### Hand, Foot, and Mouth Disease (HFMD)
#### 1. Pathology of the Disorder
Hand, foot, and mouth disease (HFMD) is a common viral illness primarily affecting infants and children, but it can also occur in adults. It is caused mainly by coxsackievirus A16 and enterovirus 71. HFMD is characterized by a combination of symptoms, including fever, painful sores in the mouth, and a rash on the hands, feet, and sometimes the buttocks and legs. The virus is highly contagious and spreads through direct contact with an infected person’s nasal secretions, throat discharge, saliva, fluid from blisters, stool, or respiratory droplets.
#### 2. Major Classifications of Medications
There is no specific antiviral treatment for HFMD; management focuses on symptomatic relief:
– **Analgesics/Antipyretics:** Such as acetaminophen or ibuprofen, used to reduce fever and relieve pain.
– **Mechanism of Action:** Acetaminophen works by inhibiting the synthesis of prostaglandins in the brain, which helps to reduce fever and pain. Ibuprofen inhibits cyclooxygenase (COX-1 and COX-2) enzymes, decreasing the formation of precursors of prostaglandins involved in inflammation, pain, and fever.
– **Topical Anesthetics:** Such as lidocaine gel, used to alleviate mouth sores.
– **Mechanism of Action:** Lidocaine works by blocking sodium channels, thereby reducing the ability of neurons to transmit pain signals.
#### 3. Pharmacological Agent: Acetaminophen
**Prescription for Adult:**
– **Medication:** Acetaminophen 500 mg tablets
– **Dosage:** 500 mg orally every 6 hours as needed for pain or fever.
– **Quantity:** 24 tablets
– **Refills:** None
**Prescription for 4-year-old Child (16 kg):**
– **Medication:** Acetaminophen 160 mg/5 mL oral suspension
– **Dosage:** 10 mL (320 mg) orally every 6 hours as needed for pain or fever.
– **Quantity:** 120 mL
– **Refills:** None
#### 4. Side Effects, Adverse Effects, Contraindications, and Patient Education
– **Side Effects:** Generally well-tolerated; may include nausea, rash, or minor allergic reactions.
– **Adverse Effects:** Hepatotoxicity with overdose or prolonged use, particularly if used with other medications containing acetaminophen or in patients with liver disease.
– **Contraindications:** Severe liver impairment, hypersensitivity to acetaminophen.
– **Patient Education:** Do not exceed the recommended dose to avoid risk of liver damage. Monitor for signs of liver toxicity such as jaundice, fatigue, and dark urine. Avoid concurrent use of other acetaminophen-containing products.
### Herpes Zoster (Shingles)
#### 1. Pathology of the Disorder
Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), which also causes chickenpox. After an initial infection (chickenpox), the virus remains dormant in the dorsal root ganglia. Reactivation occurs later in life, often triggered by immunosuppression, stress, or aging, leading to a painful, unilateral vesicular rash typically distributed along a single dermatome. The condition can result in complications such as postherpetic neuralgia (PHN), a persistent pain in the affected area even after the rash resolves.
#### 2. Major Classifications of Medications
– **Antivirals:** Such as acyclovir, valacyclovir, and famciclovir, used to reduce viral replication and severity of symptoms.
– **Mechanism of Action:** These drugs inhibit viral DNA synthesis by competing with deoxyguanosine triphosphate for viral DNA polymerase, resulting in premature chain termination.
– **Analgesics:** For pain relief, including NSAIDs, acetaminophen, or opioids in severe cases.
– **Corticosteroids:** Sometimes used to reduce inflammation and acute pain, although their use is controversial and typically reserved for specific cases.
#### 3. Pharmacological Agent: Valacyclovir
**Prescription for Adult (ages 18 – 50):**
– **Medication:** Valacyclovir 1,000 mg tablets
– **Dosage:** 1,000 mg orally three times daily for 7 days.
– **Quantity:** 21 tablets
– **Refills:** None
**Prescription for Elderly Woman (84-year-old):**
– **Medication:** Valacyclovir 1,000 mg tablets
– **Dosage:** 1,000 mg orally three times daily for 7 days, with renal function monitoring due to potential age-related renal impairment.
– **Quantity:** 21 tablets
– **Refills:** None
4. Side Effects, Adverse Effects, Contraindications, and Patient Education
– **Side Effects:** Nausea, headache, abdominal pain, and dizziness.
– **Adverse Effects:** Rarely, acute renal failure, thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS) in immunocompromised patients.
– **Contraindications:** Hypersensitivity to valacyclovir or acyclovir; caution in patients with renal impairment.
– **Patient Education:** Begin treatment at the first sign of shingles for maximum effectiveness. Maintain adequate hydration to prevent renal complications. Be aware of potential interactions with other nephrotoxic drugs. Report any severe side effects such as confusion, hallucinations, or signs of renal dysfunction.
This week in our discussion, let’s focus on specific disorders and the medications used for them.
*Disorder:
Hand, foot, and mouth disease
1. Describe the pathology of the disorder.
2. Identify the major classifications of medications that are used to treat the disorder and briefly describe their mechanism of action.
3. Choose ONE pharmacological agent and write two prescriptions: Adult and 4-year-old child weighing 16 kg
4. Describe the side effects, potential adverse effects, contraindications, and patient education.
*Disorder:
Herpes zoster
1. Describe the pathology of the disorder
2. Identify the major classifications of medications that are used to treat the disorder and briefly describe their mechanism of action.
3. Choose ONE agent and write two prescriptions: Adult (ages 18 – 50) and an elderly woman (84-year-old)
4. Describe the side effects, potential adverse effects, contraindications, and patient education.
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