REPLY TO 2 discussion posts :
The posts to reply to are as below – must reply to each of them offering another way to treat the patient besides what they have listed and information about the condition as well
Each student answers a question and you must reply to two of the posts here are the two discussion post that you have to reply to
Reply to TWO Discussion post for acute snd critical care class
Week 15 Discussion: Common Health Problems
Acute & Critical Care Pharmacology
#1
Question 1
You are managing a 25-year-old male with what you feel to be a tension headache. What is your clinical decision making and rationale on pharmaceutical management? What aspects are important to consider when making decisions on drug choice?
A tension type headache is one of the most common types of headaches that individuals suffer from however, its causes are not understood very well. Individuals who suffer from tension type headaches typically present with complaints of a mild to moderate pain in their head that feels like a tight band around their head. The feelings of tightness that these individuals experience are typically across the forehead and/or on the sides and back of their head. Individuals suffering from a tension type headache may have tenderness noted on their neck, in their shoulder muscles, and on their scalp. Tension type headaches are typically categorized into two different categories episodic and chronic (Ashina et al., 2021). Episodic tension type headaches can last anywhere from 30 min to 1 week. This episodic headache episodes are frequent and typically occur less than 15 days a month for at least 3 months. Individuals who experience these frequent episodic tension type headaches more than likely end up of having chronic tension type headaches. Chronic tension type headaches can last hours and can be continuous in nature (Ashina et al., 2021).
Upon initial assessment, these patients are often times hard to distinguish between a tension type headache and a migraine and more often than not, individuals who suffer from episodic tension type headaches tend to also have migraines. One thing to keep in mind is that tension type headaches typically do not cause visual disturbances, nausea, or vomiting like migraines tend to do. Tension type headaches are also not worsened via physical activity like migraines are. Bentivegna et al., (2021, P.1) stated, “Tension-type headaches are the most common primary headache disorder with a prevalence of up to 78% in general population and huge expenses in terms of health service. Despite its high incidence and impact on life’s quality the knowledge on the pathophysiology and efficacious treatment of TTH was still limited.” Given the available data, the recommend treatment is with simple analgesics such as nonsteroidal anti-inflammatory drugs or aspirin for patients with pure episodic tension type headaches (Bentivegna et al., 2021).
For this 25-year-old male patient presenting with signs and symptoms of a tension headache, I would assume that he is experiencing Episodic type tension headaches and would initially prescribe him Ibuprofen 400 mg PO as a single dose when he experiences this episodic headaches. Taylor (2020, P.2) stated, “NSAIDs are mainstays of acute tension type headache therapy. They are effective and are less likely to lead to medication overuse headache than other commonly used analgesics, such as butalbital, acetaminophen, and codeine.” In the event of this patient failing this prescribed therapy, Diclofenac 25 mg PO daily can be used as an alternative. When acute treatment of tension type headaches are ineffective, several important possible causes should be considered. On concern, that is least likely however should be considered and ruled out, is that the headache descriiption is consistent with tension type headaches, but the pathophysiologic mechanism is due to a secondary headache etiology, such as a brain tumor. Acetaminophen and aspirin can also be considered rather than NSAIDs or Diclofenac however, at least five trials have found that NSAIDs are more effective than acetaminophen. If these over-the-counter analgesics continue to fail, and the patient has had other causative factors ruled out, the suggestion would be to use caffeine 130 mg combined with simple analgesics for patients with suboptimal response to monotherapy with simple analgesics such as a NSAID or acetaminophen. A reasonable choice is a single dose of two tablets of combined acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg. Current guidelines strongly do not recommend the use of opioids or butalbital as initial therapy for tension type headaches. The use of butalbital for patients with tension type headaches may be considered in situations where NSAIDs are relatively contraindicated or when simple analgesics with caffeine are ineffective. Tension type headache treatment is typically patient specific and tailored to understanding the pathophysiology behind the tension type headaches and is the key to formulating a mechanistically sound, optimum treatment plan (Taylor, 2020).
