Assignment Task

Overview

This assignment is designed to assess your ability to identify, select, analyse, evaluate, and synthesise information from multiple sources to construct an evidence-based response to a series of topics relating to a clinical case.

Task

Read the following clinical case and address topics in Part I (2%) and Part II (8%).

A 24 year-old, healthy female developed significant and persistent nausea following a bout of gastroenteritis. Doctors initially prescribed her Phenergan (25 mg, tablet) for anti-emesis and sedation to aid sleep. However, Phenergan cannot be used on a chronic basis, therefore doctors prescribed an alternate antiemetic Stemetil (5 mg, tablet). After use over a few weeks, the patient`s nausea did not improve. A third antiemetic, Maxolon (10 mg, tablet), was then prescribed. Following the first dose of Maxolon, the patient began to experience mild symptoms of akathisia ("restlessness") but symptoms resolved within several hours of ingestion. Following the second dose of Maxolon (taken 6 hours after the first dose), the patient again experienced symptoms of akathisia, which took significantly longer to resolve than the first dose. Following the third dose (taken 24 hours after the first dose), the patient presented to the emergency department (ED) with severe akathisia which progressed to worsening symptoms of anxiety, heart palpitations, trembling and tachycardia. ED doctors immediately discontinued use of Maxolon in the patient and administered oral doses of Valium (5mg, tablet) and Zofran (4 mg, tablet) for their anxiolytic and antiemetic effects, respectively. Upon discharge, ED doctors prescribed Normison (10 mg, tablet) and Zofran. Zofran was taken daily over a 4-week period and, although effective for mild nausea, had significant side effects of constipation. Upon consultation with a gastroenterologist, the patient was then prescribed Nizac (150 mg, tablet) to aid contraction of gut muscles. Taken in combination with Zofran, the patient experienced significant improvements in her symptoms. Zofran was taken on an ad hoc basis (typically one dose a week) whilst Nizac was taken twice daily, 30 minutes before eating. The frequency of Nizac administration was reduced progressively from twice daily to once daily to once every 2 days until no longer required.

Part I

Read Explanotory notes  on the next page and complete and present the table below in your assignment.

Explanotory notes

• brand name listed on the PBS (Yes/No) - specify if this brand name is listed on the Pharmaceutical Benefit Scheme.
• active ingredient - specify the generic name, NOT the formulation or
• prodrug (Yes/No) - specify whether the active ingredient is a prodrug or
• primary drug target - specify ONE drug target at which the drug acts to produce the therapeutic effect stated in the clinical case. The correct full name of this drug target must be provided, e.g., nicotinic acetylcholine receptor rather than nAChR.
• classification of primary drug target - if the primary drug target is a receptor, specify the correct full name of the receptor superfamily to which this drug target If the drug target is NOT a receptor, specify whether the drug target is an ion channel, a transporter, or an enzyme.
• The completed table should occupy no more than half of an A4
• References and in-text citations are not

Part II 

Address the following topics (a to c) in your assignment. Make sure you read Explanotory notes 2 carefully before you start.

1. With the support of relevant and appropriate evidence, discuss possible cause(s) of akathisia the patient experienced after taking Maxolon.

2. With the support of relevant and appropriate evidence, explain why it took longer to resolve symptoms of akathisia after the third dose of Maxolon than the first dose.

3. Valium and Normison are drugs of the benzodiazepine class. When the patient was presented to the ED, Valium was administered to reduce anxiety. Normison, rather than Valium, was prescribed upon discharge to aid sleep. With the support of relevant and appropriate evidence, explain the different use of these two drugs.