Ibuprofen Case Summary

The focus of my case analysis is J.R., a 53 year old Hispanic male who has retired after serving 23 years in the United States Army. His hobbies include playing golf and watching sports. J.R has health insurance through Tricare and he is able to receive medications at no cost when his prescriptions are filled on the military base at which he sees his primary care provider. He is allergic to shellfish and the reactions that he experiences are hives and airway swelling. He currently smokes 1 pack of cigarettes per day and he began smoking at the age of 17. J.R. consumes an average of 2 cups of coffee per day, including the weekends and he consumes alcohol roughly 5 out of 7 days per week averaging between 6 to 12 beers each day. He denies any …show more content…
takes ibuprofen 800 mg PO every 8 hours as needed for pain due to the instruction of his primary care provider for treatment of chronic back pain. The average cost for a 90 day supply of ibuprofen 800 mg is $10 (Goodrx, 2014). Ibuprofen is a non-steroidal anti-inflammatory medication and it is also a COX-1 and COX-2 inhibitor which results in the decreased synthesis of prostaglandins within body tissues (Medscape, 2014). Ibuprofen inhibits chemotaxis, alters lymphocyte activity, decreases proinflammatory cytokine activity, and inhibits neutrophil aggregation. The bioavailability of the medication is 80-100% with an onset of 30-60 minutes and duration of 4-6 hours as described by Medscape. It is 90-99% protein bound and metabolized rapidly in the liver by the isoenzyme CYP2C9. The half-life of ibuprofen is 2-4 hours and it is excreted in the urine (50-60%) with less than 10% unchanged and the rest is excreted in feces (Medscape, 2014). J.R. has a high adherence to this medication and he states that it is due to the medication being readily available without a prescription. If he forgets a dose, most people have it on hand and he takes it whenever he begins to experience back pain. He states that he experiences an upset stomach if he takes it without eating, which is a side effect of this …show more content…
The average cost for a 30 day supply of Lotrel is $80 (Goodrx, 2014). It is a combination medication that consists of benazepril, which is an ACE inhibitor and amlodipine, which is a calcium channel blocker. The mechanism of action of amlodipine is the inhibition of the entry of calcium ions across the membranes of myocardial cells and vascular smooth muscle cells. This is achieved without the changing of serum calcium concentrations and results in the inhibition of cardiac and vascular smooth muscle contraction, which yields relaxation. This leads to the dilation of the main coronary artery and systemic arteries and ultimately causes a decrease in blood pressure through reduction of peripheral vascular resistance and decreased myocardial contractile force (Medscape, 2014). The bioavailability of Amlodipine is 64-94% with a peak plasma time of 6-12 hours. Greater than 90% of the medication is protein bound with a half-life of 10-11 hours. Amlodipine is metabolized in the liver by CYP3A4 and is excreted in the urine. (Medscape, 2014). Pharmacogenomic considerations for amlodipine include caution in patients whom have an inhibited CYP3A4 isoenzyme, which may result in stronger medication outcomes due to increased systemic exposure to amlodipine and this may require dose reduction. Symptoms of hypotension and edema should be monitored in order to determine the need for dose adjustment