Influenza Case Study
One: Patient’s drug therapy problems
- Diabetes mellitus
- Hypertension
- Influenza
- Hyperlipidemia
- Pain and fever
Two: Information suggestive of influenza
- High fever (Kudesia & Wreghitt, 2009)
- Muscle and bone ache (Kudesia & Wreghitt, 2009)
- Positive rapid influenza test
- Elevated lymphocyte count
- Non-exudative pharyngeal erythema
- Fatigue (Kudesia & Wreghitt, 2009)
- Diaphoresis
- Non-productive cough and sore throat (Kudesia & Wreghitt, 2009)
- Headache (Kudesia & Wreghitt, 2009)
- Anorexia
- Recent contact with people with clinical features of influenza
Three: Diagnostic tests
There are rapid tests which assay the various antigens on the influenza virus to differentiate the varieties. However, a viral culture is the only way to make a definitive diagnosis of influenza and to differentiate between the varieties (Kudesia & Wreghitt, 2009). Influenza tests are not mandatory for all patients. In case of outbreaks or in high risk patients, clinical criteria are enough to make a diagnosis of influenza
Four: Complications of influenza
- Bacterial pneumonia – DM causes immunodeficiency (Kudesia & Wreghitt, 2009)
- Ear and sinus bacterial infections – DM causes immunodeficiency (Kudesia & Wreghitt, 2009)
- Dehydration – DM is can accentuate the loss of fluids
- Congestive heart failure – acute flu infection can be a cause for decompensation
Five: Goals of pharmacotherapy
- Eradication of influenza
- Prevention of superimposed bacterial infections
- Alleviation of pain, fever, and discomfort
- Maintenance of optimum blood pressure, blood glucose, and blood lipids to prevent the complications that derangement of these parameters can cause
- Reassurance
Six: Antiviral drug options
- Peramivir 600mg IV as a single dose
- Oseltamivir 75mg per oral once daily for 5 days (Whelan, 2015)
- zanamivir 10 mg inhalations once daily for 5 days
Seven: Symptomatic Relief
For the patient’s pain, fever, and discomfort, analgesics with anti-inflammatory and antipyretic activities like NSAIDs and acetaminophen can help. Since he is 57 years, diabetic, and hypertensive, meloxicam 7.5mg once daily is a good option (Whelan, 2015).
Eight: Treatment Recommendations
- Continuation of oral hypoglycemic drugs, antihypertensive drugs, and lipid lowering agents that the patient is on
- Peramivir 600mg IV as a single dose (Whelan, 2015)
- Meloxicam 7.5mg orally once daily for one week (Whelan, 2015)
- Admission for observation
- IV fluids
- Adequate rest and nutrition
Nine: Other drug therapy problems
- Diabetes mellitus – continuation of glyburide and metformin in the current doses with regular assessment of HbA1c levels
- Hypertension – continuation of current medication in the current doses with regular review
- Hyperlipidemia – continuation of current medications in the current doses with regular review
- Pain, fever, and discomfort – Meloxicam 7.5mg once daily orally for one week
- Risk of bacterial infections – amoxicillin 500mg three times daily for 5 days
Ten: Assessment
- Vital signs – would reveal improvements with fever and blood pressure
- Chest X-ray – would assess the possibility of viral pneumonia or superimposed bacterial pneumonia (Kudesia & Wreghitt, 2009)
- Repeat random blood sugar and HbA1c – would reveal improvements with control of blood sugar
- Lipid profile – would reveal with the hyperlipidemia
- Repeat rapid test for influenza – negative result would confirm the eradication of the virus in the body (Kudesia & Wreghitt, 2009)
Eleven: Information for the patient
The patient should be informed of the importance of each of the drugs given to them. They should also be informed of the possible side effects of the drugs and the consequences of failing to take each of the drugs. Finally, the patient should be informed of the dosage and the times of the day when they should take each of the drugs in addition to these same instructions in writing.
Twelve: Indication for vaccination
- Previous history of influenza infection
- Diabetes mellitus and cardiovascular disease
- Old age
- Interaction with people who have clinical features of influenza
Thirteen: Vaccination
The vaccine should be given after the patient has completed their treatment for influenza and they have been confirmed to be free of the virus. The patient should be vaccinated as soon as possible. The best time for the vaccine is, however, before the end of October in the Northern hemisphere.
Fourteen: Vaccination options
- Trivalent vaccine
- Quadrivalent vaccine
- Injectable vaccine
Fifteen: Prevention of influenza for this patient
- Season vaccination against influenza
- Avoidance of crowded places or places with confirmed outbreaks
- Strict adherence to antidiabetic, antihypertensive, and lipid lowering agents
References
Kudesia, G., & Wreghitt, T. G. (2009). Clinical and diagnostic virology. Cambridge, UK: Cambridge University Press.
Whalen. K. (2015). Lippincott illustrated reviews: Pharmacology. (6th Ed.) Philadelphia, PA: Wolters-Kluwer.
