Unit 6 on Case Studies
Case Study 6/1: CHEMOTHERAPY-INDUCED NAUSEA & VOMITING
The specific goal for S.B treatment is concurrent chemoradiation which includes the combination of chemo and radiation. This will improve his quality of life and hasten treatment unlike the use of one treatment.
S.B will use etoposide and either carboplatin or cisplatin.
The parameter to use to measure the success of concurrent chemoradiation is significant shrinkage of tumors. The cancer is expected to shrink until it is invisible on imaging tests.
Chemoradiation poses the patient to different side effects. The health professional will thus educate S.B on what to expect after the procedure. For example, S.B have nausea and vomiting and the goal for the health professional is preventing or reducing nausea. Educate the patient on self-relaxation techniques to reduce nausea by encouraging and providing with audiotapes with relaxation techniques. Educate on the best foods to eat and what to avoid as well as the need to eat the food at room temperature or cold. For example, S.B should avoid eating foods that are hard to digest like fried foods, spicy foods and other high-fat foods.
Giving cisplatin 100 mg/m2 may result to several side effects. It is associated with more severe vomiting and nausea and nephrotoxicity, ototoxicity, and neurotoxicity can be replaced by carboplatin which have less nonhematologic toxicity.
The choice of second-line therapy will be based on best supportive care (BSC) through use of Topotecan the only licensed drug in Europe and US.
The alternative medicine for S.B is carboplatin 300 mg/m2 iv on day one.
The major risk to late-stage small-cell lung cancer is smoking cigarrete and the best lifestyle change is preventing the smoking onset and smoking cessation strategies. S.B requires to be health-conscious by remaining as lean as possible, remaining physically active, limit the consumption of salt, red and processed meat, and energy dense foods, and consumes more plant-based foods. Limit the consumption of alcohol and avoid sugary drinks.
Cisplatin and carboplatin which are platinum alkylators increases the tendancy of other drugs to cause kidney toxicity. Combining with etoposide may result to reduction of blood cell counts resulting to bleeding or anemia. Etoposide delays the impact of blood thinners inhibiting the clotting process.
CASE STUDY 6/2: PUD
The specific goal for J.C. treatment is to relief him from discomfort and protects the gastric mucosal barrier to promote healing.
The best drug therapy for J.C. is standard triple therapy due to low clarithromycin resistance. The therapy will include PPI, amoxicillin 1 g, and clarithromycin 500 mg (Biaxin) twice daily for 10 days or PPI, clarithromycin 500 mg, and metronidazole 500 mg (Flagyl) twice daily.
To determine the success of standard triple therapy, J.C. requires a serologic test. The Serologic antibody testing will detect immunoglobulin G specific to H. pylori in serum. Another test that can be used is stool monoclonal antigen tests to detect if he has any active infection. This should be conducted after two weeks of using therapy.
Being that J.C. is a 20 pack-year smoker, he should be educated on the impact of smoking on PUD. Smoking and nicotine stimulate basal acid output which worsen PUD. It also elevates the concentration of bile salt reflux rate and gastric bile salt inducing laceration. J.C. should be educated on the significant of quitting or reducing cigarette use. Guiding J.C. on foods that will assist the healing of the ulcer while avoiding foods and beverages irritating or causing stomach acid.
The adverse reactions for the therapy include headaches, changes in tastes, stomach upsets, vomiting, nausea, and diarrhea.
The second line therapy would be the use of concomitant therapy through Non–bismuth-based quadruple therapy. The regime will comprise of PPI, amoxicillin 1 g, clarithromycin 500 mg, and tinidazole 500 mg or metronidazole 500 mg twice daily for 10 days.
J.C. requires changing his dietary and lifestyle changes. For example, he should reduce the intake of coffee by consuming moderate caffeine daily and not 5 cups. Dietary choices like use of foods with high fibers like peas, dried beans, legumes, peanut butter, oatmeal and oat bran, fruits and vegetables. At least eat dinner more than an hour before going to bed.
