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Multi-drug resistant pseudomonas aeruginosa is one of the major problems facing most countries in fighting pneumonia. These drug resistant pathogen has proved challenging for many drug manufacturers because of its mechanisms of action.
The thesis of this essay is to analyze the mechanisms of action of pseudomonas aeruginosa. Further, my essay entails the appropriate drug therapy options for countering the pathogen. This includes the primary choice and secondary choice of drug therapy.
Pseudomonas aeruginosa is the most common cause of nosocomial infections. In order to evaluate the effectiveness of various drug therapies, a research was conducted on critically ill patients. The research comprised of various drug testing on the patents and their results. These drugs included b-lactams, flouroquinolones, aminoglycosides and carbapenems. According to the research observations, it was more effective using combination therapy to treat the infection rather than single therapy. The combination of flouroquinolone or aminoglycoside with b-lactam was more effective than a combination of flouroquinolone and aminoglycoside (Deutschman & Neligan, 2012).
The success of the combination therapy is a key breakthrough in the fight against multi-drug resistant infections. Even though the resistance ability of the pathogen is linked to cystic fibrosis and isolated outbreaks that allow the pathogens to develop, medical practitioners point out that lack of adequate novel agents is the greatest challenge.
In the treatment of multi-drug resistant pseudomonas aeruginosa antimicrobial therapy is very crucial. Antimicrobial therapy determines the success of the diagnosis. In most mortality cases, lack of appropriate primary and secondary microbial therapy is the cause of loss of lives. Nevertheless, the therapeutic options for critically ill patients have proved to be very redundant.
In order to determine what therapeutic option to undertake as a medical practitioner, it is essential to assess the mechanisms of resistance of the pathogen. The most common mechanism of resistance for these pathogen is the ability to produce B-lactamase. B-lactamase enables the pathogen to counter B-lactam antibiotics. B-lactamase enzymes have extended their spectrum of action through point gene mutations. Moreover, the secretion of carbapenemases by the pathogens adds more resilience to the pathogens. This is mostly because most antimicrobial therapy drugs were previously made of carbapenems. Thus, pathogens were previously subjected to high levels of selected pressure by carbapenems. However, the ability of the pathogens to trigger a point mutation secretion of carbapenemases led to the resilience of these pathogens (Mayers, 2013).
Pseudomonas aeruginosa has numerous drug resilience adaptations. For instance, it was later discovered that pseudomonas aeruginosa pathogens were able to resist drugs through production of beta-lactamases, outer membrane modifications and efflux pump.
In therapeutic treatment, there are various options for drug therapy determining on the development of the infection. The choices for drug therapy range between primary choice and secondary choice drug therapy.
Primary choice drug therapy entails the use of first line anti-microbial options such as carbapenems, tigecycline, B-lactamase inhibitor combinations, cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole and fluoroquinolones.
Carbapenems are used in treating ESBL producing pathogens. The diagnoses range between half grams of the drug every six hours to one gram in every eight hours in case of serious infections. The use of carbapenems showed low rates of mortality among patients compared to other antibiotic agents (Deutschman & Neligan, 2012).
Furthermore, tigecycline is preferred in treating most complex skin infections and in some cases community-acquired pneumonia. On the other hand, B-lactamase inhibitor combinations such as clavulanate, sulbactam and tazobactam all have varying levels of inhibitory activity against most ESBL enzymes. Cephalosporins are used in patients who are not in critical condition. This is because they have lower vitro susceptibility than other antimicrobial drugs. Thus, they should not be used on patients with microbial infections, which have ESBL-producing organisms.
Flouroquinolones, trimethoprim-sulfamethoxazole and aminoglycosides are also poor inhibitors of ESBL-enzymes. Thus, they should be used in mild cases with close monitoring (Deutschman & Neligan, 2012).
Secondary choice drug therapy consists of more effective drugs, most which are used in critical conditions. Their mode of action towards ESBL producing organisms is more effective than in primary choice drug therapy. These drugs include colistin, fosfomycin and rifampin. Although colistin resistance has been noticed among some resistant pathogens, combination therapy still appears successful in most cases. Colistin can be used together with fosfomycin to reduce the susceptibility of the drugs to the pathogens. Moreover, rifampin is mostly used against carbapenemase-producing pathogens (Mayers, 2013).
The use of combination therapy can lead to various side effects. For instance, the use of combination therapy can lead to nephrotoxicity, photosensitivity and anaphylactoid reactions. Consequently, combination therapy can lead to ototoxocity. Chemical agents in these drugs can also alter the mitochondrion. This is because when some of these antimicrobial agents are used together they work more adversely within the host’s body to alter the development of the parasite. This process may occur within the body cells (Aronson, 2014).
The success of combination therapy is still debatable. This is because the side effects of combination therapy may lead to a greater harm on the patient. However, researches are still undergoing to evaluate the effectiveness of the procedure and the harm posed to the patient.
