Pharmacotherapeutic plan of care for a patient

Prescribing Cases Module Seven Case One Complaint: “I think I have a sinus infection.” History: A 24-year-old presents to urgent care with a 2 week history of cough and congestion. They state it started out as a “normal cold” and it will not go away. They complain of a productive cough of green mucous and green nasal discharge, with a low-grade temperature for the past 2 days.

The patient reports an intermittent frontal headache with this cold. They are otherwise healthy, with no known drug allergies. Assessment: Vital signs are stable and temperature is 99.9°F. Tympanic membranes (TMs) are clear bilaterally, pharynx is pink with no exudate, he has greenish postnasal drainage, turbinates are swollen and red, there is tenderness when frontal sinuses palpated, there is no cervical adenopathy, and lungs are clear.

1. What is the pharmacotherapeutic plan of care for a patient with acute bacterial sinusitis?

2. Does the plan change if the patient is penicillin-allergic?If so, what antibiotic would you choose?

3. What non-pharmacologic symptomatic care is recommended for acute bacterial sinusitis?

Case Two Complaint:

“She has been poking at her ear and fussing all night.” History: Samantha is a 7-month-old female who presents with a temperature of 101°F axillary and upper respiratory infection (URI) symptoms for the past 2 or 3 days. The fever has been present only for the past 12 hours. She is taking fluids well and having wet diapers, and the fever is controlled with acetaminophen. She has been healthy since birth.

She was breastfed until age 6 months and is currently being fed commercial iron-fortified formula. Her parents do not smoke, nor is she exposed to significant tobacco smoke. She has been in day care for the past month. Her current weight is 17 pounds. Physical Exam: Her vital signs are all within normal limits, except for an axillary temperature of 101.6°F. Her physical examination reveals the following:

1. Right tympanic membranes (TMs) are a dull opaque pink; left TM is bulging with purulent fluid, greenish coryza; and throat is clear with some green postnasal drip noted.

2. Lymph glands show no adenopathy.

3. Heart has regular rhythm and rate, with no murmur.

4. Lungs show clear breath sounds in all fields, with upper airway congestion.

5. Abdomen is benign.

6. Skin is clear of rashes. Assessment: Acute Otitis Media

1. What would be the initial pharmacologic management plan for an infant with acute otitis media who is in daycare? 2. What would be the pharmacologic plan of care if the parent states “I am allergic to amoxicillin, so I am concerned she may be allergic also” or if the child has “rash” from previous amoxicillin?

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