Human populations across the globe are continually grappling with increased pulmonary diseases, which are claiming numerous lives every year. In as much as this is the saddening reality, some of the patients are not yet aware of the manifestations and treatment options of this disease. In analyzing this fact, the writer interviewed on a pulmonary hypertension condition. The interviewer interviewed a 56-year-old man from the state of California who has had pulmonary hypertension for seven years. The conversation paved the way for the writer to obtain the patient’s medical history, drugs and supplements used patient’s knowledge level on medications among other issues. In addition to this, the writer was keen on identifying the pharmacodynamics, pharmacokinetics, side effects among other aspects related to the medicine used by the interviewed patient.
Patient’s Health and Medication History
The patient who was involved in the medical interview reported having been of good health for the best part of his life until he turned 48. At this point in his life, he noticed increased fatigue, dizziness and labored breathing especially after workouts. At first, he ignored these signs which he contributed to old age and increased stress levels in his workplace. The symptoms went on for five months until it became hard for him to concentrate on his work due to constant dizziness and shortness of breath. It is at this point that his employer suggested that he visits a physician since he was becoming a bother to the restaurant's clients.
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On visiting the doctor, he was diagnosed with pulmonary hypertension which was in its initial stages. He realized that the constant shortness of breath and dizziness were warning signs he ignored. The physician informed him that his capillaries and pulmonary arterioles were narrowing fast and advised the patient to take immediate action to arrest the situation. At this point, the patient realized that this disease could be fatal as it makes harder for the blood to flow through one's lungs increasing pressure within the arteries found in the lungs. Consequently, the right ventricle is forced to work harder to ensure blood reaches the lungs which eventually weakens the heart muscles causing it to fail.
Immediately the physician put him on a treatment plan to help him prolong the functioning of his heart. The patient is currently on prostaglandins and endothelium protagonists which are meant to open the arteries and ease the pressure. The prostaglandins that this patient uses is Flolan which are given intravenously or which he inhales on a frequent basis. On the other hand, the endothelium protagonists he uses is Bosentan which he takes by mouth one or two times a day. He has been taking these medications for five years now with the help of his physician. Furthermore, the ethe patient has for three years taking various supplements to help boost the health of his health with Coenzyme Q10 (CoQ10) and L-Carnitine being his supplements of choice. The decision to use these supplements came after consulting with his physician. Additionally, he goes for weekly checkups to monitor how the disease is progressing and from his side, he confirmed significant improvement in his condition.
Patient’s Knowledge Level Regarding Medications and Compliance
It is very vital for any patient with pulmonary hypertension to be well aware regarding the drugs he takes as well as any issue regarding compliance. The reason for adducing to this is the fact that many risks may come if the patients fail to follow the prescribed dosage as well as the route of administration. In case of the interviewed patient, it is right to say that he had been a struggle in the past to strike a balance in the way he took his prescription. The reason for this is that he had not come to terms with his predicament and would at times skip his daily dosage something that almost brought his life to a standstill. However, after numerous attempts by his physician, the interviewee is on track taking his medication as prescribed. He currently takes prostaglandins at frequent intervals through inhaling and endothelium protagonists two times a day. He understands the risk e faces if he is to take the wrong dosage or use the wrong method of drug administration.
Pharmacokinetics and Pharmacodynamics of the Medication
As discussed earlier it is noted that the interviewee who has had pulmonary hypertension for seven years now has the option of using endothelium protagonists and prostaglandins. These medications are essential to this patient as they help to open narrowed arteries to ease the pressure that the heart has to endure. The prostaglandins that are administered intravenously or inhaled while the endothelium protagonists that is Bosentan are taken orally once or twice a day. Dosage for Bosentan’s is usually 600 mg for a single dose or 500mg when to it comes to multiple doses daily (Vizza, Fedele, Pezzuto & Rubin, 2012). More so in the first four weeks, a patient should take 62.5 mg twice daily and after that take 125 mg twice a day for the entire treatment period. When it comes to Flolan, a patient should take 1-2 ng/kg/minute and increase it as per clinical response.
