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Original Question

John, a 70-year-old male, was admitted with a wound infection on his right leg and was started on IV antibiotics in the emergency department before being transferred to the medical ward. John has a past medical history of DVT in his left leg and is a heavy drinker. He has been referred to the drug and alcohol team during this admission. His current condition shows good oral intake, regular bowel motions, and voiding well. Day 2 admission: At 1:20 am, John requests Endone PRN for severe pain, grimacing, groaning and moaning. Day 3 Admission: John reports coughing up blood and noticing blood in his stool. Benzylpenicillin 1.2 g IV for 3 days (then later changed to Flucloxacillin 500 mg PO) Clexane 80 mg SC once daily Endone 10 mg PO QID (PRN) – Max 40mg/24 hrs Ibuprofen 400 mg PO TDS Diclofenac 25 mg PO TDS Allergy: Ceftriaxone Question 1 – Discuss the pharmacokinetics (ADMEs) and pharmacodynamics of Benzylpenicillin and Clexane in relation to John’s condition, age, and history as a heavy drinker. Highlight potential medication safety concerns and how they could be mitigated.

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