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A) Discuss in detail the factors which must be considered before selecting anti-microbial therapy.
The factors that to be considered before selecting the anti-microbial therapy are severity of the disease, host factors, previously used drugs and its history, economic consideration (antibiotics are usually costly than other drugs), comparing the new anti-microbial drug with the previous drug in terms of efficacy, cost and the host tolerance, understanding the microbial interactions with the drug, anti-microbial resistance elicited by the microbe, bioavailability, route of administration, spectrum and stability, risk assessment of patient’s age, sex, smoking and alcohol habits, site of infection with the medical history and co-existing infections, tolerance, understanding the adverse events of the new drug including allergic manifestations, pharmacokinetic factors including Minimal Inhibitory Concentration (MIC) and Area Under the Concentration-time Curve (AUC) and the failure of the drug to respond to the microbial infection due to inefficacy, other factors including immunosuppression of the host by the disease or by other drugs.
B) If a patient has an infection caused by either Staphylococcus aureus or E coli or pseudomonas aeruginosa and you are faced with only using penicillin, discuss your selection of penicillin derivatives which you may select to treat this patient.
If there is a choice of penicillin only treatment for the infections of Staphylococcus aureus, the best choice of penicillin derivative are the Methicillin, flucloxacillin and dicloxacillin, which are classified as the beta-lactamase resistant penicillin derivatives and these drugs are very effective in the treatment of Staphylococcus aureus. However, they are not useful in the treatment of Methicillin Resistant Staphylococcus aureus (MRSA), an antibiotic resistant form of Staphylococcus aureus that is very difficult to treat. In case of E.coli infection, which are gram negative bacteria can be treated with the penicillin derivatives like the third generation cephalosporin like Cefatriaxone, Cefotaxime and Cefteram can be a better option. For the treatment of Pseudomonas aeruginosa treatment, the antipseudomonal penicillin derivatives like the Carbenicillin, Piperacillin, Ticarcillin and the third generation cephalosporin with antipseudomonal penicillin derivatives like Ceftazidime or Cefoperazone can be considered for this patient as a treatment option.
E.A. a 50 year old male with body weight of 90 Kg is referred to a primary care clinic for evaluation of high blood pressure, which was detected on routine screening. His complaint was a pounding occipital morning headache. Ten (10) years ago he was treated for peptic ulcer disease and four (4) years ago he was treated for hypertension non- pharmacologically. His father had hypertension and died of heart attack at age 59, his mother was diabetic (type - 1) and died of stroke at age 62. E. A. smoked 20 cigarettes a day and consumed 5 pints of beer daily.
A. B) What non-pharmacological treatment options would you have recommended for E. Serum Uric Acid = 12mg/dl (norm: 3. In association with this. The diabetes is also an associated risk factor in the cardiovascular events and the hypertension.0 – 7.A. A) Does E.A have the predisposal risk factors (modifiable and non-modifiable) of familial history of Hypertension and the diabetes (Type-I) that can increase the occurrence of the incidence of the hypertension in A.A four years ago? . according to clinical research findings.M. was diagnosed as being hypertensive and was prescribed tablets hydrochlorothiazide 50mg daily. A’s physical and laboratory examination revealed the following: 1.M is developing the symptoms of the hypertension as evidenced by the Blood Pressure reports and the elevated clinical chemistry reports of fasting serum cholesterol and Triglycerides. have any risk factors associated with his current medical condition? E. BP = 162/115mmHg. Pulse =100 beats/min. A.0) 5.0mg/dl (norm: 0.M is having modifiable risk factors like the smoking and alcohol consumption habits.6 – 1. E. 2. Serum Creatinine = 2. Mild and elevated level of fasting Serum Cholesterol and Triglycerides. A. Serum Glucose = 120 mg/dl (norm: 70 – 110) 4.M is also developing the risk of diabetes onset as evidenced by the mild elevated blood glucose level.E.5) 3. A.
