Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521

Pharmacokinetic and Pharmacodynamics

Pharmacokinetics (PK) and pharmacodynamics (PD) are two main branches of pharmacology that are essential for optimizing drug therapy and ensuring patient safety. PK studies the journey of a drug through the body, including its absorption, distribution, metabolism, and elimination while on the other hand, PD examines how a medication affects the physiological and biochemical functions of the body (Ernstmeyer & Christman, 2023). This paper explores the relationship of these principles with my real-world clinical experiences, emphasizing the importance of considering individualized factors that influence drug response.

Case Presentation

During my clinical experience, I came across a 65-year-old male patient with a history of chronic heart failure presented with worsening symptoms of dyspnea, fatigue, and edema. His current medications included furosemide, an aldosterone antagonist, and enalapril, an ACE inhibitor. Upon evaluation, the patient’s serum potassium level was found to be elevated, indicating potential hyperkalemia, which is a known adverse effect of aldosterone antagonists.

Factors Influencing Pharmacokinetic and Pharmacodynamic Processes

Several factors influenced the PK and PD processes in this patient, contributing to the development of hyperkalemia. According to Rosenthal and Burchum (2019), an advanced patient’s age increases the risk of impaired renal function. The patient’s age, being over 60 years old, could have slowed down the elimination of potassium from the body. Secondly, the patient’s concurrent use of enalapril, an ACE inhibitor, can further enhance potassium retention due to its mechanism of action. Additionally, the patient’s reduced physical activity may have contributed to decreased potassium excretion through sweat.

Personalized Plan of Care

Based on the influencing factors and patient history, a personalized plan of care was developed to address the hyperkalemia and optimize drug therapy. The aldosterone antagonist dosage was reduced to minimize potassium retention (American Geriatrics Society, 2019). Additionally, the patient was advised to monitor his potassium levels regularly and maintain a low-potassium diet. Furthermore, regular monitoring of renal function was recommended to ensure adequate potassium excretion.

Conclusion

This case study highlights the importance of considering PK and PD principles in patient care. Understanding these factors that influence drug absorption, distribution, metabolism, and elimination enables healthcare professionals to tailor drug regimens to individual patients, minimizing the risk of adverse effects and maximizing therapeutic efficacy.

Discussion: Pharmacokinetics and Pharmacodynamics NURS 6521 References

American Geriatrics Society. (2019). American geriatrics society 2019 updated AGS beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

Ernstmeyer, K., & Christman, E. (2023). Chapter 1 pharmacokinetics & pharmacodynamics. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK595006/

Rosenthal, L. D. R., & Burchum, J. R. (2019). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants: Laura Rosenthal DNP ACNP, Jacqueline Burchum dnsc APRN BC: 9780323554954: Amazon.com: Books. Amazon.com. https://www.amazon.com/Pharmacotherapeutics-Advanced-Practice-Physician-Assistants/dp/0323554954

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

Pharmacokinetics and Pharmacodynamics Example Solution

The human body and pharmacological agents interact in various fashions to cause desired pharmacological effects and adverse outcomes in undesired situations. I encountered a patient named Mrs. B (not her actual name) who was being treated for congestive heart failure in my training. Mrs. B is a 78-year-old black female who had been on treatment for heart failure two months ago. During that admission, she had been brought in because she had bilateral lower limb edema.

Mrs. B was put on furosemide for his edema and heart failure. She was ambulant and reported no leg pain. During the second day on furosemide, she started reporting dizziness. Her blood pressure measured that day was within the normal limits but borderline low. Her physician reassured her that her vitals were fine but there needed some adjustments in the doses of her medications. Her physician was also worried about her kidney function due to her conditions. Therefore, he ordered that Mrs. B be evaluated for serum creatinine, urea levels, and serum potassium and sodium levels.

Mrs. B’s body ad furosemide reacted in various ways to cause the improvement of the edema and the dizziness with lowered blood pressure. Furosemide is the commonest prescribed diuretic and has indications in cardiac, hepatic, pulmonary, and renal diseases (Rosenthal & Burchum, 2020). It has well documented pharmacokinetic profile and pharmacodynamics properties. The route of administration can be parenteral or enteral. Oral administration is usually through oral uncoated tablets or oral disintegrating films (Koh et al., 2021).

The route determines its bioavailability and onset of action after administration. The absorption happens in the gut after oral administration, and metabolism occurs in the liver, after which elimination will take place in the kidneys. This explains the physicians’ concerns about kidney functions. Poor elimination in kidney injury would lead to toxicity of this drug and more adverse events. Furosemide acts in the loop of Henle to promote the excretion of water and potassium.

