Module 5 - Clinical Case

Clinical features of the scenario that leads one to administer oxygen

The clinical features that led to administration of oxygen are cyanosis and lack of breathing. Vincent is unconscious and does not have the strength to breath normally. Cyanosis, which is characterized by nail-beds and bluish lips, reveals lack of oxygen in circulation an aspect that may result in fatal effects (Hillman & Bishop 2004).

The physiological rationale for administering oxygen

The fact that Vincent is not breathing normally is the major factor that have led to decreased oxygen level in his blood. Administration of oxygen will protect Vincent from possible cases of permanent damage of major body organs. Administration of oxygen will support Vincent’s life in preparation for specialized care.

The intended outcomes of administering oxygen

The intended outcome for administration of oxygen is restoration of normal breathing. It is also expected that after administration of oxygen Vincent's consciousness will be restored. In addition to restoration of consciousness, it is also expected that Vincent's normal sight will be restored.

Basis of Vincent’s list of current medication, prior to undertaking any further intervention:

Risk factors relevant to the safety of yourself and Johnny and action to take

One of the major risks associated with Vincent's current condition is that he is taking a variety of medications all of which may lead to adverse side effects. Ceftriaxone for instance, may result in gastrointestinal side effects such as abdominal pain, vomiting, nausea and flatulence among others. Administration of some other drugs may result in negative drug-drug interactions. It is also hard to administer drugs to Vincent's while he is in an unconscious state. In addition, the fact that Vincent is an alcoholic, there is a higher possibility that he may not respond to some drugs. Therefore, in order to minimize the risk of developing adverse negative effects it is important to stabilize Vincent’s condition.

Question 3 – Assuming that Vincent is an alcoholic but has no predisposing co-morbidities, discuss the possible reasons why Vincent is more affected than Johnny, noting:

Interactions with Vincent’s current medications

The potential impact of Vincent’s alcoholism

Potential recent changes to Vincent’s lifestyle or drug use habits

The alcoholic condition of Vincent may have contributed to being affected more by heroine as compared to Johnny. Vincent may also have taken a higher dose of heroine as compared to his friends. Another factor that may have contributed to Vincent being affected more is that his body may not have been in a position to down-regulate the effects of heroine. Also it may have been possible that it was Vincent's first time to engage in drugs.

Question 4 – Mechanisms by which an opioid agonist (such as heroin) causes respiratory depression. In your response, consider the:

Molecular mechanism of action of opioid agonists

The main mechanism of action of opioid agonists, such as heroine, is through inhibiting release of neurotransmitters. Opioid agonists inhibit release of neurotransmitters through directly impacting on calcium ion channels. This reduces entry of calcium ions into intracellular space in addition to increasing outward flow of potassium ions. The period of repolarisation and the time of action potential are significantly decreased. These effects are produced by opioid receptors and are coupled through G-proteins. Opiods have also been shown to act together with other intracellular effector mechanisms such as the adenylate cyclase system (Chahl 1996).

Pathophysiology of opioid-induced respiratory depression

The normal mechanism of breathing regulation is complex and comprises of central and peripheral mechanisms of control. Chemo-receptors have been shown to actively respond to low arterial pressure. These receptors also respond to high arterial pressure of carbon dioxide. These two responses are believed to contribute to initiation of breathing together with other responses. Opiods are believed to negatively impact on the chemical response of receptors. Opioids induce respiratory depression through minimizing the rate of respiration as well as the tidal volume.

Therapeutic opioid doses given to patients suffering from a variety of painful conditions is believed to lead to a significant depression of the body’s response to carbon dioxide (Ouellette & Joseph 2010).

Question 5

Pharmacodynamic rationale for administering naloxone

Naloxone is an opioid antagonist that is usually administered for purposes of counteracting the effects developed through overdose of opioids. This drug is usually administered to offset life-threatening effects such as respiratory and nervous system depression. This drug is also used in the management of addiction associated with opioids (Society of Gastrointestinal Nurses and Associates 2012).

Mechanism of action of naloxone

The mechanism of action of naloxone is not fully understood. It has however been proposed that this drug works through antagonizing the effects of opioids. Naloxone is believed to actively compete for binding sites together with opioids (Society of Gastrointestinal Nurses and Associates 2012). The perception that naloxone has a higher receptor binding capacity as compared to opioid implies that the effects of opioids will be counteracted.

Pharmacological considerations of current approaches to narcotic overdose

The fact that Vincent appears to be both an alcohol and opioid addict creates the need to administer a strong opioid antagonist. Naloxone has the capacity to counteract all ht negative effects associated with opioid overdose. Naloxone does not result in adverse effects that can aggravate the clinical condition of the patient (Society of Gastrointestinal Nurses and Associates 2012). For instance, naloxone does not lead to respiratory depression, and psychological dependence. The drug can be re-administered if Vincent does not respond in the expected manner.

Question 6

Pharmacological impact of Vincent’s drug use

It is expected that after administering naloxene, Vincent will experience relieve from depression in both the respiratory and nervous system. Moreover, the addictive nature of the opioids will also be addressed by naloxene will competitively binds on the opioid receptors more competitively. Nevertheless, continued use of the addictive opioids will continue to impair his respiratory and nervous systems by adding more stress to these systems. This may culminate into failure of these systems.

Potential need for further medical treatment and tests

Even though Vincent has become more conscious it is important to take him to hospital because he has become a bit confused after administration of naloxone. There is a likelihood of Vincent taking more heroine since he is an addict. Vincent may also end up taking more alcohol that may make him even more confused. There is need to carry out more tests to detect possible adverse effects that may have resulted due to excessive intake of alcohol and heroine.