COPD & Asthma and is 29X more selective than beta-1 receptors. Making it more favourable for pulmonary beta receptors as compared to beta-1 -adrenergic  receptors which are placed in the heart of a human. Mixture of R and S isomers is formulated in Salbutamol and contain affinity of about 150 times higher for beta II receptor, than that of an isomer, which is related to toxicity (Jacobson, et.al., 2018). The single R isomers contained a form of salbutamol is level butanol but, is a little more costly as compared to salbutamol and is not widely used as a pure version in itself.  Whereas, salbutamol is used to treat acute bronchospasm, which is mostly caused by bronchial asthma, chronic pulmonary disorders and other Broncho pulmonary disorders and can also be suggested in the treatment of prophylactically exercise induced asthma (Kar, 2018). 

Salbutamol is considered to be a very highly selective form of Beta-2 receptor which leads unto a bronchodilator effect on its patient and mostly used to ease the bronchospasm activities caused by bronchial asthma, chronic form of bronchitis and emphysema or many other forms of air passage blocking diseases (Bush and Fleming, 2015). 

About 50% of the  salbutamol is absorbed within the body from the intestinal tract post oral administration and have an onset of action which is at its peek after 2 hours of intake.  When salbutamol is taken by a patient on its own, such as it takes around 15 to 20 minutes and reaches the lungs within 5 minutes of  inhaling (Zhou, et.al., 2017).  It can be noted that only about 20% of the medicine drug is actually absorbed by the lungs and all the rest is stuck in the  mouth or the stomach wall. The length of the effectiveness of the drug is for approximately 4 to 6 hours and can be well tolerated by many with little or no severity of intolerance post administration of the drug. Common side effects of this drug can be nervousness or shaking in the hands causing palpitation, chest discomfort, tachycardia, muscle cramps with headache ,Hypokalaemia,  or paradoxical bronchospasm.  It is also known as  category C drug at the time of pregnancy and can be taken only if it is absolutely necessary for the patient.  Whereas, taking  salbutamol drugs during pregnancy can have a Peculiar advantage  of therapy action on the foetus.

We can say that salbutamol drug might be excreted in the human milk but the concentration of the drug in the component if still unknown, there are no studies that reported any adverse effect on the baby who have been fed with milk given by mothers taking Prednisone drug.  However, one has to be very careful with elderly person taking this drug dosage in high quantity as it can lead to cardiac arrest kidney or liver dysfunction. 

Most of the time symptoms of overdose of the drug can be palpitation, tachycardia, and tremors and can cause hypertension, seizures, headache nervousness sleeplessness dry mouth or cardiac arrest (Jadhav, et.al., 2015).  When the drug is discontinued, a lot of symptoms can be noticed in the patient.  If the patient is experiencing tachycardia and palpitations, another drug of cardio selective Beta receptor known as metoprolol or antenna lol is injected in the patient immediately as salbutamol can cause bronchospasm  in highly sensitive patients.  With overdose of Paracetamol drug,  the level of potassium in the blood we also decrease  drastically  and should be continuously monitored by an expert.

Nurses are told to examine the patient after every 30 minutes and key for any vital symptoms in the patient reacting  to the drug.  In the case of the little girl Jessica, her lungs were not able to breathe normally due to severe cough. The severe cough is very critical symptoms as it prevent to breathe in Asthma patients. Therefore the nurse had to being with her very politely without holding her while coughing continuously. Instead the nurse was advised to check the sound that she made and Pulse rate of the child. The inhalers help Jessica in breathing and removing blockages from the air passage.

Ipratropium drug

It is a drug of bronchodilator category which opens up the air passage in the lungs and used to treat asthma, chronic obstructive pulmonary disease also known as COPD, other breathing allergy or chronic bronchitis.  Ipratropium help in removing the effect of acetylcholine on the passage through which the air passes in the navel and is a chemical used by human nervous system to pass on the message within the muscle cells (Wongwaree, 2017).  

. Ipratropium drug controls the symptoms causes allergy of common cold is reduced due to controlling the mucous glands in the nose. As the drug directly travels to the Airways and the body does not absorbs too much of its concentration.  It has been approved by the FDA in the year 1995.  The absorption of petroleum drug is done through the mouth and has the minimum chances of linking with other blood cell or through any other extracellular or intracellular components and can be metabolized in a very little quality (Inayat, et.al., 2017).  The drug excretion in human is done through the waste product of the body in urine or through the renal system and it is advised that the excretion is closely monitored by the nurse who sample of urine so that the function of the kidney and lungs can be analysed. 

Jessica had shortness of breath at the time of being admitted to the hospital and clinical assessment of vital symptoms was done by the nurse to oxygen therapy given by the oxygen mask as prescribed by an expert doctor and ipratropium was closely monitored while the doors was given to the child so that  her  bronchial muscles can be relax and she would breathe  normally. In case of COPD and asthma, the blocked passage in the lungs cause air blockage  in the lungs and surrounding areas.

Ipratropium drug helps in relaxing the muscles and a passages going to the lungs and also controls the mucous gland that are used to communicate with other muscle cells through  nerves  (Buckle and Smith, 2013)

 Her pulse rate and respiratory rate was closely monitored throughout the process and what's administer in the time she could breathe normally.

Prednisone: is an oral steroid

This medicine family drug is majorly used to treat asthma patients at the time of attack controlling symptoms of wheezing by giving high doses of prednisolone for a couple of days in the time the patient recover along with inhaler.  It is the process of wheezing in the child and helps them take normal breath within an onset of 4 to 6 hours (Alangari, 2014).  However,  high dosages are usually avoided as it may cause side effects like stomach ache,  vomiting,   heartburn or in digestion  if taken empty stomach. 

During the course of taking this drug, the child might feel more hungry and have an increased appetite. This will lead to gaining of excessive weight if not kept under control . Therefore, it is always advised that the child is kept engaged in a lot of Physical activities during the drug course and also is given a healthy low calorie diet. Junk foods shall be greatly avoided in such scenarios as they are full of fattening calories such as pizza, cakes, burgers etc. 

The child may start feeling inseminate and experience difficulty in sleeping, leading to depression, restlessness and anxiety. They may affect their daily lifestyle. Therefore, a doctor should be consulted in such cases.

Jessica was given 22 mg Prednisolone stat dose and was shifted to the ward when she started feeling relaxed and the dosage was continued for five days. After this, she can be involved in her routine activities such as playing and attending school etc. 

Conclusion

A small child named Jessica had symptoms of shortness of breath, difficulty breathing, gasping and wheezing at the age of 5 years and later was diagnosed with severe moderate Asthmas. Hence, the expert doctors treated her with medicinal course of drugs such as salbutamol 100 mcg/ 6 puffs 1-4 hours, PO Prednisolone 22mg daily dose for 5 days and bronchial inhaler with combination of the two drugs corticosteroid. Inhibition of beta 2 receptors was done through glands which lead to clearing of the air passages and help ease breathing. The respiratory tract was cleared by the help of these drugs and therefore, Jessica could normally breathe. Although, any early signs of asthma need to be treated immediately and taken care of by the parents in future for Jessica and the nurse should also provide proper guidance and assistance to them ,specially in winter season.