Please Reply to the following 2 Discussion posts:
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DISCUSSION POST # 1 Reply to Elaine
Mr. Johnson is a 21 year old male diagnosed with community-acquired pneumonia, chlamydia, and seasonal allergies. According to Ramirez (2022), the first line of treatment for community-acquired pneumonia is amoxicillin alone or in combination with a macrolide or doxycycline. The treatment for Chlamydia is also a course of doxycycline so I have opted for the combination of amoxicillin and doxycycline for this patient (CDC, 2021). The starting dose for amoxicillin is 1g taken three times a day orally for 5-7 days (Ramirez, 2022). The dose for doxycycline would be 100mg taken twice daily orally for seven days (CDC, 2021). This medication regime can be adjusted if the patient cannot comply with taking medications this frequently. For example, chlamydia may be treated with a single dose of 1g of azithromycin as an alternative to improve compliance, and for pneumonia a single dose of intramuscular Penicillin G may be given (CDC, 2021; Rosenthal & Burchum, 2021).
According to Rosenthal & Burchum (2021), amoxicillin is available as a generic medication with Amoxil and Moxatag as examples of brand names. This medication is a broad spectrum aminopenicillin that functions by weakening the cell wall during bacterial growth targeting transpeptidases and preventing the cross binding between peptidoglycan strands. This mechanism weakens the cell wall and eventually leads to bacteria cell death. Amoxicillin, as with most penicillin’s, is well tolerated with mild adverse effects such as gastrointestinal upset and diarrhea. They also have the potential to cause allergic reactions which can also cross to other penicillins and cephalosporins. Although amoxicillin is one of the three most common antibiotics prescribed and generally well tolerated, the provider should be aware of any medications this patient is taking since there are many medications that may want to be avoided with concurrent use (Mayo Clinic, 2022).
Doxycycline is a long-acting tetracycline (Rosenthal & Burchum, 2021). Generic name is doxycycline, and has several trade names including Vibramycin. Tetracyclines are protein synthesis inhibitors that bind to the A site on the 30S subunit thereby preventing the transfer RNA from binding to the messenger RNA-ribosome complex, and stopping the formation of proteins thereby preventing bacterial growth.
Doxycycline should be given on an empty stomach. This medication can chelate and therefore should not be taken with milk-products and other supplements such as magnesium, calcium, iron, or antacids (Rosenthal & Burchum, 2021). Some side effects of doxycycline are gastrointestinal upset, nausea, and vomiting. If the patient experiences GI upset the medication may be given with food however it will affect the absorption of the medication. Food and supplements that cause chelation should be given one hour before or two hours after the medication. Doxycycline can also cause sun sensitivity increasing the risk for sunburn. The patient should be advised to avoid long periods in the sun and use sunscreen and protective clothing. Doxycycline should not be used with the medication acitretin and the provider should discuss any other medications the patient takes (Mayo Clinic, 2022).
For the patients’ seasonal allergies, I would recommend an over-the-counter medication such as Loratadine, also known as Claritin (Mayo Clinic, 2022). This medication is a second-generation histamine receptor blocker (Rosenthal & Burchum, 2021). It selectively binds to the H1 histamine receptor which blocks histamine from binding and exhibiting its effects. The recommended dose for him is 10mg daily, and this medication has no notable side effects (Mayo Clinic, 2022). This medication should not be taken concurrently with amiodarone, carbamazepine, or pitolisant.
The three medications suggested for this patient should be well-tolerated in concurrent use. In addition to medications suggested for this patient, he should be encouraged to drink plenty of fluids, rest, and provided an incentive spirometer with teaching. He may also use Tylenol for treatment of discomfort or fever. For prevention of pneumonia, I would recommend the patient refrain from smoking and get his influenza vaccination annually (Ramirez, 2022). As far as his Chlamydia diagnosis, I would advise the patient to refrain from sexual intercourse for at least one week and encourage the use of condoms for prevention with regular STI testing if the patient has multiple sexual partners (CDC, 2021). The patient should also advise his sexual partners so they can also be treated. Lastly, this patient should be encouraged to refrain from consuming alcohol while taking these medications and recovering from his illness.
