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Patient X - admitted to rural hospital for infectious exacerbation of end…

- - - - Disease process involves inflammation, loss of elastic recoil and obstruction caused by mucus hypersecretion, mucosal oedema and bronchospasm
        
        Inflammatory cells neutrophils, macrophages and lymphocytes attract inflammatory mediators and proinflammatory cytokines, with inflammatory response exagerated by exposure to toxins such as cigarette smoking
        
        Structural changes of the lungs with tissue destruction, disruption of normal defense mechanism and repair process of lungs. Bronchioles lose shape and become congested with mucus and alveolar wall destruction results in fewer numbers of larger air sacs.
        
        Gas exchange abnormalities characterized by ventilation/perfusion mismatch in combination with pulmonary circulation changes such as thickened vessels, inflammatory cell infiltration, collagen deposition and destruction of capillary bed
        
        hypoxaemia and hypercapnia
        
        Other signs and symptoms of COPD include cough, sputum production, dyspnoea, intercoastal and accessory muscle excertion, wheeze, chest tightness, fatigue, weight loss, anorexia, peripheral oedema, polycythaemia and cyanosis
        
        Pulmonary hypertension leads to hypertrophy of right ventricle of the heart
        
        Right sided heart failure - cardiovascular diseases are common co-morbidity of individuals with COPD
- - - - Indication treatment of symptoms of gastro-oesophageal reflux
      - Contraindications hypersensitivity to benzimidazoles
      - Normal dose range 20-40mg/day
      - Side effects headache, dizziness, vertigo, insomnia, rash, diarrhoea, abdominal pain, nausea, vomiting, upper respiratory infection symptoms and cough.
      - Interactions potential to increase toxicity of benzodiazepines, phenytoin and warfarin. additionally, sucralfate absorption is inhibited. some antiretrovirals, escitalopram, tacrolimus, clopidogrel, methotrexate, magnesium and sodium lowering drugs.
  - - - Contraindications – systemic infection, pancreatitis, or live viral immunisation.
      - Normal dosage range – loading dose, 10-100mg/day, maintenance – 5-20mg/day, short term – 20-40mg/day.
      - Side effects – infection, osteoporosis, avascular necrosis, pancreatitis, GI upset, peptic ulcer, haemorrhage, fatigue, leucocytosis, fluid retention, hypokalaemia alkalosis, hypertension, impaired healing, weight gain, myopathy, increased appetite, rash, skin atrophy, bruising, acne, impaired carbohydrate tolerance, cataract, glaucoma, blurred vision, psychological dependence, psychiatric effects, anaphylaxis, thromboembolism.
      - Interactions – CYP3A4 inducers or inhibitors, methotrexate, mifepristone, anticoagulants, antacids, anticholinesterases, NSAID’s, salicylates, hypoglycaemics, K depleted diuretics, carbonic anhydrase inhibitors, vaccines, oestrogen, somatropin, cardiac glycosides, amphotericin, quinolones, high dose salbutamol, salmeterol, terbutaline or formoterol
      - Indication Short term treatment of inflammatory conditions such as COPD
  - - - Indication treatment of infection of microorganisms causing pneumonia
      - Contraindications allergies to penicillin or cephalosporins, and caution should be taken from people with renal disease, pregnant or breastfeeding,
      - Normal dose range 600 mg (500/100 mg) - 1.2g (1 g/200 mg)
      - Side effects Nausea, vomiting, diarrhoea, glossitis, somatitis, bone marrow suppression, rash, fever, superinfections and lethargy
      - Interactions tetracyclines reduce the drugs effectiveness and aminoglycoside when used in combination with augmentin, becomes inactive, therefore both these drugs should be avoided with the use of this drug.
  - - - Contraindication significant hepatic, renal or spontaneous haemostasis impairment, dialysis, significant bleed pregnancy or lactation.
      - Normal dosage range 10-20mg daily.