Non–bismuth-based quadruple therapy (concomitant therapy) is very effective in individuals with dual antibiotic resistance to metronidazole and clarithromycin. Besides, the patient is provided with one unnecessary antibiotic which can increase global antimicrobial resistance.
CASE STUDY 6/3: CONSTIPATION
The specific goal for C.J. is to relieve her from the cause of constipation as well as promoting predictable and regular bowel movements.
Polyethylene glycol which is an osmotic laxative used as first-line therapy is best for C.J because it is a laxative for maintenance treatment ad fecal dismpaction.
C.J should pass soft formed stool without straining
Educate C.J on Polyethylene glycol side effects including severe stomach pain, choking gaggling, omitting, nausea, headaches, and others.
Adverse reactions of Polyethylene glycol include increased sweating, dizziness, upset stomach, gas and bloating.
The second line therapy is use of secretory laxatives mostly senna and bisacodyl
Alternatively, C.J may use lactulose
The first line approach includes fiber supplementation to improve stool frequency by consuming approximately 20 to 25g. Fiber in foods is present in stems and leaves of plants as well as the bran of whole grains. Additionally, the patient should exercises regularly and increase their water consumption .
Laxatives greatly affect the efficacy of all drugs and should be taken at least two hours before or after meals.
CASE STUDY 6/4: TRAVELER’S DIARRHEA
There are two goals to treat traveller’s diarrhea: rehydrate the patient and stop the running stool.
The best therapy for T. is Antibacterial drugs in chemoprophylaxis like Fluoroquinolones
A reduction of the frequency to pass stool. Change to consistency of stool from running stool to normal consistency. Vomiting and nausea symptoms fade.
Educate T. regarding the selection of foods and beverages by applying the aphorism “Boil it, cook it, peel it, or forget it
Fluoroquinolones increases the rate of fluoroquinolone resistance, and in particular while treating Campylobacter species.
The second line therapy for T would be azithromycin at I dose of 500mg.
T requires taking combination of an antimotility agent and antibiotic. This is because it will provide symptomatic relief and reduce bowel-movement.
The preventive standard and lifestyle change for travelling diarrhea require application of aphorism “Boil it, cook it, peel it, or forget it” while travelling to high-risk areas. Other strategies include avoiding undercooked seafood and meat, unwashed raw vegetables and fruits, and untreated water.
T have bloody stool and thus the antimotility agents may not eradicate the problem.
CASE STUDY 6/5: IRRITABLE BOWEL SYNDROME
The specific goal is to relief S.C. from symptoms of irritable bowel syndrome. For example, eradicating intermittent diarrhea and cramping through modulation of persistent visceral hyperalgesia.
The drug therapy of choice is Mebeverine and hyoscine through the use Antispasmodic drugs. Due to diarrhea loperamide is prescribed
Relieves the patient from intermittent diarrhea and cramping
Regular exercise in combination to dietary changes including low-FODMAP diet, soluble fibers like psyllium, avoiding excess alcohol and caffeine, avoiding trigger foods, and avoiding trigger foods.
Constipation and dry mouth
Cisapride (Propulsid), a promotility agent
Peppermint oil which provides anesthetic properties to relax smooth muscle spasticity and relieve nausea
Educate on relaxation strategies, stress management, reassurance, fiber intake, exercise, guar gum and take more fluids.
Adverse reactions include ischemic colitis, severe constipation, and possible deaths.
CASE STUDY 6/6: EXACERBATION OF ULCERATIVE COLITIS
Use topical mesalazine because it induces and maintains remission
One parameter is induction of remission through local topical activity at the inflamed mucosa. Other parameters include reduction of systemic absorption and increasing drug delivery to the affected colon.
Diarrhea and colitis flare, and rash, lethargy and constipation
oral prednisolone 40 mg daily
Stress management, taking nutritional supplements and avoiding trigger foods
Avoid drugs that contains sulfasalazine, olsalazine, and balsalazide
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