These pharmacological inquiries focus on a 62-year-old patient whom I will refer to as Bob Smith. Bob was medevac’d to OHSU from his home in Grants Pass, Oregon. He has been a paraplegic since the age of 19 after a motor vehicle accident. His current diagnosis happened as a result of falling and being left for three days. He has extensive pressure ulcers that were infected and needed immediate surgery. Bob also has type 2 diabetes.
Bob has a current prescription list of 31 medications. After reviewing his chart, I have decided to focus on the role vitamins play in his wound healing, how Lovenox dosings vary based on his sex and age, and if Piperacillin/tazobactam is the preferred course of antibiotics. The questions I will be researching are as follows: (a) How are ascorbic acid supplements contributing to his wound healing? (b) Based on patient’s Vancomycin-Resistant Enterococci infection, is this patient on the correct course of antibiotics? and (c) What are the influences of gender on wound healing?
Vitamin C’s role in wound healing
Traditionally, vitamin C has been thought to be a cure for many ailments. In wound healing vitamin C helps to rebuild collagen. “Vitamin C is a co-factor in proline and lysine hydroxylation, a necessary step in the formation of collagen. Hydroxyproline and hydroxylysine are essential for stabilizing the triple helix structure of collagen with strong hydrogen bonds and crosslinks.” (Collins, 2009) Vitamin C gives tensile strength to this newly laid down collagen. This is crucial for pressure ulcer healing because then the regeneration of skin will not tear as easily.
However, more recent research challenges these assumptions. A randomized double-blin...
... middle of paper ...
...c effects on wound healing may lead to a pharmaceutical outcome of prescribing estrogen creams. “Topical and systemic estrogen treatments have been shown to increase the rate of acute healing in men, and particularly in elderly women, by reducing the inflammatory response.” (Gilliver et al., 2007, p. 56)
Based on my research findings an appropriate course of action for Mr. Smith would be to continue the piperacillin/tazobactam as an effective and non-bacteria resistant forming antibiotic. Further, Mr. Smith should also continue Vitamin C in conjunction with other supplements and protein to promote maximum wound healing. Based on Mr. Smith’s stagnant wound healing and the potential gain he could receive seeing as he is a male, an appropriate next step in pharmaceutical care would be to look into the potential benefits he might gain from topical estrogen.
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