refraining from coffee. meditation and biofeedback aided relaxation therapies which are universally accepted for the non-pharmacological treatment of the hypertension.The non-pharmacological treatment recommended for E.A at the time of the reporting to the clinic is moderately impaired creatinine clearance and the hyperuricemia that may be by the underlying renal pathology.A four years ago are the reduction of body weight by the restricted food habits that can play a significant role in improving the blood lipid levels. isotonic and regular exercise that can significantly improve the hypertension. C) Comment on E.A’s renal status at the time of reporting to the clinic. the anti-hypertensive drugs tend to increase the sodium excretion by decreasing the sodium reabsorption in the Distal Convoluted . magnesium supplements for the prevention of the cardiovascular events. less or no intake of saturated fat diet. Many research studies concluded that the increased uric acid levels have a direct impact on the cardiovascular disease events and its progression. sodium restriction in food which can lower the blood pressure and also potentiate the effects of various anti-hypertensive drugs. In general. potassium supplementation by taking the fresh foods instead of processed foods. The impact of the antihypertensive medications on the renal function usually depends up on the sodium restriction and which plays an important role in the prevention of the nephrotic damage and increase or influence the beneficial activity of the anti-hypertensive drug. What impact can his renal function have on antihypertensive medication in general? The Renal status of E. alcohol and nicotine products. avoiding red meat. other dietary changes like the increased intake of fibre rich foods that can absorb the excess fat. stress reducing alternative and non-medication therapies like Yoga.
may be due to the adverse effects of the Hydrochlorothiazide that can contribute to the onset of the cardiovascular diseases. Serum glucose remained unchanged and Serum Uric acid was 13mg/dl. As an important side effect of the Hydrochlorothiazide (HCT).A returned to the clinic for evaluation of his condition. .A laboratory diagnosis report that can be worsened by the Hydrochlorothiazide medication. E. However. By this principle. weight was 86Kg.2eq/L. give details. Hyperuricemia is already reported in the E. the Sodium level is rapidly decreased in the blood thereby the blood pressure is normalised.Tubule (DCT). His headaches had resolved.A? Considering the physical and laboratory findings. E) What assessment can you make of E. For the treatment of the Hypertension in E. the Hydrochlorothiazide can be a better choice of drug for the hypertensive patients with out known renal problems and/or impaired clearance tests. After 2 weeks of hydrochlorothiazide therapy. serum potassium levels was 4. D) Is hydrochlorothiazide the appropriate choice of drug for E. there is an increase in levels of uric acid and even progression to gout can be seen in many patients taking Hydrochlorothiazide. though there is a reduction in the blood pressure levels and the body weight and there is no change in the blood glucose but the serum uric acid seems to be increased.A’s condition from these later findings? After the 2 weeks of the hydrochlorothiazide treatment. the BP was 150/105mmHg.A. the hydrochlorothiazide may not be appropriate drug of choice because of the pre-existing impaired kidney function as confirmed by the renal function test.
s. I would like to recommend the drugs like the Angiotensin Converting Enzyme (ACE) inhibitors like the ramipril and in case of intolerance. positive monoclonal antibody for Chlamydia and VDRL . A. She also complains of frequently and burning urination. for 7 days. which she complained of 4 days ago and for which she was given a prescription for Amoxicillin 500mg. For the present condition of E. Laboratory results indicates gram-negative diplococcic. with a history of multiple sex partners. tetracycline 250mg P. the next choice of the drug is Angiotensin II Receptor antagonist like Candesartan can be prescribed or other fixed combination doses of the ACE inhibitor like Perindopril with the calcium channel blockers like the Amlodipine. She had a history of recurrent UTI’s. neiseria gonorrhoea-sensitivity pending.F) What therapeutic decision will you recommended at this time? Justify your answer. She is allergic to sulphonamides. She is unmarried. She currently lives with her new boy friend and (3) children.O. as there are no proved side effects of increase in the serum uric acid levels or the lipid profiles that can contribute the hypertension and the cardiovascular diseases.M’s medication history reveals that she is on Amoxicillin 500mg orally t. QUESTION 3 A) Case study: AM is an Anorexic 28 year old woman who present to the clinic with compliant of lower abdominal pain and brown foul smelling vaginal discharge. for acne flares.d.b. This can be better choice of treatment.d.A.