DISCUSSION POST # 2 Reply to Astrid
Eric Johnson (E.J.) is diagnosed with pneumonia, chlamydia, and seasonal allergies. According to Metlay et al. (2019), the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) recommend Doxycycline (Vibramycin) 100 mg by mouth twice daily as one of the standard antibiotic treatment regimens for healthy adults with community-acquired pneumonia. Because doxycycline is a broad-spectrum antibiotic, it is also the recommended first-line treatment for chlamydial infection among adults (Centers for Disease Control and Prevention, 2021). It would be beneficial to prescribe the patient over-the-counter antipyretic and antihistamine, such as acetaminophen (Tylenol) 325 mg by mouth every four to six hours as needed and fexofenadine (Allegra) 180 mg by mouth once a day, respectively (IBM Micromedex, 2022; Johnson & Johnson, n.d).
Doxycycline is in the tetracyclines class of drugs that targets a wide range of gram-positive and gram-negative bacteria. Doxycycline is a protein synthesis inhibitor that possesses bacteriostatic action. It inhibits the growth of bacteria by binding to the A-site on the 30S prokaryotic ribosomal subunit during protein synthesis (Patel & Parmar, 2022). It prevents the binding of transfer RNA to messenger RNA ribosome complex, shutting down protein synthesis and thereby inhibiting bacterial growth. Common side effects include gastrointestinal disturbances such as stomach upsets, diarrhea, nausea, vomiting, tooth discoloration, and photosensitivity (Rosenthal & Burchum, 2021).
Acetaminophen is categorized along with non-steroidal anti-inflammatory drugs (NSAIDs) because it inhibits the cyclooxygenase (COX) pathways (Rosenthal & Burchum, 2021). However, unlike NSAIDs, acetaminophen inhibits the COX pathway in the central nervous system (CNS) but not at the peripheral sites. The reduction of the COX pathway activity leads to the inhibition of prostaglandins in the CNS, resulting in analgesic and antipyretic effects. Some side effects include nausea, stomach pain, loss of appetite, and itchiness. Severe adverse effects associated with acetaminophen are Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, toxic epidermal necrolysis, and liver injury that can result from overdose.
Fexofenadine is a second-generation histamine-1 (H1) blocker that inhibits mast cell, basophilic histamine, and inflammatory cell release (Craun&Schury, 2022). Overall, it blocks the effects of histamine in tissues with H1 receptors, alleviating symptoms of allergic reactions. Fexofenadine does not cross the blood-brain barrier and has less affinity for H1 receptors in the CNS. Therefore, it is less sedating than first-generation H1 blockers. Rosenthal & Burchum (2021) state that fexofenadine provides the best efficacy and safety out of all the second-generation antihistamines currently available. Some side effects include dry mouth, headache, and drowsiness. Even though some studies indicated that fexofenadine is less sedating than the first-generation and other second-generation antihistamines, it may still cause some drowsiness in some people (Huang et al., 2019). Therefore, taking it at night rather than in the morning can avoid daytime drowsiness.
Furthermore, there are no known drug interactions between any of the medications prescribed. However, there are drug and food interactions with doxycycline and with fexofenadine. For instance, doxycycline should not be taken with milk products, calcium, iron, and magnesium supplements, most antacids, which contain aluminum, magnesium, or both, and magnesium-containing laxatives because any of these products can decrease its absorption (Rosenthal & Burchum, 2021). Therefore, it is recommended to take doxycycline one hour before or two hours after products containing calcium, iron, magnesium, and aluminum. It is also important to let E.J. know that doxycycline may cause his skin to be more sensitive to sunlight, resulting in exaggerated sunburn. Fexofenadine interacts with certain fruit juices, such as apple, orange, or grapefruit juices, which can reduce its absorption and therapeutic effects. It is also important to avoid alcohol while taking the prescribed medications as alcohol can cause adverse effects, such as reducing the impact of the doxycycline, leading to liver damage if taken concurrently with acetaminophen, and intensifying the effects of fexofenadine.
It is essential to provide E.J. with non-pharmacological interventions to manage his diagnoses. Performing proper hand-washing, practicing safer sex, and staying home while ill can help reduce the spread and risk of infections. It is also important to note that E.J. should refrain from sex until after the completion of the antibiotic therapy and for his partner to get treated. Other interventions that can help alleviate E.J.’s symptoms include: getting lots of rest, staying hydrated, drinking warm beverages, taking steamy baths and using a humidifier to help open his airways and ease his breathing, performing cough and deep breathing exercises, using an air purifier with a high-efficiency particulate air (HEPA) filter, avoid allergens when possible, and cleaning the living areas regularly to remove allergens.