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Mary's Joint Pain: A Case Study

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Mary’s joint pain seems to be well controlled by her current use of paracetamol and diclofenac. The expected outcomes of Mary’s asthma treatments however, are not being achieved. Poor control is evident in night-time symptoms, and nightly requirement of Salbutamol (1). Beclomethasone has been prescribed at a moderate dose. While this dose is safe, it is too high to be prescribed without the pairing of a long acting Beta2 agonist (LABA) (1). The therapeutic guidelines stepwise approach to treatment recommends pairing an ICS with a LABA first, before increasing the ICS dose, in order to obtain adequate symptom management (1). If increased does is required combined therapy with a LABA should still remain. Therefore, while the does may be adequate, the current therapy is not effective. The expected outcome of St John’s Wort has not been achieved, the medication is not effective, and Mary’s depression resides. Mary has just begun Fluoxetine in the last few days, however depression pharmacotherapy can take 2- 3 weeks before patients start to see a difference, and 6 or more weeks before the full effect of the antidepressant is achieved (12). Currently Mary is confined to only pharmacological treatment therapy, which is not best …show more content…
She has received incorrect counselling regarding her SSRI, which should be taken at a lower dose, in the morning (7); and her diclofenac and paracetamol prescriptions are not appropriately timed (5). Mary should be using regular paracetamol, and intermittent NSAIDs for breakthrough pain, not the reverse. Furthermore, the prescriber has failed to caution her against, nor protect her from the risk of long term, regular NSAID use. The general practitioner has also put Mary at risk of adverse gastrointestinal complications by prescribing both an SSRI and long term, regular diclofenac

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