Medication Management for Allergies- Case Study of a College Student
Q1. Recommended Medications to Start This Patient On
The patient will be treated for chlamydia, pneumonia, and seasonal allergies.
- Drug Class: Antihistamine
- Generic name: Cetirizine
- Trade name: Zyrtec
- Starting Dose: 5 milligrams orally once daily. Max dose of 10 milligrams per day orally (Naqvi & Gerriets, 2021).
- Drug class: Macrolides
- Generic name: Azithromycin
- Trade Name: Zithromax
- Dose: 1000 mg initial dose followed by 500 milligrams once daily for two days to treat both pneumonia and chlamydia (Gautam, J., & Krawiec, 2020).
- Drug class: Antipyretic Analgesic
- Generic name: Acetaminophen
- Trade Name: Tylenol
- Dose: 650 mg orally every 4 to 4 hours to manage fever. The maximum daily dose is 4 grams (Rosenthal & Burchum, 2021).
Q2. Mechanism of Action of Drugs listed
Zyrtec acts selectively at the peripheral histamine H1-receptors (Rosenthal & Burchum, 2021). It blocks the action of histamine primarily on the respiratory tract smooth muscle cells to reverse histamine effects, thus reducing the amount of fluid and, hence, congestion in the airways in allergic rhinitis.
Zithromax binds 50s ribosomal subunits of bacterial DNA, thus inhibiting the synthesis of bacterial proteins. It achieves this by stopping the transit of aminoacyl-tRNA and the elongating bacterial protein at the ribosomal apparatus. It is, therefore, a bacteriostatic agent but bactericidal at higher doses.
Tylenol acts by inhibiting the cyclooxygenase (COX) pathway that synthesizes prostaglandins in the CNS, thus resulting in analgesic and antipyretic action (Rosenthal & Burchum, 2021). The patient has a relatively elevated body temperature which Tylenol will manage.
Q3. Side Effect Profile
Zyrtec has a few uncommon side effects, including fatigue, dry mouth, pharyngitis, and somnolence. Others include hypersensitivity, anemia, and hepatitis (Rosenthal & Burchum, 2021).
Zithromax is also relatively safe with side effects, including QT prolongation and tachycardia, hepatotoxicity, nausea and diarrhea, and hypersensitivity reactions like Steven-Johnson syndrome.
Tylenol adverse drug reactions include possible hypertension and hypersensitivity, usually presenting as on-the-skin toxic epidermal necrolysis (Rosenthal & Burchum, 2021).
Q4. Drug-drug Interaction of medications prescribed
Zyrtec has a low-risk QT prolongation effect; therefore, therapeutic regimens with Zithromax cause additive and significant QT interval prolongation.
Q5. Non-Pharmacological Intervention
Nasal saline irrigation is an important adjunctive treatment to wash out allergens, thick mucus, and other irritants in allergic rhinitis (Dubey & Htay, 2020).
References
Dubey, K. K., & Htay, M. N. N. (2020). Pathophysiology and Non-Pharmacological Management of Allergic Rhinitis. Int Arch Public Health Community Med, 4, 050.
Gautam, J., & Krawiec, C. (2020). Chlamydia pneumonia.
Naqvi, A., & Gerriets, V. (2021). Cetirizine. StatPearls [Internet].
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.
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Question 
Post your answers to the 5 questions corresponding to this week’s primary care medication management content. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)
Medication Management for Allergies- Case Study of a College Student
Eric Johnson is a 21-year-old Caucasian male who is in his senior year of college. The patient has a history of seasonal allergies. He does not remember what his allergist told him to take for his allergies in the past. He wants to know what he can take. He presents to the clinic today with complaints of a stuffy nose, shortness of breath, fever TMAX 102 at home, and a productive cough. He also notes that over the past few months, he has also noticed a watery discharge and burning when he urinates. He does admit to having unprotected intercourse last month. He undergoes rapid testing and a chest x-ray while in the clinic. His diagnoses are pneumonia, chlamydia, and seasonal allergies.
Clinic Vital Signs: BP 125/75, HR 116, Temp 102.5, O2 94%. He has no known drug allergies.
Q1. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and the initial starting dose.
Q2. Please discuss the mechanism of action of each of the drugs you listed.
Q3. Please discuss the side effect profile of each medication you listed.
Q4. Are there any interactions between any of the medications you prescribed?
Q5. What other non-pharmacological interventions would be suggested?