PUBH1101 Introduction To Public Health And Health Services

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Question :

PUBH1101 Introduction To Public Health And Health Services The George Washington University USA

Provide current pharmacological management plan for Simon. 

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Answer :

Answer 1 

The current pharmacological management plan for Simon is discussed below 

The pharmacodynamics of Metformin of 500 mg helped Simon to reduce the by (blood pressure). The short-term administration of metformin lower blood pressure through dropping sympathetic neural outflow. Lower blood glucose levels produce salutary effects over glucose metabolism; metformin reduces blood pressure (Waterman et al.; 2019). The drug also reduces blood pressure produces physiological situations of blood pressure lowering unclear. Simon was suffering from diabetes as it was mentioned in the case study that he was suffering from high blood sugar. Metformin diminishes liver production for glucose, declines intestinal absorption for glucose, in addition increases sensitivity for insulin through growing uptake of marginal glucose besides utilization (Markowicz-Piasecka et al., 2017). Metfonnin has oral bioavailability for 50 to 60% under fasting situations, in addition absorbed slowly (Markmicz-Piasecica et al.,2017). The side effects includes physical weakness, diarrhoea, muscle weakness, infection at upper respiratory tract, lower blood sugar, and abdominal pain followed by lower blood levels for vitamin B-12 (Markowicz-Piasecka et al.. 2017 and Frost et al.. 2017). The medications does not show proper effect that is reducing blood pressure because, Simon might have not taken it in required dosages. There might be cases that Simon might have skipped some of his medication and also not maintaining proper diet. In case of medicine to work for reducing blood pressure Simon also needs to maintain food habit. Simon might not be having required food hence, medicine is not working. Medicine might be having other effects such as hormonal issues, poor sleep, megative metabolism and other health issues that are producing contraindication. Atenol, pharmacodvnamics includes cardio-selective beta-blocker. It acts as antagonist towards sympathetic innervation in addition avoids upsurges in heart rate, contractility at heart, and electrical conductivity, augmented issue of norepinephrine from peripheral nervous system (Hibma et al., 2016). The phamiacokinetics of Atenol includes oral management atenolol absorbed partly from intestine, around 50% of beta blocker bioavailable. The linear relationship among atenolol plasma stages in addition wade beta blocking outcome measured through exercise-induced tachycardia (Hibma et al., 2016). The side effects includes cold hands, feet, headache, dizziness, breathing shortness, constipation, and diarrhoea. Oral tablet, taken every day 50 mg post lunch (Hibma et al., 2016). On other hand, pharmacodvnamic and kinetics for Aspirin. Atenolol and Aspirin belongs to beta-blockers class of drugs and it works through blocking action of natural chemicals over body, for example epinephrine, on heart and blood vessels. Hence, this medication was prescribed as it can affect reduces heart rate, blood pressure, in addition straining on the heart. Acetylsalicylic acid (ASA) stops synthesis of prostaglandin. 

Non-selective in case ot cox-1 in salmon cux-1 enzymes (sun et al, 2020). truumnon of COX-1 primes to inhibition of aggregation platelet for 7-10 days. Acetylsalicylic acid attaches through serine residue of cyclooxyaenase-1 (COX-1) enzyme, causing irretrievable inhibition. Quickly hydrolysed in body towards salicylic acid; plasma absorption for latter was been preserved in comparatively narrow range towards attain tolerable anti-inflammatory outcome in addition diminish systemic contrary effects (Cavalca et al., 2017 and Alhadab et al., 2019). 

Pharmacokinetics and phanuacodynamic went wrong for the drug due to certain action of Simon. Simon might not have been taking the drug with proper dosages. It might be the cause that the patient-linked factors and on drug's chemical possessions. Some patient-linked factors such as renal function, genetic makeup, and age affect both pharmacodynamic and phannacokinetic parameters for Simon. Drugs. presumed be linked to inhibition of CNS 

neuronal acceptance of serotonin (5HT) (Hibma et al., 2016). Zoloft a effective selective inhibitor for neuronal serotonin reuptake besides weak impacts on norepinephrine or dopamine neuronal reuptake (Alhaclab et al., 2019). Sertraline eradicated from body through metabolic pathways forming ketone in addition alcohol, excreted (Sun et al., 2020). 

Answer 2 

Goodwin et al., 2019 suggested that the mentioned in the case study Simon is allergic to Penicillin and hence. any Penicillin related drugs were to be avoided for acute cellulitis. The drugs chosen for Simon's case would be dicloxacillin, cephalexin, and Levofloxacin. Renal adjusting dosing with his antibiotics for acute cellulitis in case of Simon includes correction of fluid in addition electrolyte stages; avoidance of nephrotoxins; in addition kidney replacement therapy, wherever appropriate. Usage of acetylcysteine for anticipation of acute renal failure at patients experiencing numerous procedures.