It is imperative to prevent the co-infections like Chlamydia infection with the Gonorrhoea. (iii) Antibiotic Treatment – The choice of the antibiotic for the treatment of the PID is very important. and patient education. scarring and reproductive organ anomalies with other complications like pregnancy related death. (i) Differential Diagnosis of PID – Since there is no specific and sensitive clinical diagnosis are available for the PID. the complications of the PID and the spread of the infection to the other parts should be prevented. hemorrhagic or ruptured ovarian cysts should be ruled out.A) If you had to treat A. Immediately after the diagnosis. gonorrhoea and HIV diagnosis for an effective treatment. To treat A.M’s Pelvic Inflammatory Disease (PID) as an inpatient the treatment plan is as follows: (i) Differential diagnosis of PID from other similar reproductive diseases (ii) prevention of secondary complications (iii) Antibiotic Treatment (iv)Patient’s counselling with the partner (Sexual health education) (v) Treatment Goal. outline a treatment plan for her PID including goals. (ii) Prevention of secondary complications – The PID can cause irreversible damage. This can include the antibiotic treatment with the regimen of Cefatriaxone 2 gm IV Q (6 hrs) plus Doxycycline 100 mg PO or IV Q (12 hrs) or Cefoxitin 2 gm IV Q (6 hrs) or . the disease symptoms are the similar to the features of the PID. septic abortion. Though. the laboratory diagnosis should be considered for the Chlamydia infection. other similar conditions like the degeneration of the myoma.M’s pelvic inflammatory disease (PID) on an inpatient basis.
Saline wet mount test can be prescribed to rule out the co-existing fungal infections. which is highly reliable for a suspecting PID. Advice the patient and the partner to avoid the oral sex like activity that can lead to serious event. (v) Goal of the Treatment – This kind of systematic approach can be useful to prevent and decrease the incidence.w) (8 hrs). (iv) Patient’s counselling with the partner (Sexual Health Education) – The counselling of the patient along with the partner for a safe sex using barriers like condoms to prevent the STD transmission and also the complications. B) Given A. And also the diagnosis of VDRL for the partner can be prescribed to rule out the pre-existence of the disease. antibiotic resistance and recurrence can be greatly reduced. . Also the blood culture and sensitivity can be done to rule out the bacterial sepsis. For the existing medical history of UTI and the concordant laboratory reports.5 mg/kg Q (b.M’s history of recurrent history UTI and her prevailing laboratory result what other laboratory test(s) would you consider.Cefotetan 2 gm IV Q (6 hrs) with Doxycycline 100 mg PO or IV Q (12 hrs) or the Clindamycin 900 mg IV Q (8 hrs) with Gentamycin 2 mg/kg b.w (IM/IV) followed by 1. subtle infection rate. STD and the HIV like complication that can lead to a safe and hygienic sexual activity and healthy world. prevalence and recurrence of the PID. Even the abstinence is highly appreciated. Also other tests like the pregnancy tests can be done as a preventive measure. the other options of the laboratory diagnosis are the Polymerase Chain Reaction (PCR) of the cervical sample specimens can be assessed. This can act as a bacteriostatic and bactericidal dose and the organism load.
M’s boy friend is Patient-Delivered Partner Therapy (PDPT). he can treated as an outpatient and with oral medications and antibiotics after ensuring that he is non-allergic to sulphonamides and specific antibiotics of the treatment. adhesion with chronic pelvic pain. If the A.C) What are the potential complications of PID including neisseria infection and. recurrent infections. The treatment plan for the A. permanent organ anomaly. irregular menstrual cycle and impaired fertility with chances of ectopic pregnancy (tubal pregnancy). This complication can be avoided by the proper laboratory diagnosis with pelvic ultrasound imaging and pelvic examination by the Physician. how can be prevented? The potential complications of the PID including neisseria and the chlamydial salpingitis can lead to a serious complication with the symptoms of perihepatitis with the pain in the right quadrant pain and discomfort which is called as Fitz-Hugh-Curtis Syndrome. a treatment plan that has an efficacy rate of 95%. as a preventive measure recurrent UTI should be treated carefully and ensure the safe sex and avoiding multiple sex partners and periodical medical examination. Other complications like the scarring. and hydrosalpinx. However.M’s boy friend. . D) Outline a treatment plan for A. if there is a medical history of UTI or STD. and tuboovarian abscess.M’s boy friend is asymptomatic. This kind of patients is often referred as the “index patients” for whom the diagnosis and the treatment is same as like the partner but with the proper referral and the informed consent of the patient.
