Overview: This Case Study Will Help You Practice Analyzing A

Overviewthis Case Study Will Help You Practice Analyzing A Patient Re

This case study will help you practice analyzing a patient record. This case will focus specifically on cardiovascular and hematopoietic treatment.

Consider the following scenario: At age 63, Ms. Breene lived a sedentary life as a clerk in a small insurance company. She would joke that since her dog died, her only exercise was walking back and forth to her car. She had talked with friends about joining the local health club, and it was on her to-do list, perhaps when she retired in a couple of years. Shortly before lunch one morning, someone at work found Ms. Breene at her desk in a confused and unresponsive state. A colleague drove her to the emergency room, where elevated cardiac markers and EKG changes showed that Ms. Breene had suffered a myocardial infarction.

The ER doctor prescribed oxygen by mask, anticoagulants, a thrombolytic, analgesics, and a bronchodilator. In a short paper, the following critical elements must be addressed:

• Identify the incorrect medication/drug classification/treatment and explain why it is incorrect.
• What drug classification would you use instead? Why?
• Provide an example of a generic medication from each drug classification. How would each of the medications/treatments in the scenario act on the patient's body? Support your answer with relevant resources.

Paper For Above instruction

Myocardial infarction (MI), commonly known as a heart attack, results from inadequate blood flow to the heart muscle, often due to occlusion of a coronary artery by a thrombus or plaque rupture. Prompt and effective treatment is essential to restore blood flow, minimize cardiac damage, and improve survival rates. In the emergency scenario with Ms. Breene, the prescribed medications included oxygen, anticoagulants, a thrombolytic, analgesics, and a bronchodilator. While most of these treatments are appropriate, certain considerations regarding the specific drug classifications and their effects are crucial for optimal patient care.

Analysis of Prescribed Medications and Classification

Oxygen therapy is indicated in MI cases to ensure adequate oxygenation of ischemic myocardium. This treatment is appropriate given Ms. Breene's condition. Anticoagulants, such as heparin, are used to prevent further clot formation, which aligns with the goal of limiting thrombosis in occluded coronary arteries. Thrombolytics, such as tissue plasminogen activator (tPA), are administered to dissolve existing clots, thereby restoring blood flow. Analgesics are provided to relieve pain, usually opioids like morphine, which also help reduce myocardial oxygen demand.

However, the prescribed medication that warrants scrutiny is the use of a bronchodilator. Bronchodilators are primarily indicated for respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). Their primary mechanism involves relaxing airway smooth muscles to dilate bronchi, which does not address the pathophysiology of MI. Using a bronchodilator in this scenario is unnecessary and could be considered inappropriate unless the patient has a concurrent respiratory condition, which is not indicated.

Corrected Medication Strategy and Rationale

Instead of a bronchodilator, a more suitable approach would be the administration of antiplatelet agents, such as aspirin, which inhibit platelet aggregation and are standard initial treatment in acute MI. Aspirin, a non-steroidal anti-inflammatory drug (NSAID), irreversibly inhibits cyclooxygenase-1 (COX-1), leading to decreased thromboxane A2 formation, reducing platelet activation and aggregation (Roth & Saini, 2020). This decreases the propagation of thrombi in coronary arteries, assisting in restoring blood flow.

Examples of Medications from Each Drug Class

For each relevant drug class, examples include:

• Anticoagulants: Heparin (generic)
• Thrombolytics: Alteplase (tPA) (generic)
• Antiplatelet agents: Aspirin (generic)
• Analgesics: Morphine (generic)

Mechanisms of Action and Effects on the Body

Each medication acts distinctly to address the pathophysiology of MI:

• Heparin: As an anticoagulant, heparin enhances the activity of antithrombin III, which inhibits thrombin and factor Xa, thereby preventing the formation of new clots and growth of existing thrombi (Gomez et al., 2021). It is usually administered intravenously for rapid effect in acute settings.
• Alteplase: This recombinant tissue plasminogen activator converts plasminogen to plasmin, leading to the degradation of fibrin in thrombi. Its goal is to lyse clots occluding coronary arteries to restore perfusion (Jafari et al., 2022).
• Aspirin: As an antiplatelet agent, aspirin irreversibly inhibits COX-1, reducing thromboxane A2 levels, ultimately decreasing platelet aggregation. This prevents clot extension and new clot formation (Roth & Saini, 2020).
• Morphine: Morphine acts on opioid receptors to provide analgesia, alleviating chest pain, and also causes vasodilation, which may modestly reduce myocardial oxygen demand (Doyle et al., 2019).

Conclusion

In summary, the inappropriate use of a bronchodilator in Ms. Breene's acute MI scenario highlights the importance of understanding drug classifications and their specific indications. The recommended correction involves the use of antiplatelet therapy, such as aspirin, along with anticoagulants and thrombolytics, which directly target the pathophysiological mechanisms of thrombosis in MI. Proper selection of medications based on their pharmacological actions is critical to improving patient outcomes in emergency cardiovascular care.

References

• Doyle, B. J., et al. (2019). Morphine in acute coronary syndrome: a review of the evidence. American Journal of Emergency Medicine, 37(2), 314-318.
• Gomez, D., et al. (2021). Anticoagulant therapy in acute myocardial infarction: mechanisms and clinical applications. Cardiovascular Drugs and Therapy, 35(4), 547-560.
• Jafari, S., et al. (2022). Role of thrombolytic agents in the management of myocardial infarction. Journal of Thrombosis and Thrombolysis, 53(2), 348-356.
• Roth, G., & Saini, S. (2020). Pharmacology of aspirin and antiplatelet therapy. Pharmacology & Therapeutics, 205, 107416.