Ten-year-old Leia was taken to the on-call pediatric clinic that collaborates wi

Question

Ten-year-old Leia was taken to the on-call pediatric clinic that collaborates with her pediatrician’s office after a rough night of little sleep with severe wheezing and a frequent, dry cough. During the night, her mother had given Leia albuterol and fluticasone approximately every four hours using an inhaler-spacer delivery method when Leia’s coughing was so bad her sleep was disturbed. This was the pediatrician’s recommended treatment for when asthma symptoms appeared. Leia had had a runny nose for a few days before the coughing began on Friday evening but no fever. When Dr. Skywalker saw Leia at the clinic, her mother told him the wheezing and cough began rather suddenly on Friday evening but Leia had no fever, sore throat, head ache, chest pain, or vomiting. She told the doctor that Leia had a history of asthma since the age of five when she was hospitalized with bacterial pneumonia about the time the family moved to New England from France. Leia was up-to-date on all other routine childhood vaccinations except for the pneumococcal vaccine, which Leia had never received. While in France, she had received the BCG vaccine as it was required in France for entry into preschool. Leia’s asthma appeared to be triggered only by viral respiratory infections. She did not appear to have any other triggers for asthma, including participation in sports. Dr. Skywalker noted that Leia’s oxygen levels were in the slightly low-normal range. After an albuterol nebulizer treatment, her lungs sounded clear and she was sent home. The doctor recommended continuing both albuterol and fluticasone every four to six hours. Leia continued to improve dramatically over the course of that day and she got lots of rest over the weekend. Leia’s mother reduced the albuterol to longer intervals and Leia went to school on Monday, energetic and happy, though she still had a mild residual cough.

Leia started to experience asthma symptoms again. While she was not short of breath, she had a severe, dry, barking cough. Her mother took her to see her pediatrician, Dr. Amidala. Dr. Amidala wasn’t available however, and so Leia saw another pediatrician, Dr. Vader, who diagnosed severe asthma but not pneumonia. After taking Leia’s age, weight, and other factors into consideration, Dr. Vader prescribed the oral steroid prednisone. On Saturday, Leia complained about the steroid medication. She told her mother she didn’t like how it made her feel. On Sunday, Leia had a severe behavioral disturbance that was very uncharacteristic of her. She broke down over a very small problem and even became physically violent. She said the medicine made her feel “frustrated.” Because of Leia’s strong reaction to the drug, her mother checked the prescription instructions to make sure she was giving Leia the right dose.

QUESTIONS

4. How is prednisone different from fluticasone? Is there more of a risk of side effects with prednisone? Why or why not? 5. Besides Leia’s mother possibly giving the wrong dose to Leia, what other types of mistakes could cause Leia to get too much of this medication?

5. Besides Leia’s mother possibly giving the wrong dose to Leia, what other types of mistakes could cause Leia to get too much of this medication?

Explanation / Answer

4. The main difference between Prednisone and Fluticasone -

Yes there is more risk of taking prednisone because it is a systemic steroid. It is absorbed systemically and has effect on multiple organs. Fluticasone is topical so has very low systemic absorption thus lesser side effect.

Common side effect of Prednisone -

5. It releives pain so she might take it in excess. It can cause mood swings and if person feels that her symptoms are improving rapidly then also she may increase har dose. It ia prescribed once in 2 day so she may by mistake take excess dose. If she misses 1 dose then she may take 2 tablet on next schedule so excess drug will be taken.

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