While these medications are helpful to the patient, they possess various uncomfortable side effects as per the patient. Inhaled Flolan may be accompanied by nausea, dizziness, vomiting, flushing, increased coughing, diarrhoea, muscle cramps, and headache among others. In this case, the patient reports a constant feeling of dizziness, headaches and fleeting nauseous moments which he is learning to cope with. On the other hand, it is noted that use of Bosentan by pulmonary hypertension patients may be accompanied by anaemia, itchiness, low blood pressure, diarrhoea, rashes among other adverse effects. The patient in this particular interview reported experiencing most of these side effects with nausea and flushing being the most common contraindications. However, his physician is continuously doing trials to find if he can find other medications with less severe side effects.
Drug interactions are common when it comes to pulmonary hypertension medications, and as such, it is vital for a patient to be aware of the frequent interactions. When it comes to the use of Flolan one needs to know that some prescription, nonprescription and herbal drugs can interfere with its working. One everyday drug interaction may be between Flolan and antiplatelet drugs an example being clopidogrel. Additionally, pain reliever medicines such as aspirin and ibuprofen may interfere with Flolan as they can accelerate bleeding rates as well as increased heart rates. On the other hand, Bosentan reacts with a lot of different medicines. According to Spangler & Saxena (2010), Bosentan interacts with at least 400 different medications including Abstral, Aspirin, Butorphanol among others. The drugs can either slow down the working of these medicines or increase the side effects that are associated with these medications.
The use of Flolan and Bosentan though is helpful to the patient carries with it various safety issues which should be considered keenly to avoid complications. According to ISMP (2011), it was reported that an interruption of Flolan treatment for a patient suffering from pulmonary lead to the death of that patient. The death was because Flolan has a short half-life of around 2.7 minutes meaning that it has to be administered continuously at specified rates. As such, it is crucial for patients opting for this kind of medication to be aware of such existing risks with the use of Flolan. Bosentan just like Folan poses some safety issues though to a lower degree. According to Sohn et al. (2009), a study conducted on Korean patients showed an 8.3 percent cases of a headache and 16.7 percent of patients with increased aminotransferase levels when given the correct dosage.
Possible Interventions Related To Identified Loopholes
During the interview, it was noted that the patient lacked substantial information regarding the efficacy of the two drugs that he was relying upon to ease his suffering. As stated above it is clear that the two drugs that are Bosentan and Flolan have various contraindications as well as side effects which can limit its effectiveness. As such, there is a need for medical researchers to come up with a combination of therapies to ensure that clients get the best out of the treatment process and ensure their longevity. Again, during the interview, it was noted that the patient lacked sufficient knowledge concerning this disease which is reflected in his delay in seeking medical interventions. Furthermore, the client was not aware of the possible side effects of the medication as he thought it was the manifestations of the disease itself. There is a need to form community-based groups which are keen on educating people about this disease to address the situation. The creation of such awareness will help people deal with the disease before it advances to critical stages. On compliance, it was noted that the patient was quite reluctant to comply with a dosage of the drugs at first. However, increased symptoms and physicians directives helped him to stick to the right dosage. To curb this destructive behaviour, it is essential for physicians to ensure that they provide individuals who can monitor the patients on a frequent basis. This kind of monitoring is very vital considering that these drugs require specific dosage and method of administration which if ignored can be fatal.
References
Institute for Safe Medication Practices (ISMP). (2011). Interruption of epoprostenol (Flolan) infusion leads to patient’s death. Dialogue, 3(2011): 29-34.
Sohn, D. et al. (2009). Beneficial and adverse effects of bosentan treatment in Korean patients with pulmonary artery hypertension. Korean Circulation Journal, 39(3): 105–110.
Spranger, M.L. & Saxena, S. (2010). Warfarin and Bosentan interaction in a patient with pulmonary hypertension secondary to bilateral pulmonary emboli. Clinical Therapeutics, 32(1):53-56.
Vizza, C. D. Fedele, F., Pezzuto, B. & Rubin, L. J. (2012). Safety and efficacy evaluation of ambrisentan in pulmonary hypertension. Expert Opinion on Drug Safety , 11(6):1003-1011.
