14 Jan What are the side effects

NU636 Advanced Pharmacology

Unit 1 Assignment

Case Study Polypharmacy

Instructions

Case Study

Mrs. A is a 71 year old widow with CCF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother’s ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:

Furosemide 40 mg daily in the morning

Digoxin 250 micrograms daily

Paracetamol 500 mg, 1-2 tablets 4-hourly PRN

Piroxicam 20 mg at night

Mylanta suspension, 20 ml PRN

Coloxyl 120 mg, 1-2 tablets at night

Assignment Questions

Critically discuss this case study in terms of the problematic nature of this patient’s pharmacological management.

Outline some pharmacokinetic changes in the geriatric population that may affect drug disposition.

Outline how changes in renal and hepatic function may affect treatment strategies.

In the drug regimen presented above – discuss potential side effects and potential interactions, if any?

Your response should include a discussion of the problems of polypharmacy as it is related to this case study and the assessment/management and educational strategies which could have been implemented to improve the outcome of Mrs. A.

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to the Submit Assignments/Assessments area:

NU636 Advanced Pharmacology

Unit 2 Assignment

Cardiac Impact

Instructions

Health Interview Survey (NHIS) were findings that 38% of adults use CAM [complementary and alternative medical] health care modalities.

Construct a professional paper that outlines how the use of the following CAM health care modalities impacts the cardiovascular system.

Ginseng

Hawthorn

L-Arginine

St. John’s Wort

For each of the modalities the discussion must include:

effect on the cardiovascular system

anticipated benefits

any identified risks or adverse effects

relative patient education

supporting reference from scholarly literature.

Instructions

Prepare and submit a minimum of a 6 page paper pages [excluding title and reference pages].

Format consistent with APA style without an abstract page.

Answer all the questions above.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 3 Assignment

Case Study Diuretics

Instructions

A 70 year old man with a history of myocardial infarction presents to the ER with shortness of breath and chest pain. Over the past 2 weeks he has developed increasing dyspnea with exertion and swelling in the limbs. Over the past 3 days he has found the need to elevate his head while sleeping to reduce the incidence of coughing and shortness of breath. At the moment he uses 4 pillows.

In the ER while sitting upright he seems to be in respiratory distress and is tachycardic with a blood pressure of 195/112. JVD is predominant. Upon auscultation of the lungs rales are heard bilaterally and he has pitting edema of both lower legs up to his knees.

Chest x-ray confirms pulmonary edema and he is immediately place on oxygen.

He is currently on hydrochlorothiazide, metoprolol and enalapril.

Assignment Questions

What would be the anticipated diagnosis for a patient with the clinical presentation in the case above? Correlate the symptoms noted with the pathophysiology of the condition you identified.

What pharmacologic agent would be anticipated as the first management step for this patient and why?

Explore and describe any potential interactions of the anticipated pharmacologic agent and the patient’s existing pharmacologic management.

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 3 Assignment

Case Study Antiarrhythmic

Instructions

Case Study

A 70 year old male patient develops a large anterior wall myocardial infarction. He is currently being managed with oxygen, aspirin, nitrates and a beta blocker.

He develops recurrent episodes of ventricular tachycardia and remains conscious however has dizzy spells and also becomes diaphoretic and hypotensive. An IV bolus of lidocaine is given followed by IV lidocaine infusion.

Assignment Questions

Which class of antiarrhythmics does lidocaine fall under?

What is the mechanism of action of lidocaine?

Why is lidocaine indicated in this patient

What are the side effects of lidocaine?

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 4 Assignment

Case Study Gastrointestinal

A 60 year old woman with a 10 year history of Type II diabetes presents with multiple complications including retinopathy, peripheral neuropathy and declining renal function.

She has not had the urge to eat as of recently she feels “full” after a few bites. The incidence of nausea and feeling bloated occurs at least twice a day and even after a glass of water she feels bloated. She also complains of fatigue and not been able to keep up with daily chores.

A radiographic gastric emptying study shows a prolonged gastric emptying time.

