Question

Mariyam is an 80 year old woman who suffers with seasonal allergy. Mariyam’s liver and kidney functions are below normal levels. Recommend a treatment plan for Mariyam’s allergy, discussing the pharmacological effects and mechanism of action for your choice of therapy with all possible factors which might affect her response to the drug.

(400 words) *thumbs up*

Answer 1

Allergic rhinitis or hay fever are most common that occurs in particular season. It occurs when our immune system over reacts to the outdoor- allergen such as pollen grains, tree, grass, weeds etc. Indoor allergens like molds or pet danders etc.

Mariyam is an 80 years old (Geriatric patient) has liver and kidney functions below normal levels thus treatment strategy should be accordingly.

Seasonal allergies are related to histamine release from mast cells in response to allergens thus Anti-histamines would be the choice of treatment regimen.

1.) Fexofenadine: (second generation anti-histamine)

Would the primary choice of agent as it has 12-24 hrs of duration of action and it does not cause sedation so it will help her better if she does not want sedation.

M.O.A : it competes for H1 receptor site on target cells of respiratory tract, gastrointestinal tract, blood vessels thus reduces histamine action.

Dose : available in 30mg, 60mg and 180 mg. As mariyam is 80 yrs old we can start with 60mg twice daily on empty stomach.(total 60mg + 60mg) = 120mg per day indicated for allergic rhinitis).

Pharmacological action: Symptomatic relif by anticholinergic action (reduces rhinorrrhoea).

2.) Levo-cetrizine: second generation anti histamine.

Along with Fexofenadine, addition of levo-cetirizine (enantiomer of cetirizine)will help in relieving symptoms. Estimated action 7-10 hrs.

M.O.A : it inhibits the release of histamines and cytotoxic mediators from platelets and eosinophil chemotaxis, during the secondary phase of allergic response.

It produces less sedation, thus preferred over cetirizine.

3.) Nasal spray: if she experience nasal block due to allergies. This will systematically provide relief.

□ Factor affecting: As she is geriatric patient first generation antihistamines are less preferred as they cause sedation thus she will require a person for monitoring.

- Age is one of the factor that affects drugs actions. As age increases the human body physiological actions changes decrease.

- Decreased liver functions is common in old age were metabolism of drug can be affected by this.

- Decreased renal function is common in old age were the elimination of drug from the body can be affected by this.

- Thus dosing is done based on these factors.

□ Treatment regimen:

1.) Tablet Fexofenadine 120mg  (morning on empty stomach) once daily

2.) Tablet Levo-cetrizine 5mg at night before bed time. Once daily

3.) Nasal spray as needed for nasal block.

On symptomatic relief Fexofenadine can be discontinued were 5mg Levo-cetrizine to be continued daily dose can be reduce based on respone to 2.5mg.

Non-Pharmacological approach:

Avoid allergic (allergen) triggers.

Use humidifiers to avoid moisture etc.

Thankyou...