Some diseases come with time and may as well last longer in the human body. However, it is worth considering some drug treatment to allow the affected patients to lie while managing the available syndromes. Such diseases are known as chronic illnesses. One of the primary characteristics of a chronic condition is the fact that the disease affects multiple areas of the human body as opposed to acute illness which interferes with a particular portion only. Even though some of the diseases require psychological intervention, it is worth blending that treatment method with approved drugs to enhance recovery or help patients in coping with the illness.
A mock patient
A typical example of a patient suffering from chronic illnesses is Miss Doreen Lindonin. She is a retired preschool teacher currently living in Edgewood, New Mexico. Lindonin is a female patient aged 67 years. She is suffering from two chronic illnesses, namely arthritis (osteoarthritis) and Alzheimer’s. Two drugs for treating this type of arthritis are Acetaminophen and Duloxetine (Cymbalta). Alzheimer’s treatment, on the other hand, requires Donepezil and Razadyne (Armstrong, 2016). Such drugs need a physician’s prescription and monitoring for the patient to recover.
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Medical problems
Arthritis refers to joint inflammation. The patient described above suffers from a form of arthritis known as osteoarthritis. Some of the issues associated with the disease include stiffness, aching, and swelling of the joints (Shuangling, 2017). The most commonly affected area is Miss Lindonin’s left knee. According to Shuangling (2017), osteoarthritis also causes cartilage. The phenomenon refers to a hard slippery tissue mostly formed at the end of bones where a joint exists. Therefore, the condition leads to a wear and tear of the cartilages.
Alzheimer’s, on the other hand, is a condition which interferes with the brain cells. Miss Lindonin suffers from the inability to function independently. For instance, she forgets recent events since she has a memory impliedness. As it is known, Alzheimer’s affects a person’s ability to remember things and organize thoughts (Shuangling, 2017). The disease, therefore, makes the patient lose track of events, ask questions repeatedly, and routinely misplace possessions.
Acetaminophen
The drug's generic name is Acetaminophen. However, its trade name is Tylenol, for fever or pain. Antipyretic and Analgesic is the therapeutic class of the drug. The medicine also falls under a centrally acting COX inhibitor as its pharmacological class (Shuangling, 2017). Dosage relies on a patient’s age. For Miss Lindonin, for example, 650 mg after every 4 hours works best. However, under some circumstances particularly for immediate release formulation, doctors prefer a dosage of 500 mg after every eight hours (Armstrong, 2016). When administered in the human body, the drug acts as a reducing agent thus prevents a secondary step involved in prostanoid synthesis from occurring. Cyclooxgenase (COX-1 & COX-2) enzymes become weak, hence enhances the production of lipid hydroperoxides. As a result, acetaminophen becomes ineffective and blocks the production of prostaglandins (Shuangling, 2017).
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Relevant Contraindications/Precautions Side Effects |
1. Should not be used with other drugs containing acetaminophen 2. The patient should not take too much alcohol when using acetaminophen to avoid liver damage 3. Should only be taken after meals. Headache, nausea, loss of appetite, and dark urine |
| Common adult dosage & Route(s) of delivery |
-Taken orally in the form of powder, solution or granules - Preferably 650 to 1000 milligrams (mg) every 4 to 6 hours. |
| Patient and Family teaching considerations |
1. One should notify a doctor whenever side effects occur 2. To be used exactly as prescribed by the doctor 3. Avoiding using extra drugs to cover up a mixed dose |
| Priority Nursing Implications |
1. Assess the signs of hepatotoxicity and liver failure before administration 2. It is relevant to ensure that the pains does not feel any pain seven days after the dose 3. Monitor the signs of neutropenia and leukopenia after administration 4. Advise on other non-medical methods of managing chronic illnesses such as exercise and relaxation techniques. |
| Evaluation of Drug Therapy |
Changes that suggest the viability of the drug include: 1. Pain relief in joints 2. withdrawal of symptoms 3. Absence of fatigue |
| Other drugs in the same pharmacologic class | Rofecoxib (Vioxx) and valdecoxib (Bextra) |
Duloxetine
Also known as Cymbalta, duloxetine is another alternative drug for osteoarthritis. The drug’s brand name is Cymbalta while its generic name is duloxetine. Patients take duloxetine orally. For adults, the swallowing may start at 60 mg once daily for one week and then increases to 60 mg daily for the other weeks (Armstrong, 2016). When taken by a patient, the drug increases the amount of dopamine, especially in the prefrontal cortex. After undergoing extensive metabolism, duloxetine binds to the human protein in the plasma. Absorption begins to take place after 2 hours while plasma concentration may take place during the sixth hour after the dose (Shuangling, 2017). The chemical composition after the absorption prevents the reuptake of norepinephrine in the patient’s central nervous system.
| Relevant Contraindications/Precautions |
1. One should not breastfeed a baby when using the drug 2. Avoid use in patients with cirrhosis 3. Avoid use in patients with severe renal impairment |
| Side Effects | Dizziness, constipation, insomnia, and diarrhea. |
| Common adult dosage & Route(s) of delivery |
-Swallowed whole without chewing or crushing - Preferably 30 mg once in a day for two weeks before advancing to the expected 60 mg dose. |
| Patient and Family teaching considerations |
1. The drug increases suicidal thoughts among its users 2. Storage should take place at a room temperature between 59F to 86F 3. There is a need for close observation and communication with the prescriber. |
| Priority Nursing Implications |
1. Assess the preexisting cardiorespiratory conditions before prescribing 2. Asses the presence of suicidal thought after administration. 3. For patients with diabetes mellitus, monitor changes in glycemic control |
| Evaluation of Drug Therapy |
Changes that suggest the viability of the drug include: 1. Pain relief in joints 2. withdrawal of symptoms 3. Absence of fatigue |
| Other drugs in the same pharmacologic class | Fluoxetine, quinidine, and fluvoxamine |
Donepezil
Donepezil is a type of drug aiding in treating people with Alzheimer’s. Its generic name is donepezil while the drug’s brand name is Aricept. Massoud and Léger (2017) confirm that the pharmacological classification of donepezil is a reversible acetylcholinesterase inhibitor. Patients diagnosed with Alzheimer take the drug orally. Individuals can take medicine with or without food, particularly at bedtime. In most cases, it is preferable to dissolve donepezil on the tongue and follow with drinking water (Massoud & Léger, 2017). After the absorption, donepezil reaches a steady state after two weeks — 96 % of the absorbed content bind to plasma protein. Metabolism takes place through the influence of CYP-450 isoenzymes 2D6 and 3A4 (Massoud & Léger, 2017). After that, glucuronidation then takes place.
