"Acute Sinusitis Treatment" is a well-written example of a paper on drug therapy. Based on the scenario, the patient assessment is acute sinusitis. Looking carefully at her recent medications, and symptoms, she is suffering from rebound congestion. Treatment of congestion and the prevailing conditions is necessary. Discontinuing the use of a nasal spray will be appropriate. This is because all the nasal spray does reduce the symptoms for a short duration like thirty minutes and the symptoms crop back. This will lead to overuse of the nasal spray continually so as to ease the discomfort.
This action will, therefore, inhibit the mechanism of other drugs i. e. OTC Sudafed and make the condition worse. The appropriate medication for Sally will be a series of intranasal sprays, i.e. , Nasonex (mometasone furoate monohydrate) nasal spray, 18gm/ pack. Selection over the alternatives is superior in the pharmacodynamic action versus other options based on its effective glucocorticoid receptor binding, metabolism, bioavailability, and its role in activating and suppressing the transcription of steroid-dependent genes. This is because the selected medication delivers maximally effective therapy to the affected nasal tissues at the same time reducing systemic adverse effects.
This means that the chosen medication offer stable effect to the nasal tissues, at the same time it is metabolized in the liver. Moreover, the systemic bioavailability of the selected medication is ranked the lowest versus other options, and no bioactive glucocorticoid metabolites have been noted with this option (Ferguson et al. , 2001). Question 2 Advising the patient on self-care is vital as this will alleviate the symptoms and speed recovery. Instructional points included in educating the patient/parents include: Before using the drug, the pump must be primed.
The medication must be shaken well, and the cap removed, and the bottle pumped ten times till a mist appears The right steps to spray must be followed as illustrated and as a physician, and demonstration must be done so that the parents/guardians may follow. Careful attention must be given when spraying such that the medication does not get in contact with the eyes The medication must be used regularly to achieve effective results. This means that it must be used around the same time daily Doses must not be skipped and if skipped should be administered immediately.
Moreover, days should not be skipped even though the symptoms are under control. This medication must be used consistently within the first two weeks. Question 3 Potential side effects and or adverse drug reactions include tiredness, weakness, nausea, low blood pressure, nose bleeds, coughing, headache, sore throats, and headache, viral infection, pharyngitis, epistaxis, slow wound healing, development of glaucoma and/or cataracts, and issues with the immune system thus increasing the infection risk (Merck & Dohme Corp, 2013). Management of the mentioned effects includes: not to use the medication until healing has occurred, and close monitoring must be done for patients taking this medication.
As a medical practitioner, I would expect that my patient may recover well. The worst-case scenarios include Cataracts and glaucoma, Epistaxis, Candida albicans infection, ulcerations, impaired wound healing, and Immunosuppression. I would expect the patient to inform me immediately in case of any issue (Spratto & Woods, 2012). Question 4 Potential drug interactions as from studies have indicated that mometasone furoate is metabolized in the liver. This means that it contains effective glucocorticoid receptor binding, metabolism, bioavailability, and its role in activating and suppressing the transcription of steroid-dependent genes.
Thus, the nasal tissues will be stabilized (Pawankar et al. , 2009). Management includes: Emphasize on the avoidance of upper respiratory infections. This can be done by minimizing contact with people who have colds, frequent washing of hands especially before any meal Proper management of allergies so that the symptoms can be avoided Moistening the sinus cavities by steaming therapy Drinking plenty of fluids and having proper bed rest. Sleeping with the head elevated can help the sinuses in draining and prevent congestion Question 5 I prescribed the Brand name: Nasonex, by Schering-Plough.
There is no generic type of this medication. Question 6 The cost of Nasonex Nasal Spray 1 x 18g Bottle is $80.50 (USD). With medication, no option is available as there are no generic brands. This medication is not on the $4 list available at area stores. Question 7 Results will be achieved in one or two weeks. The patient must be seen after two weeks and in case of any emergency from the side effects. Physical examination is necessary so as to determine the progress.
I would know if the medication has worked if the patient has no nasal symptoms and inflammation, i.e. , nasal congestion and mucus production. Question 8 Should this option fail, alternative treatment plans include: Antibiotics- to eliminate the bacterial symptoms of a cold Analgesics- pain reliever Saline irrigation- improve nasal comfort Topical glucocorticoids- decreases mucosal inflammation thus improving sinus drainage Question 9 If the patient is pregnant, the dosage plan will change to little or none. This medication falls under category C. approaching this medication with a pregnant patient will be dependent on her medical condition at the point.
If in dire need, then she will take it but with minimal dosage, I will recommend bed rest and the consumption of fluids (Rajendran, 2010).
Ferguson BJ, Paramaesvaran S, Rubinstein E. A study of the effect of nasal steroid sprays in perennial allergic rhinitis patients with rhinitis medicamentosa. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: PUBMED 11555762. DOI: 10.1067/mhn.2001.117717. CN-00356390. Issue 3. http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/390/CN-00356390/frame.html
Merck Sharp & Dohme Corp (2013). About NASONEX. NASONEX (mometasone furoate monohydrate). Retrieved July 16, 2014, from http://www.nasonex.com/nasx/index.jsp
Pawankar, R., Holgate, S. T., & Rosenwasser, L. J. (2009). Allergy frontiers. Tokyo: Springer.
Rajendran, R. (2010). Shafer's textbook of oral pathology. S.l.: Reed Elsevier.
Spratto, G. R., & Woods, A. L. (2012). Delmar nurse's drug handbook: The information standard for prescription drugs and nursing considerations. Clifton Park, N.Y: Delmar Cengage Learning.