Therefore, it reduces fluid overload and reduces cardiac output. In so doing, it can lower blood pressure and cause hypotension and dizziness. This explains the phenomenon that Mrs. B was experiencing on the second day of therapy (Khan et al., 2022). Therefore, the pharmacokinetics and pharmacodynamics of furosemide explain the entire phenomena Mrs. B had. This understanding provides the basis for the care plan for this patient.

Individualized Plan for Mrs. B

Mrs. would require rehydration despite still having fluid overload. This would prevent acute kidney injury and furosemide toxicity. Mrs. B is an elderly patient, and the administration of furosemide would require monitoring of sodium levels for this particular population, according to the American Geriatric Society (American Geriatrics Society, 2019). Decreased kidney function among the elderly population would lead to decreased drug elimination and thus toxicity. This plan would also include blood pressure monitoring to prevent orthostatic hypotension and dizziness.

The personalized plan for Mrs. B is based on what furosemide does to the body (pharmacodynamics) and what the body does to furosemide (pharmacokinetics) and the factors influencing these interactions. Age has stood out as a key factor in the pharmacodynamics and pharmacokinetics of furosemide. The diminished physiological capacity of the body in adults influences how they eliminate and metabolize medications. Therefore, nursing interventional adjustments and physical intervention adjustments would be justified in this case.

References

American Geriatrics Society. (2019). American geriatrics society 2019 updated AGS beers criteria® for potentially inappropriate medication use in older adults: 2019 Ags beers criteria® update expert panel. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

Khan, T. M., Patel, R., & Siddiqui, A. H. (2022). Furosemide. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499921/

Koh, S.-K., Jeong, J.-W., Choi, S.-I., Kim, R. M., Koo, T.-S., Cho, K. H., & Seo, K.-W. (2021). Pharmacokinetics and diuretic effect of furosemide after the single intravenous, oral tablet, and newly developed oral disintegrating film administration in healthy beagle dogs. BMC Veterinary Research, 17(1), 295. https://doi.org/10.1186/s12917-021-02998-4

Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders. https://evolve.elsevier.com/cs/product/9780323554954

Example Discussion 1 Approach 2

The patient case that I recall from my past experiences is about a 40-year-old male patient who was admitted following an amputation. The patient transferred to rehab just days after the surgery and was not medically stable to endure 3 hours of therapy. Some comorbidities include a kidney transplant, ESRD on peritoneal dialysis, hypertension, and diabetes. The patient was  chronically hypotensive, with normal systolic blood pressures in the 80s. Current medications included anti-hypertensives and alpha-adrenergic agonists. During therapy, the patient would experience orthostatic hypotension dropping down to the 60’s.  

Some factors might have influenced pharmacokinetic and pharmacodynamic processes in this patient. Pharmacokinetics involves absorption, distribution, metabolism and excretion. After the medication is ingested, it gets absorbed into the bloodstream, which moves from the blood into the cell.

The drug is then metabolized by the liver and excreted primarily by the kidneys. Drugs and their metabolites can exit the body in urine, bile, sweat, saliva, breast milk, and expired air (Rosenthal, 2021). Patients with chronic kidney disease will respond to drugs   differently than patients with normal kidney function. In patients with healthy kidneys, small molecules and drugs get filtered through the glomerulus. In the tubules, lipid-soluble drugs undergo passive reabsorption. Lastly, active transport systems can pump drugs into the tubule to be excreted with urine. 

For patients who have ESRD, the excretion of drugs is affected tremendously. Whether kidney disease is acute or chronic, drug clearance decreases, and the volume of distribution may remain unchanged or increase” (Roberts, et.al., 2018). Duration and intensity are factors to consider in these patients due to the increased number of free drugs in the blood. With patients who are taking multiple drugs, there is a delayed excretion of drugs if they use the same transport system, and the medication effects can be delayed. According to Sommer, Seeling, and Rupprecht, “70.4% of the residents with an estimated glomerular filtration rate (eGFR) < 60 mL/min take at least five drugs, with 17.7% of them taking > 10 drugs as long-term medication” (2020).  

The personalized care plan that I would implement for this patient included taking a full history of medications including herbal and over-the-counter drugs. Accurate documentation of medications prevents adverse drug-to-drug interactions, medication replication, and dosage errors. As the provider, we can adjust the dosage of medications accordingly. In the case of this patient, a decrease in the dosage of antihypertensive medications should be considered because the patient continues to have hypotension.

Renal dosage of these medications also must be taken into consideration, are these medications appropriate for patients with chronic kidney disease? I would monitor for signs and symptoms of toxicity including low blood pressure, dizziness, headaches, and feeling tired. Monitor blood pressure throughout the day, especially before and after taking blood pressure medications and when the patient reports symptoms of hypotension. The patient would benefit from education about the medications and what signs and symptoms to monitor for.