Assignment Questions

What is the typical diagnosis for a patient who presents with this clinical picture?

What is the likely pathophysiologic process responsible for the presenting symptom? Support your response with a credible source.

What is the class of the drug used to treat the pathophysiolog?. Discuss the pharmacologic management plan for this patient.

Outline the mechanism of action and any possible contraindications of the pharmacologic management plan that you identified for the patient.

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 4 Assignment

Case Study: Hyperlipidemia

A 70 year old hypertensive and diabetic male is taking an ACE inhibitor and a thiazide for his hypertension.

For his type II diabetes he is taking metformin.

Both his hypertension and blood glucose are within normal range.

Routine blood work reveals normal renal function and liver enzymes. His total cholesterol and low density lipoprotein (LDL) is elevated.

To reduce the risk of coronary artery disease he is commenced on a HMG-CoA reductase inhibitor.

Assignment Questions

What drugs fall under a HMG-CoA reductase inhibitor.

What is the mechanism of action of this drug.

What effect will this drug have on total LDL and cholesterol levels.

What are the common adverse effects and drug interactions?

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 5 Assignment

Case Study Acute Joint Inflammation

Mr. Y is a 47 year old, mixed race [Asian/African ethnicity], male patient who presented to your office with severe right great toe pain. Onset of the pain was 2 days ago. Mr. Y denies any known trauma to his right foot or his great toe on that foot. His right great toe is red and became so swollen in the last day that he cannot put on his shoe.

Mr. Y has a history of hypertension for which he is taking HCTZ 25mg daily, Metopralol 50 mg twice daily, and Lisinopril 10 mg daily. He denies any other medical problems.

Results of the lab tests that were ordered:

Sed rate – 93; Glucose, random – 117 mg/dl; Hgb – 13.4 gm/dl; WBC – 8200/ccm with normal diff; Serum uric acid – 10.9 mg/dl; Serum creatinine – 1.2 mg/dl

Assignment Questions

Based on presenting symptoms and lab findings, what is most likely diagnosis that will be made for Mr. Y?

What is the anticipated pharmacologic plan for managing Mr. Y’s acute pain? Provide a justification for the plan including a citation from a peer-reviewed source.

What is the anticipated pharmacologic plan for long-term management of Mr. Y’s diagnosis? Provide a justification for the plan including a citation from a peer-reviewed source.

Identify the key elements of the education plan that would be appropriate for the patient about the acute and chronic pharmacologic plans you identified above.

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 5 Assignment

Case Study: Rheumatoid Arthritis

Case Study

A 50 year old woman has had rheumatoid arthritis for 3 years and has been taking multiple NSAID’s. She has taken corticosteroids a few times during flare ups.

The disease seems to be progressing with stiffness and swelling in her hands and wrists. Examination reveals rheumatoid nodules, synovitis of both wrists and metacarpo-phalangeal joints. This is an indication of an acute exacerbation of rheumatoid arthritis. She is prescribed methotrexate with sulfasalazine and a short course of prednisone.

Assignment Questions

What is the mechanism of action of prednisone?

What is the concern with chronic treatment with glucocorticoids?

What is the mechanism of action of methotrexate and sulfasalazine.

What are the side effects of methotrexate and sulfasalazine

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to the Submit Assignments/Assessments area:

NU636 Advanced Pharmacology

Unit 6 Assignment

Antibiotic Stewardship

CDC Antibiotic Stewardship Initiative Discussion Paper

Construct a professional paper that outlines the advanced practice role – as a nurse educator, a nurse leader, or a nurse practitioner – to advance the CDC’s antibiotic resistance initiative.

Assignment Requirements

Introduction that identifies your advanced practice role and your view of how that role will be able to impact the antibiotic resistance dilemma. Support your discussion with at least two references from the literature.

Review the CDC’s goals and identify one of the CDC’s key strategies that you will be able to promote/support in your advanced practice role. Support your discussion with at least two references from the literature.