her partner had passed away 2 months earlier. Other possible regimen is the Continuous Prophylaxis which contains Nitrofurantoin 100 mg PO qhs x 6 -12 months. They should be informed that the periodical clinical visit and the laboratory monitoring are essential. Cefaclor 250 mg PO qhs x 6 -12 months. A. On investigation. the use of barriers like condoms should be encouraged.M is confirmed form clinical and laboratory investigations eligible for HAART.M for prophylaxis of recurrent UTI’s? List one advantage and one disadvantage of each regimen Six month later. The advantages of this regimen are safe and efficient in the long term use. the use of the first line regimen of TrimethoprimSulfamethoxazole should not be used. F) What possible regimens are available to A. Since A. Also after the treatment.E) How would you counsel A.M is allergic to the sulphonamides.M is diagnosed HIV positive. Ciprofloxacin 125 mg PO qhs x 6 – 12 months. The main disadvantage of this regimen is the some significant side effect profile that varies from person to person due to idiosyncrasy and pharmacogenomic effects and the possible antibiotic resistance as reported in the clinical . A. It is important to educate them that the birth control pills and vaginal jellies and spermicidal agents cannot prevent the STDs.M and her boy friend on safe sex and the proper use of condoms? The counselling and sex education plays an important role in the treatment and the prevention of the PID and STDs. they can be advised to refrain from sexual activities like penetration and oral sex activities for a while at the time of treatment. a best way to prevent the transmission and the recurrence.
M in Sierra Leone? The first line ARV treatment regimens available for A. The advantage of this regimen is the selfmedication and the off-clinical administration of the drugs and there is no need of Physical visit to the clinic. Still the second line drug therapies are available in other parts of the world which are more effective in the treatment of the disease. Nitrofurantoin 50 – 100 mg PO. Efavirenz or the both in combination plus Stavudine and the Lamivudine or the Abacavir with Lamivudine or the Tenofovir with Emtricitabine or the Zidovudine with Lamivudine that can serves as an a first line drug in the ARV. the Oflaxacin 100 mg PO or Norfloxacin 200 mg PO or Ciprofloxacin 125 mg PO that can given post coitally. The second regimen is the post coital regimes in which the medication should be taken with in 2 hours of the coitus. In this. but they are not available to them because of its unaffordable cost. G) What are first line ARV treatment regimens available for A.research studies and the clinical trial studies. post coitally. . mainly in the African countries. The main disadvantage of this regimen is the failure to monitor the beneficial and adverse effects clinically. H) What are the possible causes ARV treatment failures in the management of HIV? The discontinuation of the treatment because of the side effects like the lipodystrophy and the hepatotoxicity and the lack of drug availability and accessibility in due time and the nonadherence to the treatment plan and non-co-ordination of the treatment due to the mental stress caused by the disease are the main reasons for the treatment failure in the management of the HIV in many parts of the world.M in the Sierra Leone are the tripledrug regimen like the Nevirapine.
despite the side effects of the HAART. Dyslipidemia. hives. J) What interventions would you recommend to ensure effective treatment of A. skin reaction mediated by cell-mediated immunity. QUESTION FOUR .M to experience while on HAART are the gastrointestinal symptoms.M to experience while on HAART Some of the common types of the adverse effects that A. flares. The psychological counselling can be an effective intervention that can help the patient in HAART treatment to cope with the situation and also for the better understanding of the disease. that can show promising and beneficial effects. fever.I) List the common types of adverse effects you would expect A. lipoatrophy. severe hypersensitivity to the drug causing rashes like urticaria. symptomatic treatment like the anti-histamines can be prescribed.M? To ensure effective treatment of A. malaise. nausea and vomiting with or without diarrhoea. there should be a co-ordinated and continuous treatment is required. benign hyperbilirubinemia. For the complications and the side effects like the hypersensitivity and the skin reactions. bone mineral depletion and its associated changes that can be evidenced by the DEXA Scan and Bone Mineral Densitometry (BMD). deposition of visceral adipose tissue and peripheral fat.M. progression and the role of HAART in the treatment of the disease and to understand the side effects of the HAART that can make the patient to co-ordinate well to the treatment plan.