In Cases of Simon suffering from health issues with cellulitis treated with outpatient basis, dicloxacillin, amoxicillin, in addition cephalexin reasonable choices. Clindamycin reasonable alternatives for Simon allergic to penicillin. Nonsteroidal anti-inflammatory drugs (NSAID5) besides angioten.sin-converting, enzyme (ACE) inhibitors known to reason prerenal azotemia. NSAIDs impact kidney through blocking cyclo-oxygenase, leading for increase in thromboxane A2, with effective vasoconstrictor of preglomerular arterioles (Cavalca et al., 2017 and Alhadab et al., 2019). The afferent vessels source blood to kidney, vasoconstriction reasons reduced perfusion glomerular. 

Streptococcus pyogenes (Wright et al., 2020). The medication changes needed were Azithromycin, cephalexin. and Levofloxacin. Azithromycin is considered as beta-lactamase resistant comparable to that of oxacillin. Dicloxacillin causes an in vitro activity in contradiction of gram-positive in addition gram-negative aerobic as well as anaerobic bacteria (Azithromycin,  Bioavailability of azithromycin around 37%. Associated management of oral azithromycin through food meaningfully declines through 50% drug bioavailability. Azithromycin additional immunomodulatory impacts in addition been used in chronic respiratory inflammatory illnesses. Skin reactions occur with medicine. It might lead to diarrhea or loose stools, vomiting (Azithromycin, 2021). Cephalexin a first-generation cephalosporin antibiotic (Cephalexin, 2021). It was operative in contradiction of most gram-positive bacteria over the inhibition of the cross-linking response amongst N-acetyl muramicacid besides N-acetylelucosamine in cell wall, important to cell lysis (Cephalexin, 2021). Cephalexin was not metabolized in body. Cephalexin was over 90% excreted at the urine post 6 hours through glomerular filtration in addition tubular secretion having a mean urinary recovery of 99.3% (Cephalexin, 2021). Levofloxacin was related with QTc-interval perpetuation in addition would be used through caution in Simon undergoing risk factors for continuation (Drugs. 2021).Levofloxacin established in vitro activity in contradiction of number of aerobic gram-positive in addition gram-negative bacteria besides might can-y activity against firm species of anaerobic bacteria as well as other pathogens like Chlanzydia and Legionell (Drugs; 2021). Levofloxacin formulations were bioequivalent Levofloxacin pharmacokinetics linear in addition foreseeable post single in addition manifold oral or I.V dosing regimens (Drugs; 2021). 

It is not good for Simon to take aspirin as heavy dose of Aspirin source chronic kidney ailment like chronic interstitial nephritis. Wanting labels over analgesics defines that the drugs for more 10 days intended for pain in addition greater than three days for fever causes side effects. Certain studies showed that lower dose of the aspirin does not appear to upsurge risk of kidney illness in people with normal kidney function (Cavalca et al., 2017). Though, taking doses which are too large might temporarily- as well as pennanently- decrease kidney function. Persons with chronic kidney illness usually directed not to take NSAIDs, with exception of aspirin in case of cardiovascular indication. NSAIDs related with acute kidney injury over general population and development of disease with chronic kidney disease. 

Atenolol to be changed to different antiHTN because it is laiown that atenolol is the most used beta blockers clinically. It was seen that the very high dosages, beta blockers worsen heart failure, slowing heart rate too as well as produce wheezing in addition worsening of lung illness. Increased doses might also source lightheadedness from drop in blood pressure, putting Simon at risk for falls and injury (Markowicz-Piasecka et al., 2017). Azithromycin is the best antibiotic choice to his cellulitis. It is essential to swab the cellulites and hence this antibiotic recommended as Simon is allergic to penicillin. 

It was noted that ways to tightly control by and BSL with medication adjustment in case of Simon includes maintenance and assessment of plasma glucose amounts among 60-100 mg.-d1. Hence, in case of Simon the stress of health issues alters controlled balance among glucose production in addition glucose utilization over peripheral tissues. Increase in secretion of counter regulatory hormones such as catecholamines, glucagon, in addition growth hormone happens, producing extreme issue inflammatory cytokines containing tumour necrosis factor-a, interleukin-6 besides interleukin-l[3 (Waterman et al.. 2019). The right medication for Irbesartan (Avapro) is an angiotensin II receptor blocker and Lisinopril (Prinivil, Zestril) is an ACE inhibitor.. As mentioned by Smith et al.. 2018, the antibiotics and doses used for giving erysipelas along with cellulitis abridged through bacteria. It was seen that the antibiotic regimens effective among 90% of patients (Brindle et al., 2017).