Objective 1: Clinical Manifestation & Risk Factors
• Rhabdomyolysis occurs due to the breakdown of muscle tissue o Muscle breakdown causes myoglobin to enter the bloodstream which can lead to kidney damage (Miller, n.d).
• Creatine Kinase (CK) o Is an enzyme released by damaged muscle. CK is used to diagnose and follow muscle disease (Miller n.d).
• Aspartate transaminase & alanine transaminase o Elevated levels of may be due to damaged muscles or overworking the muscles (Sjogren 2007).
• Creatinine o A product of o A breakdown produce created by muscles. Normally removed from the body by the kidneys (Miller n.d).
• Risk factors include: infection, inflammation, medications and genetic or metabolic disorders (Case-Lo & Cirino 2016)
Objective …show more content…
• Alanine Transaminase (393 U/L) (Orlewicz 2014) o Elevated since normal level is between is 20 –60 U/L
♣ Indicates patient is experiencing liver damage (Weibrecht et al 2010)
• Creatinine (255 μmol/L) o Elevated since normal level is between 35.37 - 96.26 μmol/L
♣ Indicates patient is experiencing renal failure (Horowitz 2014)
• CK (23 000 U/L) o Elevated the normal level (in females) should be 145 U/L
♣ Indicates skeletal muscle breakdown, this the reason for the diagnosis Rhabdomyolysis (Junpaparp 2014)
• Aspartate transaminase (1030 U/L) o Elevated levels since normal values (in females) should be between 8-40 U/L
♣ Indicates that the patient is experiencing acute kidney injury (Devaraj 2015)
Objective 3: The potential for any drug – drug interactions that may explain the rhabdomyolysis
• Simvastatin (for hypercholesteremic) o Causes ALT elevations are cause by liver …show more content…
This means less excretion of the drugs and more buildup of the drugs in the bloodstream
Objective 4: Pharmacokinetics vs. Pharmacodynamics drug interaction
• Pharmacokinetic: How the body handles the medication (Adams & Holland, 2010, p.37) o Drug interaction: influences the absorption, distribution, metabolism and excretion of the drug (ADME) (Cascorbi, 2012)
• Pharmacodynamics: how the drug changes the body (Adams & Holland, 2010, p.46) o Drug interaction: interactions where a drug influences the other drug’s effects (Cascorbi, 2012)
♣ This usually occurs at the receptor, signaling or effector levels (Vogel, 2011, p. 367-376)
• Care Scenario 3 o Type of interaction: pharmacokinetic drug interaction between clarithromycin and simvastatin o Reason: Clarithromycin will influence the metabolism of CYP3A4 which in turn will affect simvastatin (Medscape n.d)
Objective 5: Alternate treatment choices
• A low fat, high fiber diet plan (Mandal 2014)
• Improving lipid levels though physical activity
• Reduce triglycerides and raise HDL cholesterol levels though Niacin
• Get rid of excess cholesterol through PCSK 9 inhibitor (Myerson
• Rhabdomyolysis occurs due to the breakdown of muscle tissue o Muscle breakdown causes myoglobin to enter the bloodstream which can lead to kidney damage (Miller, n.d).
• Creatine Kinase (CK) o Is an enzyme released by damaged muscle. CK is used to diagnose and follow muscle disease (Miller n.d).
• Aspartate transaminase & alanine transaminase o Elevated levels of may be due to damaged muscles or overworking the muscles (Sjogren 2007).
• Creatinine o A product of o A breakdown produce created by muscles. Normally removed from the body by the kidneys (Miller n.d).
• Risk factors include: infection, inflammation, medications and genetic or metabolic disorders (Case-Lo & Cirino 2016)
Objective …show more content…
• Alanine Transaminase (393 U/L) (Orlewicz 2014) o Elevated since normal level is between is 20 –60 U/L
♣ Indicates patient is experiencing liver damage (Weibrecht et al 2010)
• Creatinine (255 μmol/L) o Elevated since normal level is between 35.37 - 96.26 μmol/L
♣ Indicates patient is experiencing renal failure (Horowitz 2014)
• CK (23 000 U/L) o Elevated the normal level (in females) should be 145 U/L
♣ Indicates skeletal muscle breakdown, this the reason for the diagnosis Rhabdomyolysis (Junpaparp 2014)
• Aspartate transaminase (1030 U/L) o Elevated levels since normal values (in females) should be between 8-40 U/L
♣ Indicates that the patient is experiencing acute kidney injury (Devaraj 2015)
Objective 3: The potential for any drug – drug interactions that may explain the rhabdomyolysis
• Simvastatin (for hypercholesteremic) o Causes ALT elevations are cause by liver …show more content…
This means less excretion of the drugs and more buildup of the drugs in the bloodstream
Objective 4: Pharmacokinetics vs. Pharmacodynamics drug interaction
• Pharmacokinetic: How the body handles the medication (Adams & Holland, 2010, p.37) o Drug interaction: influences the absorption, distribution, metabolism and excretion of the drug (ADME) (Cascorbi, 2012)
• Pharmacodynamics: how the drug changes the body (Adams & Holland, 2010, p.46) o Drug interaction: interactions where a drug influences the other drug’s effects (Cascorbi, 2012)
♣ This usually occurs at the receptor, signaling or effector levels (Vogel, 2011, p. 367-376)
• Care Scenario 3 o Type of interaction: pharmacokinetic drug interaction between clarithromycin and simvastatin o Reason: Clarithromycin will influence the metabolism of CYP3A4 which in turn will affect simvastatin (Medscape n.d)
Objective 5: Alternate treatment choices
• A low fat, high fiber diet plan (Mandal 2014)
• Improving lipid levels though physical activity
• Reduce triglycerides and raise HDL cholesterol levels though Niacin
• Get rid of excess cholesterol through PCSK 9 inhibitor (Myerson