Melina Remold is a 38-year old single mother of five children. She is in the middle-income category and spends most of her time running her small business. She is a bar owner who also works in the local government as part of the administrative staff. Miss Remold was diagnosed with COPD two years ago, having experienced a lot of difficulty in breathing among other things. In addition, while she may be considered as one of the few young patients, her symptoms are often very severe. The damage of her lungs is serious and she depends on medication for most of her life.
Health History
Miss Remold has been smoking since she was fourteen and has had minor respiratory challenges like chest infections as well as incidents of bronchitis and she has suffered pneumonia twice so far. Originally, the patient can be classified among the otherwise healthy individuals owing to the fact that she lives an active life with two demanding occupations and children to take care of. Her only compromise is the smoking and drinking that have been a great part of her life since her early teenage years. She smokes at least three packs of cigarettes each day and has made some attempts to quit as her respiratory problems worsen. However, it has not been very successful. Currently, she is making some progress with her smoking habit and has managed to reduce to one pack a day, still a lot but relatively better.
Medication History
When she was first experiencing chest pain due to her first bout of chest infections, she was given over the counter antibiotics. It had worked for a while before she had to go to the hospital and since then she has been on a number of medicines ranging from antibiotics to bronchodilators and pain relievers. For all her visits to the hospital, the resounding solution has been to quit smoking, and she is working on it. For the pneumonia, she was prescribed antibiotics on both times as the doctors established the cause as bacterial infection in her lungs. She has thus used both tetracyclines and penicillins in her recent past. For the most part of her medical history, the patient has been using antibiotics both as prescription and over the counter. When she was diagnosed with COPD, her main treatment course was the long acting bronchodilator inhaler Atimos and Mucodyne. She still takes these medications except that now she needs frequent antibiotics as the chest infection causes frequent flare-ups. In addition, she often requires painkillers and has been on Vicodin for some time now.
Client’s Current Knowledge Level of Medications and Compliance with the Prescribed Dosing and Administration
Miss Remold is fully aware of her medical condition and the dangers of the medication she is using. Despite her busy schedule, she has been complying with the prescribed dosing and administration of the medicines. Fortunately, she is not on any IV or oxygen therapy and can thus afford to live a normal lifes. The difference is that she carries with her medicines and a water bottle. With COPD, she cannot predict a flare-up and she is thus always ready for an emergency (Lisby, Nielsen, Brock, & Mainze, 2010). She carries all her medication with her to keep herself strong and independent at all times. She is also fully aware that the medications could have certain side effects and for this reason, she has the numbers of her sons, the hospital and the ambulance service on speed dial for severe emergencies. She has also made it a habit to always be around people, whether at the office or at her bar.
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The Medications
Atimos
- Pharmacokinetics and Pharmacodynamics
The active ingredient in this inhaler is Formoterol, which is classified as a beta 2 agonist. It thus acts on the beta 2 receptors of the lungs, stimulating them in order to relax the lung muscles. Inhaling this medication takes it directly to the lungs where the active ingredient helps to open up the passageways almost instantaneously although most patients report relief after two to three minutes.
- Dose
It lasts for up to 12 hours and thus the average dosage is twice a day.
- Route of Administration
Atimos is an inhaler and thus it is administered by inhaling it directly into the lungs.
- Side Effects
The main side effects here include hand tremors, palpitations, coughing and headaches. Dizziness, insomnia, hyperglycemia, hypokalaemia and restlessness are also possible although very uncommon (Bullock & Manias, 2010).
- Adverse Reactions
The only possible adverse reaction with this medication would be the unexpected narrowing of the airways but this is not common (Bullock & Manias, 2010).
- Drug Interactions
Atimos should not be taken with other medications that contain Formorterol as the active ingredient as it will constitute exceeding the dosage. Also, medications that reduce the level of potassium in the blood would react badly causing an acute deficiency of potassium as Atimos also reduces potassium levels. Beta blockers cause airways to narrow and thus taking them with Atimos would counteract the medicine’s action leading to its ineffectiveness as a relief for COPD (Bullock & Manias, 2010).
- Potential Safety Issues
Inhalers are often easy to use but they need guidance in case they are jammed or simply faulty. Inhaling too much of the medicine is a cause for concern and if the patients report that their inhaler is somehow defective, it must be replaced immediately. Also, the possibility of dizziness with this medication implies that one must refrain from operating machinery, driving or exposing themselves to any form of accident prone situations (Bullock & Manias, 2010).
