You are to choose 2 different drugs that treat different diseases, disorders, or

Question

You are to choose 2 different drugs that treat different diseases, disorders, or conditions. The drugs you choose also must be used to treat a condition, disorder, or disease that mainly effects one of the body systems. In your paper, you need to discuss and detail many aspects of the drug such as what disease, disorder, or condition it treats and how does it do it and how does it work. What does the drug target? What system? What organ or organs? What possibly cell types, pathways, or receptors? What are some of the side effects of this treatment? Success of the drug or treatment? Has to be minimum 4-5 pages double spaced typed

Explanation / Answer

CASE 1:

A 26-year-old female patient, admitted in our hospital for chief complaints of intermittent cough with sputum since 7 to 8 days, fever on and off, right side pleural chest pain, dyspnea on exertion since 4 to 5 days and generalized weakness. Patient had history of Stevens-Johnson Syndrome with allergic history to tetracycline and ibuprofen at the age of four, with no previous history of diabetes or hypertension. On general examination, patient was febrile (98.60 F), thin built, eye lashes were absent, pulse 80 beats/minute, blood pressure- 120/80 mmHg and with respiratory rate of 36 breaths per minute. Systemic examination revealed, respiratory system: Right infra scapular bronchial breathing sound, cardiovascular system: Normal S1 S2, per abdomen soft and non tender, central nervous system: Conscious and oriented. A chest X-ray was advised and report revealed pneumonia of the right middle and lower lobe. Patient was further investigated for routine blood tests for hemogram, ESR, sputum, acid fast bacilli (AFB), fecal occult blood (FOB). Bronchoalveolar (BAL) and sputum sample was sent for routine microscopy. Gene expert study along with antinuclear antibody (ANA) and sputum sample was sent for routine microscopy. Gene expert study along with antinuclear antibody (ANA) blot assay was advised. Laboratory reports showed hemoglobin 9.5 g/dL (low), white blood cells 11000 per mm3, platelet count 2.4 lakhs/Cumm, erythrocyte sedimentation rate (ESR)- 21 mm/hr, renal function test(RFT) and liver function test (LFT) were within normal limits. Tuberculin test (T.T), sputum acid fast bacilli (AFB) and antinuclear antibody (ANA) blot test were negative. and was noted that the Pseudomonas aeruginosa isolated from sputum and BAL was MDR with intermediate sensitivity to meropenem, imipenem- cilastatin, cefepime, piperacillin-tazobactam.

The treatment with Elores was started on the basis of culture and sensitivity report and based on improving condition of the patient. Elores was continued for 7 days and repeat chest X-ray, culture and sensitivity of sputum sample was advised. Chest radiography revealed significant resolution of pneumonic patches. Sputum sample showed no growth for Pseudomonas aeruginosa. Patient was discharged and advised to continue the Elores therapy along with with supportive medications to reduce the chances of recurrence. Follow up was advised post 6 days of discharge. No relapse with marked improvement in general condition was noted when the patient visited out patient department on 7th day post discharge

Dosage and frequency of Drug:

Injection Elores 2gm per dose BID for 7days of course was Administered

Mechanism of Action of Elores

bactericidal action against both gram positive & gram negative organisms by inhibiting bacterial cell wall synthesis. Ceftriaxone inhibits transpeptidase & thus prevents cross linking of bacterial cell wall. Transpeptidase & associated proteins constitute various types of specific binding proteins which have affinity for cephalosporins like Ceftriaxone.

Pharmacokinets of Elores

Absorption: Orally not well absorbed & should be given parenterally, Distribution: widely distributed & good CSF penetration, Metabolism: A portion of the drug is metabolized in the body. Excretion:
Excreted through urine & bile. A small portion of drug appears in breast milk.

We have seen mild side effects such mild nausea weakness after Elores Administration that was not making any changes of patient condition

CASE 2:

A 36-year-old woman initially presented to her rheumatologist with active bilateral synovitis in her hands, wrists, and ankles, and nodules on her left elbow. Her laboratory results were as follows:

C-reactive protein (CRP) = 5.7 mg/dL (normal: 0.1–0.9 mg/dL)

Erythrocyte sedimentation rate (ESR) = 38 mm/h (normal: 0–15 mm/h)

Rheumatoid factor (RF) = 344 (normal: 0–29 IU/mL)

Cyclic citrullinated peptide (CCP) = 90 (normal: 0–20)

Other parameters within normal limits

A radiography revealed small erosions in both feet. She was subsequently diagnosed with moderate rheumatoid arthritis (RA) and started on methotrexate (MTX) at 10 mg/week, which was then increased to 15 mg/week. At her next visit, she reported some symptomatic relief after a few weeks of treatment. After 3 months, however, she visited her rheumatologist, presenting with stiffness, pain, and swelling in her wrists. Her sedimentation rate was elevated, and she complained that she could not be fully productive at work because of joint pain.

we have selected to methotrexate In clinical trials, patients treated with a biologic agent plus methotrexate have experienced significantly better clinical and radiologic outcomes compared with patients treated with methotrexate alone. Like TNF-? inhibitors,

Methotrexate is a folic acid derivative and a folic acid antagonist. In the cell it is a competitive inhibitor of the dihydrofolate reductase. The inhibition of the reduction of dihydrofolate to tetrahydrofolate causes blocking of the DNA synthesis and the cell replication through the inhibition of another enzyme. If there are high concentrations of methotrexate in the cell over a long period of time, methotrexate-polyglutamates develop that cause a lengthy folic acid antagonism.

Dosage: initially 10mg per week gradually increased to 15mg

Absorption:Oral absorption is dose dependent in adults and leukemic pediatric patients. In adults, peak serum levels are reached within one to two hours. At doses of 30 mg/m^2 or less, methotrexate is generally well absorbed with a mean bioavailability of 60%. At doses greater than 80 mg/m^2, the absorption of the doses is significantly less due to a saturation effect.

Volume of distribution

0.18 L/kg [initial volume of distribution (Vd)]

0.4 - 0.8 L/kg [steady state Vd] Methotrexate competes with reduced folates for active transport across cell membranes by means of a single carrier-mediated active transport process. At serum concentrations greater than 100 micromolar, passive diffusion becomes a major pathway by which effective intracellular concentrations can be achieved. Methotrexate does not cross the blood-brain-barrier.

Protein binding

50% bound to protein, primarily to albumin

Metabolism

Methotrexate undergoes hepatic and intracellular metabolism to polyglutamated forms which can be converted back to methotrexate by hydroxylase enzymes. These polyglutamates act as inhibitors of dihydrofolate reductase and thymidylate synthetase. A small amount of metabolism to 7-hydroxymethotrexate may occur at doses commonly prescribed. Furthermore, intestinal flora partially metabolizes methotrexate after oral administration.

Route of elimination

Renal excretion is the primary route of elimination and is dependent upon dosage and route of administration. IV administration, 80% to 90% of the administered dose is excreted unchanged in the urine within 24 hours. There is limited biliary excretion amounting to 10% or less of the administered dose.

Half life

Low doses (less than 30 mg/m^2): 3 to 10 hours; High doses: 8 to 15 hours.

Clearance

Methotrexate clearance rates vary widely and are generally decreased at higher doses. Delayed drug clearance has been identified as one of the major factors responsible for methotrexate toxicity.

Toxicity

Symptoms of overdose include bone marrow suppression and gastrointestinal toxicity. LD50=43mg/kg(orally in rat).

Affected organisms

Humans and other mammals

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