450 is also very less that can cause the decreased drug absorption. the bioavailability of the same drug and other acid labile drug products may be higher than the adults than can lead to serious adverse effects. Excretion . in case of the decreased acid secretion the host needs large doses of the drugs as in case of the Phenobarbital. mainly in the neonatal state. Other factors that affect the drug distribution in the paediatric patients are the comparatively high body water and low body fat which can affect the distribution of the lipophillic drugs.A) Discuss the pharmacokinetics factor influencing paediatric therapy Absorption The Pharmacokinetics factors that influence the paediatric therapy are the gastric pH. Distribution The drug distribution for the same drug differs from the paediatric patients with the adults because of the plasma protein structural and conformational changes that can influence the drug absorption (Foetal proteins may change or disappear over time which is usually not present in adults). Other gastric influences in the paediatric pharmacokinetics are the slow gastric emptying that can delay the peak concentration in the infants. which may change over time and there is a constant fluctuation in the pH. And in case of the increased acid secretion. Also the villous absorption is also slower than the adults because of the less absorption surface when compared to the adults. This can affect the drug absorption. the adjusted dose of the drug should be considered and also the production of intestinal Cytochrome P .
D.The renal excretion (Glomerular Filtration Rate) of the drugs and the CYP 450 mediated metabolism are low in the early childhood and the CYP 450 isoforms are also vary from adults that can influence the drug excretion by the renal route and can cause side effects. Respiratory rate was 30min.D a 5 year old female presented to an emergency room with complaints of dyspnoea. B) Case study: D.40C. Wheezes. However wheezing on auscultation became louder. physical examination for the chest tightness. in moderate they can talk phrases and in severe form they can talk words only). 1) What are the important features in assessing the severity of an asthmatic attack? The important features in assessing the severity of an asthmatic attack are the Peak Expiratory Flow (PEF) and the Forced Expiratory Volume in the First Second (FEV1). auscultation for the wheezing. prolonged expiratory phase and hyper inflated chest.5mg Albuterol was administered by nebulizer every 20min over two hours. altered consciousness due to dyspnoea. temperature 37. the words they can talk (in mild form the patient can talk sentence. Following incomplete relief of symptoms. further 2. in case of delayed excretion. if another drug is administered even after a day later. BP 110/83mmHg. was given 2. She subsequently felt better and more comfortable.5mg Albuterol delivered by compressed air nebulizer over 10 min and paracetamol 120mg Q. Other assessments like the pulse . The delay in the drug clearance and the increase in plasma half life can cause the drug-drug interaction. After 60 minutes of drug administration breath sounds became clear and cardiovascular parameters were back to normal. coughing with production of purulent sputum. heart-rate 130B/min and temperature 39. These are some of the Pharmacokinetic consideration taken in to the account in the paediatric therapy. 4-6 hrs.D.50C.