      - Side effects include GI upset, headache, fever, haemorrhage, pain odema, dizziness, haemoptysis, renal impairment, hypotension, anaema, haematoma, rash, itching.
      - Interacts with contraindicated drugs, drugs affecting haemostasis, strong CYP3A4 inducers or inhibitors. (MIMS)
      - Indication Acute treatment and prevention of pulmonary embolism
  - - - Indication therapeutic anxiolysis, treating anxiety associated with breathlessness
      - Contraindications hypersensitivity to benzodiazepine
      - Normal dose range 0.5-15 mg depending on the route of administration, for example, oral doses are higher due to hepatic metabolisation lowering the concentration of active ingredients.
      - Side effects GI upset, dry mouth, hiccups, drowsiness, fatigue, confusion, euphoria, hallucinations, headache, dizziness, falls, muscle weakness, ataxia, diplopia, altered libido,
      - Interactions other inhaled anaesthetics, CNS depressants (eg alcohol), opioids, propofol or thiopentone. Combinations of midazolam with these drugs required doses to be carefully balanced
  - - - Contraindication severe milk protein allergy.
      - Normal dosage 100/25-200/25 daily = fluticasone furoate (corticosteroid)/vilanterol (B2 antagonist), one puff daily.
      - Side effects headache, nasopharyngitis, fracture, pneumonia, upper respiratory tract infection, coughing, muscular pain, pyrexia.
      - Interactions B-blockers, that slow the heart rate and lower blood pressure, and CYP4A3 inhibitors, that block an enzyme excreted from the liver for metabolising drugs, such as a chemical component of grapefruit.
      - Indication conditions that cause inflammation of the airways, reducing the physiologically ability to effectively exchange gases and adequately oxygenate the body
  - - - Contraindication occurrence of vomiting can be exacerbated with use of morphine due to nausea and vomiting side effects.
      - Normal dose range 5-10mg/dose 4 hourly
      - Side effects constipation, ileus, altered taste and mood, abnormal thinking, headache, dizziness, sedation, sweating, rash, flushing, chills, involuntary muscle contraction, bronchospasms, decreased cough, dry mouth, asthenia, malaise, circulatory and respiratory depression, cardiac and respiratory arrest, shock, apnoea, hypo, hypertension, syncope, oedema, palpitation, tachy, bradycardia, SVT, tremor, hypertonia, ureteric, biliary spasm/pain, elevated LFT’s, paraesthesia, confusion, insomnia, agitation, anxiety, delirium, dys/euphoria, hallucination, seizures, visual disturbance’s, miosis, nystagmus, anaphylaxis, hyperglycaemia, prolactin release, adrenal insufficiency, SIADH, amenorrhea, infertility, sexual/erectile dysfunction, reduced libido, hypogonadism, decreased cortisol & testosterone, urinary retention, dependence, tolerance, withdrawal, serotonin syndrome, hyperalgesia
      - Interactions other opioids and analgesics, CNS depressants, amphetamines, coumarins, some antihistamines, anticholinergics, antiperistaltic antidiarrhoels, BP lowering drugs, orally administered drugs, skeletal muscle relaxants, cyclizine, cisapride, domeperidone, metoclopramide, ritonavir, zidovudine, serotonergics, 5HT3-antagonist, drugs affecting motility.
      - Indication relief of pain and anxiety associated with respiratory distress during palliative care
  - - - Contraindication hypersensitivity to atropine or derivatives (used to treat certain types of poisonings, increases heart rate).
      - Normal dose range 5-18mcg inhaled daily.
      - Interactions other anticholinergic medications
      - Side effects dehydration, oral changes such as gum disease and fungal infections, gastrointestinal changes such as constipation, respiratory changes such as bronchospasms and coughing, cardiac changes such as tachycardia, palpitations or atrial fibrillation, urinary changes such as UTI, dysuria and urinary retention, dizziness, insomnia, rash, blurred vision or joint swelling.
      - Indication treatment of bronchospasms