- Impact on the Client’s Health Status
The medication enables a patient to continue with his/her daily routines by keeping patient’s airways open enough for normal, unaided breathing (Bullock & Manias, 2010).
Mucodyne
- Pharmacokinetics and Pharmacodynamics
Mucodyne’s active ingredient is Carbocysteine, a mucolytic that acts by liquefying the sputum to make it easier for the patient to cough it out. The ingredient acts on the cells that are responsible for producing mucus, causing them to produce enough mucus that can easily be expelled (Bullock & Manias, 2010).
- Dose
The starting dosage is two tablets three times a day, reduced gradually to 1 tablet four times a day once the desired results are observed (Bullock & Manias, 2010).
- Route of Administration
Mostly, oral as the medicine comes in the form of capsules or a syrup (Bullock & Manias, 2010).
- Side Effects
The only side effects are nausea and headache but allergic and anaphylactic responses have been noted in some patients (Bullock & Manias, 2010).
- Adverse Reactions
Dermatitis bullous is a possible reaction to the drug although very rare (Lisby, Nielsen, Brock, & Mainze, 2010).
- Drug Interactions
None has been observed so far.
- Potential Safety Issues
The dosage needs to be followed promptly or the patient risks gastro intestinal disturbances (Bullock & Manias, 2010).
- Impact on the Client’s Health Status
It makes the patient better by allowing them to clear their lungs of viscous mucus thus breathing becomes easier and less tasking (Bullock & Manias, 2010).
Vicodin
- Pharmacokinetics and Pharmacodynamics
The active ingredient is acetaminophen whose analgesic action remains largely unknown. However, it is established that the medicine inhibits prostaglandin synthetase causing little effect on respiratory and cardiovascular systems. It is rapidly absorbed from the gastrointestinal tract and works within seconds of absorption. It also lasts in the body for about 1 to 3 hours depending on the individual. It means it is a fast acting reliever that must be taken with caution (Lisby, Nielsen, Brock, & Mainze, 2010). Overdose has severe effects on the liver, heart and respiratory system.
- Dose
One or two tablets every 4 hours or as needed with respect to the pain occurrence. However, the patient cannot take more than 6 tablets within a day as it will constitute overdosing (Lisby, Nielsen, Brock, & Mainze, 2010).
- Route Of Administration
Oral administration as the absorption occurs in the gastro intestinal tract.
- Side Effects
Side effects include dependence, allergic skin reactions, anaphylactic responses, respiratory depression in some patients as well as abdominal challenges.
- Adverse Reactions
Dizziness, nausea and drowsiness are amongst the common adverse reactions with mental clouding, lethargy and mood changes for some patients.
- Drug Interactions
Other narcotics, antidepressants and antihistamines will not interact with this medication and thus must be avoided.
- Potential Safety Issues
Vicodin is a strong medication which can develop addiction or dependence. It means that the patient needs to be monitored and fully educated on the risks of over indulging this medication. Usually it is only meant to be taken for unavoidable acute pain.
- Impact on the Client’s Health Status
The pain relief is effective and keeps the patient on feet even when the pain could have rendered the patient bedridden. It is thus worth the side effects seeing as the patient is able to live a daily life and take care of children and the business while also working full time.
- Possible Interventions
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Miss Remold is fully aware of her condition and the seriousness of the prescribed medication. It means that she does not need any additional information on how important it is for her to comply with the dosage. However, she will need some help with her smoking and thus I recommend a nicotine replacement therapy. She has made some efforts to reduce the daily amount of smoked cigarettes but her continued smoking causes the COPD to progress much faster. The fact that she takes Vicodin implies an advanced stage of lung damage that may be fatal if not slowed down by completely quitting cigarettes (Lisby, Nielsen, Brock, & Mainze, 2010). Since she already knows this, she just needs to be introduced to the nicotine replacement therapy with her consent and commitment.
Conclusion
COPD is a progressive illness and it cannot be reversed easily. The only alternative is to manage the illness progression. The only available way of containing CORP is stem cell therapy. However, stem cell therapy is not available in most jurisdictions. Therefore, this means that the only treatment option available is meant to reduce the disease effects to manageable levels.