Albuterol is a long-acting anti-asthmatic and even that can be delivered at the target site by the nebulizer or by the inhaler for the immediate relief. Also the increase in levels of cAMP leads to the mast cell stabilization and prevents the degranulation process. the pulse rate may be less than 100/min. a chemical that causes extreme smooth muscle contraction including the airway and bronchial smooth muscles. which can consider as a normal. Degranulation is a process that causes the release of Histamine. an enzyme that mediates the metabolism of the Cyclic Adenosine Mono Phosphate (cAMP) that leads to the activation of the intracellular Protein Kinase – A (PK-A) thereby it decreases the intracellular calcium (ionic) concentration which leads to the smooth muscle relaxation. 3) Why was Albuterol chosen but not another type of anti-asthmatic? When compared to the other drugs.rate is very high (more than 200/min) in severe form and between 100 – 200/min in the moderate attack and in mild attack. 4) Why was Albuterol administered by nebulizer instead of oral or parenteral routes? . beta-2 selective Adregenic agonist that acts specifically in the bronchial smooth muscles. mainly the bronchial smooth muscles. 2) By what mechanism does Albuterol work? Albuterol is a long-acting. Albuterol increases the smooth muscles relaxation by increasing the intracellular adenyl cyclase. Because of this reason. Albuterol remains as a first line drug of choice for most of the Physicians in the treatment of the acute and severe asthmatic attacks.
The Albuterol when administered by the nebulizer can reach the target site immediately the action of the drug is rapid and long-acting and as it reach the target site immediately up on administration and there is a fastest onset of bronchodilation and the drug is not subjected to the first-pass metabolism. the best choice of the drug will be the Zafirlukast. what drug would you recommend? (Give reasons) If the Albuterol fails to give the complete relief even after the administration of the additional dosage of the Albuterol. which can block the action of the leucotrienes and other inflammatory mediators like the Slow Reacting Substances of Anaphylaxis – A (SRS-A) by which the drug can prevent the smooth muscle contraction.D was the intermittent grade fever that is managed with Paracetamol administration in a dosage of 120 mg Q. Hence there is a maximum bioavailability than the parenteral or oral route. which is very less or negligible in the inhalation route. 5) Should additional Albuterol dosing fail to give complete relief of symptoms. 6) What other symptoms of D.D is back to the normal body temperature. the fever is reduced and D. . a long acting drug with high bioavailability that is best choice for the patients with age of 5 and above.D. could suggest a second medical condition and how could that is managed? The second medical condition and the associated symptoms of the D. By this. This treatment can be accompanied by the inhalation of the Salmeterol and Fluticasone preparations for a quick and complete relief as a complimentary therapy for the patient.6 hrs. 4 . Also the oral administration shows significant side effects like tremors and the accelerated heart beat.
dosage of the medication is for the patients use.QUESTION FIVE 4. address and sex are mentioned in the prescription to give the identity information about the patient to whom the drug is dispensed and also for the use of the patient to identify their own prescription. A. The doctor’s signature is very important and the pre-printed prescription without Doctor’s signature is not valid in case of controlled substance . which may be once. route of administration is also for the patient’s use by which they can get the idea of “how to take the drug”. or else some drugs can be refillable up to five to six months of duration. The importance of these components is as follows: The date is mentioned for giving the exact information about the date of the purchase and/or the start of the medication for the particular disease and also for the expiry of the prescription after six months in case of the controlled substance prescription. twice or thrice daily as prescribed by the Physician. Pills dispensed should be strictly given. what are the essential components of “The Prescription”? Justify their importance. whether they can refilled or not. in case of the controlled substance prescription and the exact number of the pills dispensed. which they should follow and take the medication. It may be by oral or injection. Strength of the medicine is given in the prescription to give the idea to the Physicians about the patient’s medical history in the future clinical visits. The essential components of “The Prescription” are (a) the Date (b) Patient’s name and address (c) Name of the Medication (d) Strength of the Medication (e) Dosage (f) Route (g) duration of the drug to be taken (h) Pills dispensed and Refills (i) Doctor’s Signature. The duration of the drug to be taken must be given in the prescription to give the direction “how long the medicine should be taken”. the name. age.
John (qualification……………. this medications are prescribed may be for an infection condition associated with inflammatory reaction or pain symptoms.d 2/52 3) Suspension Maalox 10ml t. For this condition.d 4) Aspirin 600mg t.d REFILL = 2 SIG: Dr B.i. John 1) What are your comments on this prescription? As per the prescription given above.i.i. Name: Ann Moore Address…………………………. This is not applicable for the over the counter drugs like Acetaminophen..i.d (quantity 50) 2) Tabs Cimetidine 400mg b.d 3/52(quantity 20) 5) Tetracycline 259mg capsule iii t.. Paracetamol and Cetirizine etc. You are the community pharmacist at four star pharmacy working morning shifts.i.) Add ……………………………… Tele …………………………….prescription. Rx 1) Tabs Zantac 1 b.… Age…………………………………………… Sex……………………………. the . B. 4.. You received the following prescription orders: PRESCRIPTION 1 Dr.. B.