Discussion 1 Schizophrenia and Diabetes Example 3

My patient is an incarcerated 43-year-old Hispanic male with schizophrenia, currently being treated with 20mg of olanzapine once at nighttime. This treatment has effectively treated the positive and negative symptoms of his mental health illness. However, his blood sugar levels have become elevated lately He has no reported history of diabetes nor other known medical conditions. He has a history of methamphetamine and alcohol use. He has gained approximately twenty pounds over the past three months while incarcerated. 

It is well documented that patients undergoing treatment with antipsychotics are at an increased risk of gaining weight and developing diabetes mellitus (DM) in comparison to the general population, an approximate eight to ten-fold increased risk according to Jaworski et al. (2021). Holt (2019) noted that among atypical (second generation) antipsychotics, olanzapine has been associated with the highest rate of weight gain and DM (71%) when compared to first generation antipsychotics (p.4).

Among the atypicals, olanzapine is closely followed by risperidone and quetiapine in causing these adverse effects, with the least likely being ziprasidone and aripiprazole (Khandker et al., 2022, p.2). However, the possible causational mechanism of developing DM associated with initiating antipsychotics is still being studied. There is the general belief that it correlates with weight gain, but there is also evidence that suggests that it may be due to a direct decrease in insulin sensitivity and insulin secretory capacity (Holt, 2019, p. 5).  

To determine the best course of treatment to take with this patient, it is important to review and balance the control of symptoms, risk of side effects, and the risk of relapse (Khandker et al., 2022, p. 9). Our patient has a history of taking other antipsychotics including Haldol and risperidone, but the patient experienced most benefit of his symptoms with olanzapine. He does not recall having received treatment with either ziprasidone or aripiprazole.

In this case, I would recommend that we adjust his antipsychotic medication to aripiprazole, monitor for therapeutic response, and continue monitoring his blood sugars. We want to avoid having to treat another disease process if it can be avoided which might be accomplished with this adjustment. It is also important to note that it may be necessary to treat him with olanzapine if it is discovered that he is not responded favorably to other treatments or if the patient wishes to continue with his current treatment after being given the risks of benefits of his options. 

NURS 6521 Week 1 Assignment Ethical and Legal Implications of Prescribing Drugs 

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Assignment 2: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

Photo Credit: Getty Images/Caiaimage

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to do no harm. It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority.

Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

1. Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
2. Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
3. Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
4. Explain the process of writing prescriptions, including strategies to minimize medication errors.

SCENARIO:

You see another nurse practitioner writing a prescription for her husband, who is not a patient of the nurse practitioner. The prescription is for a narcotic. You can’t decide whether or not to report the incident.

Give examples. For example, say it was Dilaudid (hydromorphone) tablets. Talk about the drugs effects on patient (kinetics & dynamics briefly), use highest level pharmacological information, since you are doing advanced pharmacology. Talk about Ethical Moral & Legal aspects of this error & how you will rectify the issue. Talk about long term consequences of opioid prescriptions. Give information as short paragraphs, not big blobs.

NOTE:
PLEASE INCLUDE A TITLE PAGE, INTRODUCTION AND SUMMARY.
MY STATE IS PENNSYLVANIA.

Use peer reviewed scholarly reference articles, provider/clinician based, not patient based, from peer reviewed, current US based journals. Within 5 years.

NURS 6521 Week 2 Pharmacotherapy for Cardiovascular Disorders

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 33, Review of Hemodynamics (pp. 285-289)
Chapter 37, Diuretics (pp. 290-296)
Chapter 38, Drugs Acting on the Renin-Angiotensin-Aldosterone System (pp. 297-307)
Chapter 39, Calcium Channel Blockers (pp. 308-312)
Chapter 40, Vasodilators (pp. 313-317)
Chapter 41, Drugs for Hypertension (pp. 316-324)
Chapter 42, Drugs for Heart Failure (pp. 325-336)
Chapter 43, Antidysrhythmic Drugs (pp. 337-348)
Chapter 44, Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels (pp. 349-363)
Chapter 45, Drugs for Angina Pectoris (pp. 364-371)
Chapter 46, Anticoagulant and Antiplatelet Drugs (pp. 372-388)

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke some of the leading risk factors for heart disease

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

Write a 2- to 3-page paper that addresses the following:

1. Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
2. Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
3. Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Here is the Case for your Study!

Patient JJ has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia.

Drugs currently prescribed include the following:

Glipizide 10 mg po daily
Metformin 500 mg po daily
HCTZ 25 mg daily
Atenolol 25 mg po daily
Hydralazine 25 mg qid
Simvastatin 80 mg daily
Verapamil 180 mg CD daily

Facilitator/Professor help:

INFORMATION AS SHORT PARAGRAPHS, READABLE. All information & presentation have to be at advanced clinician level.