Discuss three activities/actions that you will develop to support the promotion of the key strategy that you identified in item 2 above. Each action/activity needs to be well designed and supported with at least one reference from the literature. For example, if you are a:

nurse educator student – in what course(s) will you be able to promote your identified key strategies, be specific about what that would look like using example lesson plan(s), identify any active learning strategies you will utilize, etc., and provide justification for your strategies, etc.

nurse leader student – what program(s) and activities will you engage with relative to your organization, be that existing programs or creation of new programs, reporting mechanisms, development of collaborative committees, etc., and provide justification for your strategies, etc.

nurse practitioner student – what prescribing practices, patient education practices, monitoring programs, etc., will you engage with, and provide justification for your strategies, etc.

Instructions

Prepare and submit a minimum of a 6 page paper pages [excluding title and reference pages].

Format consistent with APA style without an abstract page.

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area:

NU636 Advanced Pharmacology

Unit 6 Assignment

Case Study: HIV

Linda is a 28-year-old female in a discordant relationship with her boyfriend of 1 year. Linda is 12 weeks pregnant based on her last menstrual period. She is engaged in HIV-care and is naïve to antiretroviral therapy (ART) because her CD4 cell count is 538 per mm3 and viral load is 8,300. No tobacco, alcohol, or illegal or illicit drug use.

Physical examination: Normal, healthy 28-year-old gravid female. She is overweight with a body mass index of 28.2.

Laboratory and other tests: Genotype is pan-sensitive without HIV mutations. Ultrasound at her 2-day follow-up estimates she is 15 weeks pregnant.

Assignment Questions

What are the Public Health Service Panel on Antiretroviral Guidelines for Adults and Adolescents guidelines for HIV-positive pregnant females regarding starting ART? What antiretroviral medications are recommended as first line? Which drugs should be avoided? Provide a rationale for all answers.

What education does Linda need regarding her medication?

Are there any risks to the baby during labor?

What should be done for the baby at birth if he/she tests positive for HIV? What will the providers need to do in terms of monitoring the baby?

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to the Submit Assignments/Assessments area:

NU636 Advanced Pharmacology

Unit 7 Assignment

Case Study Breast Cancer

Mrs. V is a 47 year old white female who noted a lump near the lower, outer edge of her right breast. After undergoing work up, Mrs. V. was diagnosed with breast cancer. She underwent a right mastectomy without surgical reconstruction.

The pathology report relative to the patient’s tumor revealed the tumor was estrogen receptor positive.

Assignment Questions

What chemotherapeutic agent would be anticipated for this patient’s treatment plan? Support your discussion with a reference from a scholarly source.

Discuss the mechanism of action for the anticipated chemotherapeutic agent. Support your discussion with a reference from a scholarly source.

Discuss what the anticipated side effects of the chemotherapeutic agent are. Support your discussion with a reference from a scholarly source.

Anticipating the potential side effects of the treatment plan, what are the key elements to include in the patient education plan? Support your discussion with a reference from a scholarly source.

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to the Submit Assignments/Assessments area:

NU636 Advanced Pharmacology

Unit 8 Assignment

Case Study: Antidepressants Assignment and Discussion Response

A 40 year old woman presents with fatigue. She reports feeling ‘very run down’ for the past three months. She has no interest in participating in her usual activities and sporting events. She reports sleeping problems and low appetite. She is constantly feeling low and has frequent crying spells.

Her physical examination is normal and thyroid function is normal.

She is diagnosed with major depression and is referred for counseling and started on fluoxetine.

Assignment Questions

What is the mechanism of action of fluoxetine?

Why is fluoxetine the drug of choice?

What are the side effects of fluoxetine? (include both the side effects and the potential adverse effects of excessive doses of SSRIs.)

What are the risks of abruptly discontinuing fluoxetine?

Instructions

Prepare and submit a 3-4 page paper [total] in length (not including APA format).

Answer all the questions above.

Support your position with examples.

Please review the rubric to ensure that your assignment meets criteria.

Submit the following documents to this assignment area: