Assignment
Case Study: Cystic Fibrosis.
1. Problem Identification
• Identify this patient's drug related problems. Include those relating to both her acute medical issues and her chronic CF management.
• What information indicates the disease severity and the need to treat Jenna's acute pulmonary exacerbation pharmacologically?
• Could any of her problems be caused by drug therapy?
2. Desired outcomes
• What are the goals of pharmacotherapy in this case?
3. Therapeutic Alternatives
• What nonpharmacologic therapies might be useful for this patient?
• What pharmacotherapeutic alternatives are available for treatment of this patient's acute pulmonary exacerbation and chronic CF management?
• What economic and psychosocial considerations are important in this patient's acute and chronic CF management?
4. Optimal Plan
• What drugs, dosage forms, doses, schedules, and durations of therapy are best for this patient?
• During the clinical course, serum tobramycin concentration were drawn around the second dose of tobramycin 160 mg (10 mg/kg/dose) IV every 24 hours. Levels are reported as follows:
Random level: 7.4 mcg/mL collected 4 hours
Random level 1.4 mcg/mL collected 10 hours after end of the 30 minute infusion
Based on this new information, evaluate her drug therapy. Calculate the maximum concentration at the end of infusion (Cmax), true trough, AUC, elimination rate, half life, volume of distribution, and clearance (standardized for BSA) of her tobromycin therapy. If necessary, suggest modifications. Assume that the previous doses were administered on time.
• What pharmacologic therapies should be considered for Jenna's chronic CF management?
5. Outcome Evaluation
• What clinical and laboratory parameters are necessary to evaluate the efficacy and safety of therapy for CF exacerbations?
6. Patient education
• What information should you provide the patient regarding the administration of aerosolized drug therapy? The patient will be going home on aerosolized dornase alfa, hypertonic saline, tobramycin, and albuterol.
• Where can you obtain information about the patient assistance programs that are available for children, adolescents, and adults with c f on a national and state local level?