References
Aronson, J. K. (2011). Side effects of drugs annual 29: A worldwide yearly survey of new data and trends in adverse drug reactions. Amsterdam: Elsevier.
Mayers, D. (2009). Antimicrobial drug resistance handbook: Volume 2. Totowa, N.J: Humana.
Deutschman, C. S., & Neligan, P. J. (2010). Evidence-based practice of critical care. Philadelphia, PA: Saunders/Elsevier.
Acupuncture can be described as an ancient form of Chinese Medicine that involves the insertion of solid fill from acupuncture needles into the skin. The needles are often inserted into specific points in the body in order to achieve what can be described as therapeutic effect. There is no drug that is injected into the body and the needles alone are able to create the benefit of relaxation. The foundation of acupuncture lies in an ancient Chinese belief in an energy that is referred to as Qi.
This energy or life force often circulates around the body through what can be described as invisible channels that are referred to as Meridians. It is this flow of Qi in the meridians that when disrupted, a disease may follow (Birch, 1998). However, by inserting the fine needles into the particular acupuncture points, the disruption that occurs is often corrected and the flow of the original Qi is restored. Scientific trials that have been done around the world have found that when acupuncture is done by a skilled practitioner then it is a safe and useful treatment of many different disorders.
The ancient Chinese proposed that indeed the balance the two opposite but at the same time complementary forces of energy referred to as Yin and Yang can be able to sustain any living organism in the earth. Half the body organs as well as meridians are defined as yin in relation to the other side that are referred to as Yang. When Ying and Yang are in balance then disease in the body cannot occur. Acupuncture needles are often solid and are usually stainless steel, however there are several times that they either gold or silver.
The needles in many cases measure from 13-70mm, although there are also longer ones that are about 150 mm in length. The needles that are used for acupuncture are often very fine, flexible and have a sharp tip. They are atraumatic and this mean that they do not have a cutting edge as that which appears in a hypothermic needle which often slices through the tissue (Mann, 1963). It is this design which allows that allows the needles to be able to slide smoothly through the tissue and this often makes them unlikely to cause bleeding or even damage to the underlying structures in the body.
The acupuncture points also sometimes referred to as acupoints are often places in the skin that have lower resistance to the passage of electric than other parts of the skin and are a part of a network that were mapped out by Chinese ancients. Most of the points are often found along the meridians or channels are believed to be the passage points of the ancient Chinese energy referred to as Qi. Acupoints in many cases are located by identifying the anatomical landmarks (MacPherson, 2007). However, a new technique has appeared where the middle figure touches the thigh when standing at attention. The twitching of the thigh at different points shows the acupoints. A dull and heavy feeling is often felt when a needle is correctly placed in the body. This aching feeling is often referred to as de Qi and is considered by many as being the disturbance of Qi. The needles are often left in the place for around 15-30 minutes and the practitioner then goes ahead and either strengthens or reduces the flow of Qi. This is done by lifting, twisting or rotating the needles in the acupoint.
The British National Health service was able to carry out systematic reviews of the evidence of the use of acupuncture in order to treat as well as manage a range of disorders (Hecker, 2008). During this review, they were able to found out that the evidence that acupuncture is effective when it comes to the treatment of dental pain, jaw pain as well as the general control of nausea after an operation or even during chemotherapy treatment. For the many conditions when acupuncture is used, the evidence has however not been systematically reviewed and consequently, the current scientific evidence to prove its absolute effectiveness has not yet been established.
After a session most people often feel very relaxed as well as refreshed. However, it is of importance to understand that the specific responses are often dependent on each person. For example, some people have cited feeling energized after acupuncture whereas others have said that after acupuncture they felt very sleepy. However, the truth of the matter is that the symptoms at times may get worse before they start improving after acupuncture (Hecker, 2008). The number of treatment that one needs often depends on the condition that the person is having and in most cases, people often experience a reduction in symptoms in a few sessions. The general idea of acupuncture is often to restore the natural balance that exists inside the body. Once the balance is restored, the body can be able to take care of itself and there are no further treatments needed.
It is of essence to understand that at the hands of an unskilled practitioner, acupuncture might bring some problems. One of the most notable problems is allergic reactions (Hecker, 2008). The herbs that are used sometimes are burnt over the skin and they can cause an allergic reaction with the body when the practitioner does not apply them effectively. Secondly, if the needles are unsterile, the bacteria can cause a local infection in the areas where the needles have been inserted.
There is also a risk of contracting diseases such as HIV, hepatitis and other bloodborne diseases if the needles are not properly sterilized and are reused. Lastly, there is also the worry of unexpected side effect such as increase in pain, depression as well as convulsions (Hecker, 2008). There has also been some allegations that acupuncture might cause insomnia in some patients. Acupuncture can often produce significant changes in the nervous system and for this reason it is vital that the correct points are stimulated in the right way in order to produce the desired effect. If this is not done correctly, the above conditions might appear and the acupuncture might lead to more complications to the patient.