References
Ashina, S., Mitsikostas, D. D., Lee, M. J., Yamani, N., Wang, S.-J., Messina, R., Ashina, H., Buse, D. C., Pozo-Rosich, P., Jensen, R. H., Diener, H.-C., & Lipton, R. B. (2021). Tension-type headache. Nature Reviews Disease Primers, 7(1). https://doi.org/10.1038/s41572-021-00257-2
Bentivegna, E., Luciani, M., Paragliola, V., Baldari, F., Lamberti, P. A., Conforti, G., Spuntarelli, V., & Martelletti, P. (2021). Recent advancements in tension-type headache: A narrative review. Expert Review of Neurotherapeutics, 21(7), 793–803. https://doi.org/10.1080/14737175.2021.1943363
Taylor, F. R. (2020, November 10). Tension Type Headaches in Adults: Acute Treatment. UpToDate. Retrieved from https://www.uptodate.com/contents/tension-type-headache-in-adults-acute-treatment
Second post to reply to
#2
2 You are managing a 21-year-old male with a corneal abrasion subsequent to a metallic foreign body. What is your clinical decision making and rationale on pharmaceutical management? What aspects are important to consider when making decisions on drug choice?
A corneal abrasion is a fairly common reason for an individual to seek medical attention. Corneal abrasions occur when there is a disruption to the corneal epithelium as a result of trauma, foreign bodies, contact lens-related, or may occur spontaneously (Domingo et al., 2022). In the case of this 21-year-old male, a metallic foreign body is the cause of his abrasion. It is critical that the foreign body be removed after an anesthetic is applied, however, this will likely be done by an ophthalmologist or other specialist. Jacobs (2022) recommends that this occur within 24 hours. An important factor is the possibility of infection. One study showed 14% of foreign bodies (the majority being metallic) cultured positive, with the major pathogen being coagulase negative Staphylococcus (Jacobs, 2022). Therefore, it is suggested that all foreign body abrasions be treated empirically with broad spectrum antibiotics. An ointment is recommended over drops because it acts as a lubricant to reduce disruption of remaining and newly generated epithelium (Jacobs, 2022). When deciding on an antibiotic, it is important to consider the type of abrasion and its cause. It would also be important to distinguish whether he wears contact lenses or not. Domingo et al. (2022) explain that for patients who wear contact lenses, the antibiotic ointment or eye drop should cover Pseudomonas such as ciprofloxacin or ofloxacin. If the patient does not wear contact lenses then erythromycin should be applied four times per day for three to five days (Jacobs, 2022). A 1-centimeter ribbon should be applied into the affected eye up to 6 times daily depending on how severe the abrasion is (Lexicomp, n.d). There are no significant side effects for this drug besides mild erythema or irritation (Lexicomp, n.d.). The patient should also be advised to finish the antibiotic regimen, but not to use the ointment for longer than prescribed.
Corneal abrasions may also be very painful. For a small abrasion covering less than one-fourth of corneal surface area, oral ibuprofen may be used or a topical NSAID such as diclofenac. Larger abrasions may require opioid therapy for 1-2 days such as acetaminophen-oxycodone. Cycloplegic drops may be required for large abrasions causing ache and photophobia. Cyclopentolate 0.5 to 1% one drop twice daily may be used to inhibit the miotic response to light (Jacobs, 2022). Due to side effects of cycloplegics and their effects on vision, such as difficulty with reading they are typically utilized for 1-2 days only (Domingo et al., 2022). Additionally, cyclopentolate would be the standard choice due to its short duration of action (Domingo et al., 2022).
References
Domingo, E., Moshirfar, M., Zabbo, C.P. (2022). Corneal Abrasion. StatPearls. StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK532960/
Jacobs, D. (2022). Corneal abrasions and corneal foreign bodies: Management. UpToDate. Retrieved from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/corneal-abrasions-and-corneal-foreign-bodies-management?search=corneal%20abrasion%20treatment&source=search_result&selectedTitle=1~89&usage_type=default&display_rank=1#H7154919
Lexicomp. (n.d.). Erythromycin (ophthalmic): Drug information. UpToDate. Retrieved from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/erythromycin-ophthalmic-drug-information?search=erythromycin%20eye%20ointment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1&showDrugLabel=true#F8089538