Kamara Age: 11yrs. Since for the need of antiulcer drug. Msc. 2) Will you dispense the medication as directed? Justify your answer. anti-secretory drugs like Ranitidine and Cimetidine along with antacid are prescribed for a patient.i.d for 1/7 .Tetracycline and Aspirin are prescribed. No such form of 259 mg capsule is available and it should be redirected again to the Physician to rectify it for the proper dosage.i.d for 1/52(quantity 42) 2) Caps Doxicycline 100mg 1 b. PhD agriculture 4 Brook Street Freetown Tele: 228497 Diff. Cole Bsc. either ranitidine (Zantac) or Cimetidine is enough and no need to prescribe the two drugs at the same time with an antacid. Actually the generic and proprietary forms of Tetracycline are sold in either 250 mg or 500 mg only. Diag: Bacterial Vaginosis.d for 5/7 (quantity 10) 3) Tabs Metronidazole 200mg ii t. Name: K. To reduce the gastric irritation caused by the Aspirin. I will not dispense the medications as directed by the Physician. Also the Tetracycline prescribed here is not correct drug dosage. PRESCRIPTION 2 Dr R.i. Sex: Male Rx 1) Caps Tetracycline 250mg ii t.
4) Tabs ibuprofen 400mg ii prn (quantity 40) 5) Tabs Paracetamol 500mg ii t. co-existing protozoal infection and the Ibuprofen is prescribed and it should be taken.i. if needed can be taken and the Paracetamol for the fever are necessary. Hence I will respond to this prescription by redirecting the prescription again to the Physician for a re-evaluation of the patient standard and the disease condition. Hence there should be any one antibiotic like Doxycycline with metronidazole can be prescribed. 2) How would you respond to this order? The prescription given for the bacterial vaginosis is not meaningful. PRESCRIPTION 3 . which are the same group of drugs and the Doxycycline is the broad spectrum antibiotic and analogue of the Tetracycline and therefore there is no need to prescribe the Tetracycline. the Physician prescribed the antibiotics like the Tetracycline and the broad spectrum antibiotic like the Doxycycline and the Metronidazole for any subtle. The other medications are the Ibuprofen. if necessary and the Paracetamol is prescribed. may be for an intermittent grade fever. As the prescription contains the Tetracycline and Doxycycline.d for 5/7 (quantity 30) REFILL – NIL SIG 1) what are your comments on this prescription? Since the patient suffered from the bacterial vaginosis.
Rose 1) What are the directions for use of the ordered medication? The Physician prescribed the drug for the patient to take the Propanolol Omni mane. Hence the Bendrofluazide too can be taken in the morning time. The Physician also prescribed the Bendrofluazide Hora decibius which is known as “bed time dosage”. which is the Latin abbreviation of the “every morning”.Tabs Bendrofluazide 5mg Hora decibitus for 4/52 (quantity 30 REFILL = 3 SIG: M. So the Physician directed the patient to the take the Propanolol in the morning and the Bendrofluazide as the bed time dosage. as it can causes nocturnal diuresis which can disturb the sleep. Rose Bsc. a diuretic cannot be prescribed for the patient in the night time. MBCHB.Dr M. Kargbo Age: 42 Sex: Male Rx 1 –Tabs Propanolol 40mg Omni mane for 4/52 (quantity 30) 2.. . Add: …………………………….Tele: 225678 Diagnosis: Hypertension Name:A. 2) Do you agree with the time of administration of the medications? The propanolol can be prescribed for the hypertensive patients in the morning time but the Bendrofluazide.
.3) What advice would you give this patient when dispensing the medication? I will advice the patient to take both the drugs in the morning time simultaneously for a beneficial effect in the treatment of the hypertension.
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