In conclusion, acupuncture has been a part of traditional medicine in China for a thousand years. It often involves the insertion of fine needles into specific points of the skin in order to bring out healing. It is dependent on an ancient belief of an energy force that is referred to as Qi, which circulates around the body through invisible channels referred to as Meridians. The insertion of needles in the body brings back the balance of energy between the Yin and the Yang and the body can be able to effectively heal itself.
References
Hecker, H.-U. (2008). Color atlas of acupuncture: Body points, ear points, trigger points. Stuttgart: Thieme.
MacPherson, H. (2007). Acupuncture research: Strategies for establishing an evidence base. Edinburgh: Churchill Livingstone Elsevier.
Mann, F. (1963). Acupuncture: The Chinese art of healing. New York: Random House.
Birch, S., & Ida, J. (1998). Japanese acupuncture: A clinical guide. Brookline, Mass: Paradigm Publications.
What are the pharmacologic effects of epinephrine and norepinephrine?
The oral administration of epinephrine is ineffective because it rapidly metabolizes in the gastrointestinal liver and mucosa. Thus, epinephrine is mostly administered IV or SC. After SC injection, epinephrine absorption is slow because of vasoconstriction induced by the local epinephrine. Moreover, epinephrine is a poor lipid soluble, thus this prevents its ready entrance to the central nervous system and it causes the lack of cerebral effects by the drug (Clark, 2012).
On the other hand, norepinephrine produces intense venous and arterial vasoconstrictions in the vascular beds. Norepinephrine causes lack of bronchodilating effects on the airway smooth muscles. Thus, hyperglycemia is less likely to occur for patients taking norephrine (Clark, 2012).
What are the therapeutic applications of catecholamine administration?
Catecholamines are used for therapeutic treatment of severe heart failure. Patients who have severe heart failure present with increased activity of the sympathetic-adrenergic function, which occurs as a compensatory mechanism. Catecholamines are preffered in heart failure treatment because they increase cardiac output. Thus, catecholamines are used to treat cardiogenic shock resulting from myocardial infarction and severe heart failure, low level of cardiac output mostly after cardiac surgery and chronic congestive heart failure (Strauss, 2013).
What toxicities can occur following administration of catecholamines?
Low dosage of epinephrine can lead to selective beta2 adrenergic agonist effects such as hypokalemia. Hypokalemia can cause cardiac dysrhythmias (Clark, 2012).
Are there any special considerations in the administration of catecholamines to pediatric and geriatric patients?
Children and geriatric patients should receive careful monitoring when they are prescribed catecholamines. This is because the drugs may affect children negatively because their body systems may be underdeveloped. Further, geriatric and pediatric patients may react excessively to the adverse effects of these medications (Strauss, 2013).
What is the history of neuromuscular junction blockers?
Neuromuscular blocking drugs led to the new medical use of anesthesia. Before the invention of muscle relaxants, doctors used intravenous and inhalation agents as anesthesia. When muscle relaxation was triggered by deep anesthesia inhalation. This posed various risks such as cardiac and respiratory depression. The invention of muscle relaxants redefined anesthesia as drugs that cause analgesia, narcosis and muscle relaxation (Karch, 2014).
What is the pharmacologic effect in skeletal muscle following neuromuscular junction blocker administration?
Suxamethonium, the only depolarizer in medical use, has an advantage over non-depolarizers because it acts within 60 seconds. Further, it causes muscle relaxation for less than five minutes. The action of suxamethonium cannot be reversed by anticholinesterases. However, plasma cholinesterase can make the drug wear of quickly (Karch, 2014).
What is malignant hyperthermia and how does it occur?
People susceptible to malignant hyperthermia have an abnormal ryanodine receptor in the skeletal muscles. This abnormal condition interferes with the regulation of calcium levels present in the skeletal muscles. Thus, this leads to over release of calcium in the skeletal muscles resulting to a metabolic reaction (Goodman & Spry, 2014).
What other toxicities occur with neuromuscular junction blocker administration?
Neuromuscular blockers can lead to malignant hyperpyrexia. Further, suxamethonium can cause hyperkalaemic cardiac arrest in children (Goodman & Spry, 2014).
References
Karch, A. M. (2014). Lippincott's nursing drug guide. Philadelphia: Wolters Kluwer Health.
Goodman, T.& Spry, C (2014). Essentials of perioperative nursing. Burlington, Mass: Jones & Bartlett Learning.
Clark, M. A. (2012). Lippincott's illustrated reviews. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Strauss, H. W. (2013). Nuclear oncology: Pathophysiology and clinical applications. New York: Springer.
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