1WK 4 Discussion: antibioticsEric Johnson is a 21-year-old Caucasian male who is in his senior year of college. The patient has a history of seasonal allergies. He does not remember what his allergist told him to take for his allergies in the past. He wants to know what he can take. He presents to the clinic today with complaints of a stuffy nose, shortness of breath, fever TMAX 102 at home, anda productive cough. He also notes that over the past few months he has also noticed a watery discharge and burning when he urinates. He does admit to having unprotected intercourse last month. He undergoes rapid testing and a chest x-ray while in the clinic. His diagnoses are pneumonia, chlamydia, and seasonal allergies. Clinic Vital Signs: BP 125/75, HR 116, Temp 102.5, O2 94%. Hehas no known drug allergies. Q1. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and the initial starting dose.

Mr. Johnson’s assessment findings require immediate

intervention and education. The CDC has recently updated STI

treatment guideline in 2021. The CDC (2022) recommends

Doxycycline, 100mg po bid for 7 days. Next in line is

Azithromycin, 1gram po in a single dose, or Levofloxacin,

500mg orally q day for 7 days. Interestingly, treating men with

azithromycin vs doxycycline has shown been shown in clinical

trials to fail and the failure rate for rectal chlamydia drops

>25% if azithromycin is used over doxycycline (Centers for Disease

Control and Prevention [CDC], 2022).

Best practice for treating pneumonia. We do not know what

bacteria grew for the pneumonia diagnosis; however, the first

line treatment of pneumonia is macrolide or doxycycline for

patients without comorbidities (Grief & Loza, 2018)

Best practice for seasonal allergies. Intranasal glucocorticoids

(corticosteroid) are the best choice for seasonal allergies

according to Rosenthal and Burchum (2021). Monotherapy

using an intranasal glucocorticoid for seasonal allergies is

recommended for adult patients (Emeryk et al., 2019).

Clinical decision:

Doxycycline (generic), Vibramycin (trade), 100mg po bid for 7

days will cover both chlamydia and pneumonia.

Fluticasone Propionate (generic) Flonase (trade), 2 sprays

(50mcg) in each nare daily starting dose (Ilyina et al., 2019).

Q2. Please discuss the mechanism of action of each of the

drugs you listed.

Doxycycline: Broad spectrum antibiotic suppresses bacterial

growth by binding to the 30S ribosomal subunit inhibiting the

transfer between RNA and mRNA (Rosenthal & Burchum, 2021). Inhibits

bacterial synthesis of proteins suppressing the replication and

growth of bacteria rather than killing it outright (Rosenthal &

Burchum, 2021). Second line agent.

Flonase: As a glucocorticoid (nasal corticosteroid) Flonase

works to activate the receptors within the cell migrating to the

nucleus to regulate the production of proteins (Rosenthal & Burchum,

2021). The receptor-steroid complex alters the activity by

binding to the chromatin thereby increasing mRNA molecules

specific to the proteins to interrupt the inflammatory process

(Rosenthal & Burchum, 2021). Decreasing inflammatory cells, decreases

mucus secretions.

Q3. Please discuss the side effect profile of each medication

you listed.

Rosenthal and Burchum (2021) lists adverse effects of the

following medications

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