CASE STUDY (Total 20 marks)

Adapted from p 1120 6th Ed. Bullock & Manias

Ms PB is a 81-year-old widow living at home independently. Her ongoing health problems are:

chronic asthma, hypertension, peripheral oedema and angina pectoris, but she is managing them well using a combination of drugs and sensible lifestyle. The drugs she is taking for her condition are:

• for asthma – the inhaled corticosteroid beclomethasone (daily); the inhaled asthma prophylactic sodium cromoglycate (daily); the inhaled β2 agonist salbutamol (as required)
• for hypertension – the thiazide diuretic hydrochlorothiazide (daily); the α-antagonist prazosin (daily)
• for angina pectoris – the peripheral vasodilator glyceryl trinitrate (as required)

Over the past few years her intraocular pressure has been rising and she has recently been diagnosed with open-angle glaucoma. She is prescribed the β-blocker betaxolol, the prostaglandin analogue latanoprost, and the muscarinic agonist pilocarpine, and has just had them delivered by her local pharmacy. You watch her instil the drops and offer her encouragement and advice about the correct use of these drugs. Within a couple of months of starting therapy her intraocular pressure is rechecked and found to be reduced.

Answer the following questions:

1. By which route would the β-blocker, the prostaglandin analogue and muscarinic agonist be administered in the treatment of TH’s glaucoma? Why? (2 marks)
2. Explain how each of the drug groups used to treat her glaucoma relieve the high intraocular pressure. You must cover the pharmacological mechanisms. (6 marks)

1. How can systemic absorption of these drugs be minimised? (2 marks)
2. What are the common local adverse reactions associated with topical administration of eye drops? (2 marks)
3. Given PB’s pre-existing health problems, are there likely to be any precautions associated with her prescribed glaucoma therapy? (2 marks)

1. Are there any potential drug interactions between her existing therapy and her glaucoma therapy worth noting? (2 marks)

1. What changes to eye structures are associated with prostaglandin analogue therapy? Are these changes harmful to the eye? (2 marks)
2. What advice would you give her regarding the adverse effects she might expect when using the β-blocker and the muscarinic agonist? (2 marks)

Use your text book and other references to answer these questions.

This question requires you to apply the framework developed by Corey (2005) to a fictional case, using a person-centred framework. For the purposes of this assignment, you are to choose one of the characters in the movie below and adapt the client’s role to meet the requirements of the assignment:
American Beauty (1999) movie, directed by Sam Mendes and starring Kevin Spacey as Lester Burnham, an office worker who has a midlife crisis when he becomes infatuated with his teenage daughter’s best friend. If you choose option 1, you can pretend that any member of the Burnham family has been referred to you for counselling by their GP:
· Dad ‘Lester’ (Kevin Spacey)
· Mom ‘Carolyn’ (Annette Bening)
· Daughter ‘Jane’ (Thora Birch)
The framework for your case study should include the following:
· An introduction to the client you have chosen
· Your basic assumptions about using a person-centred approach for this particular fictional client
· Your ‘assessment’ or understanding of the case from a person-centred perspective
· The goal(s) of therapy with this client
· A description of fictional key moments of the therapeutic process, preferably demonstrated with the use of ‘verbatim’ interaction between therapist and client.
Refer to Module 5 for an outline of Corey’s (2005) framework (Ch 1 & 5 of Case Approach to Counselling & Psychotherapy) and the example of “Ruth” to guide you on how to approach this case study assignment. When writing up a case study, you may use a loose report structure with decimal notation, or an essay structure with headings. However, full sentences and descriptive prose is required, not dot points or lists. In text and end text referencing are both essential for academic work.
Suggested length:
Maximum 2,500 words (excluding references) Penalty for word count 10% above applies. Please record your word final count (excluding reference list & cover page) on the cover page.
Assignment Presentation & Submission