| Relevant Contraindications/Precautions |
1. Should not be used with patients suffering from the blockage of urinary bladder 2. Avoid diets that cause alkaline urine 3. Should only be taken after or with meals. 4. Not suitable for patients with severe renal impairment. |
| Side Effects | Frequent urination, diarrhea, dizziness, fatigue, headache |
| Common adult dosage & Route(s) of delivery |
-Taken orally in the form of tablets - Preferably 23 mg per day PO for the elderly. |
| Patient and Family teaching considerations |
1. Create awareness regarding the importance of taking the drug as prescribed 2. Emphasize on the importance of follow up exams to monitor the patient’s progress 3. Remind caregivers that the drug causes dizziness and drowsiness. 4. Create awareness that patients should avoid activities requiring alertness |
| Priority Nursing Implications |
1. Assess the history of asthma or pulmonary disease before prescribing. 2. Recommend on the type of exercise and physical fitness required after dosage. 3. Monitor cardiovascular status 4. Assess the patient for S&S of GI ulceration and bleeding |
| Evaluation of Drug Therapy |
Changes that suggest the viability of the drug include: 1. A high level of therapeutic effectiveness noted on the Alzheimer's Disease Assessment Scale 2. withdrawal of symptoms 3. Speech and language improvement |
| Other drugs in the same pharmacologic class | Carbamazepine, phenytoin, and dexamethasone |
Razadyne
Razadyne is an alternative medicine for Alzheimer’s. Its generic name is galantamine while the brand name is either Razadyne of Reminyl. Its pharmacologic classification is reversible, a competitive acetylcholinesterase inhibitor. On the other hand, the drug’s therapeutic classification is cholinomimetic (Armstrong, 2016). The drug is available in both oral solution (4 mg/ml) and tablets (4 mg, 8 mg, 12 mg). At first, adults take 4 mg PO two times a day with food. After the fourth week, the patient advances to 8 mg PO twice daily for another four weeks before considering 12 mg PO twice daily (Massoud & Léger, 2017). The pharmacodynamics of galantamine confirms that the drug increases the amount of acetylcholine in the human brain thus enhancing cholinergic functions. Absorption takes place in about one hour. Eventually, metabolism takes place in the liver by cytochrome P-450 enzymes after the products’ distribution in the blood cells (Massoud & Léger, 2017). Excretion takes place in urine as both metabolite and glucuronide.
| Relevant Contraindications/Precautions |
1. Should not be used when a serious rash develops 2. Use with caution on patients suffering from hepatic disease 3. Used with caution for asthmatic patients. 4. Not suitable for patients with severe renal impairment. |
| Side Effects | Nausea, vomiting, dyspepsia, anorexia, abdominal pain, and diarrhea. |
| Common adult dosage & Route(s) of delivery |
-Taken orally in the form of tablets or solution - Preferably 4 mg PO twice a day after weeks. Adjusted to 8 mg twice a day PO for 4 weeks and finally to 12 mg twice a day PO. |
| Patient and Family teaching considerations |
1. Remind the patient to take the drug with morning and evening meals 2. Advise that the dosage increment should take place after every four weeks 3. Recommend appropriate technique for measuring the solution 4. Remind patients that vomiting and nausea are common side effects of the drug |
| Priority Nursing Implications |
1. Assess the presence of bradycardia during medication 2. Making a follow up on the recommended dosing and administration schedules 3. Monitor cardiovascular status 4. Assess appetite and nutrition pattern. Weigh weekly and report the progress |
| Evaluation of Drug Therapy |
Changes that suggest the viability of the drug include: 1. A high level of therapeutic effectiveness noted on the Alzheimer's Disease Assessment Scale 2. withdrawal of symptoms 3. Speech and language improvement |
| Other drugs in the same pharmacologic class | Memantine, ambenonium, neostigmine, rivastigmine, and tacrine |
Conclusion
Treatment of chronic illnesses does not end at the prescription of the right medicine. It is worth making a follow up to assess the patient’s progress and provide further recommendations. For this reason, it is advisable to focus on patient and family education. Creating awareness regarding the benefits of medical interventions as well as how to deal with side effects play a critical role in addressing the needs of patients suffering from chronic illnesses. Therefore, a well-laid procedure for addressing chronic diseases is necessary to assist in treating Miss Lindonin.
References
Armstrong, J. (2016). Lectures on the morbid anatomy, nature, and treatment, of acute and chronic diseases . [Place of publication not identified]: FORGOTTEN Books.
Massoud, F., & Léger, G. (2017). Pharmacological Treatment of Alzheimer Disease. The Canadian Journal Of Psychiatry , 56 (10), 579-588. doi: 10.1177/070674371105601003
Shuangling, L. (2017). 30 Cases on Moxibustion Treatment for Knee Osteoarthritis. Amur Medical Journal , (3), 65-66. doi: 10.22448/amj.2017.3.65-66