1. Discuss pharmacology of existing agents briefly, molecular mechanism of action, therapeutic & adverse effects, & relevant kinetics, all as short paragraphs, readable.
2. Talk about what modifications are needed, what drugs are not at the best interest.
3. Follow a guideline, preferably JNC 8 and its current modifications (also ACC/AHA 2019 guidelines).
4. Talk about the drugs you have substituted or added, & their key pharmacology.
5. Address any specific questions that you are asked for in this case.

Example, here are some questions you may want to address in your assignment:

Does this patient need both verapamil & atenolol at the same time, since both have similar actions?

Recent guidelines do not recommend beta blockers for hypertension. But it was possibly added for the best therapeutic outcome? Why beta blockers? (example, he had strokes?).

Is there a drug to be added for stroke prevention?

What are the major adverse effects of Statins (muscle related), Hydralazine (many, lupus like syndrome), glipizide (hypoglycemia) HCTZ (hypokalemia) etc.

Why can\’t this patient be a candidate for metformin, the best used diabetes drug, efficacious, no hypoglycemic attacks etc.?

Please include a title page, an introduction with a purpose statement, and a summary.

NURS 6521 Week 3 Asthma and Stepwise Management 

Please be mindful of plagiarism and APA format, I have included the rubric and a template. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.

Photo Credit: Photo Library / Getty Images

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.

Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.

Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

1. Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
2. Explain the stepwise approach to asthma treatment and management for your patient.
3. Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

PLEASE USE THE TEMPLATE
5-6 SLIDES

Concepts of Cardiovascular and Respiratory Disorders Knowledge Check

QUESTION 1

1. Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.” 

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question:

Which cholesterol is considered the “good” cholesterol and what does it do?

QUESTION 2

1. Scenario 1: Myocardial Infarction

CC: “I woke up this morning at 6 a.m. with numbness in my left arm and pain in my chest. It feels tight right here (mid-sternal).” “My dad had a heart attack when he was 56-years-old and I am scared because I am 56-years-old.” 

HPI: Patient is a 56-year-old Caucasian male who presents to Express Hospital  Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states this started this morning and has been getting worse, pointing to the mid-sternal area, “it feels like an elephant is sitting on my chest and having a hard time breathing”. He rates the pain as 9/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, or lightheadedness. Nitroglycerin 0.4 mg tablet sublingual x 1 which decreased pain to 7/10.

Lipid panel reveals Total Cholesterol 424 mg/dl, high density lipoprotein (HDL) 26 mg/dl, Low Density Lipoprotein (LDL) 166 mg/dl, Triglycerides 702 mg/dl, Very Low-Density Lipoprotein (VLDL) 64 mg/dl

His diagnosis is an acute inferior wall myocardial infarction.

Question:

1.     How does inflammation contribute to the development of atherosclerosis

QUESTION 3

1. Scenario 2: Pleural Friction Rub

A 35-year-old female with a positive history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 5-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.

Question:

1.     Because of the result of a pleural friction rub, what does the APRN recognize?

QUESTION 4

1. Scenario 4: Deep Venous Thrombosis (DVT)

A 81-year-old obese female patient who 48 hours post-op left total hip replacement. The patient has had severe nausea and vomiting and has been unable to go to physical therapy. Her mucus membranes are dry. The patient says the skin on her left leg is too tight. Exam reveals a swollen, tense, and red colored calf. The patient has a duplex ultrasound which reveals the presence of a deep venous thrombosis (DVT).

Question:

1.     Given the history of the patient explain what contributed to the development of a deep venous thrombosis (DVT)

QUESTION 5

1. Scenario 5:  COPD

A 66-year-old female with a 50 pack/year history of cigarette smoking had a CT scan and was diagnosed with emphysema.  He asks if this means he has chronic obstructive pulmonary disease (COPD).

Question:

1.     There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.

Concepts of Cardiovascular and Respiratory Disorders Example Solutions

Which cholesterol is considered the “good” cholesterol, and what does it do?

When the body has excessive LDL cholesterol, the LDL cholesterol builds up on the walls of blood vessels, forming plaque. The vascular lumen narrows and might obstruct when plaque accumulates over time. This constriction prevents blood flow to and from the coronary artery, as well as to and from the heart and other organs.

When blood flow to the heart is obstructed, it can result in angina which is chest pain or a heart attack. Cholesterol circulates in the blood on proteins known as lipoprotein. Two forms of lipoproteins transport cholesterol throughout the body: LDL and HDL. LDL (low-density lipoprotein), often known as bad cholesterol, accounts for the majority of the body’s cholesterol.

High LDL cholesterol levels increase your risk of heart disease and stroke (CDC, 2020). HDL (high-density lipoprotein) is the beneficial cholesterol that absorbs and transports cholesterol back to the liver. It is subsequently eliminated from the body through the liver (CDC, 2020). High HDL cholesterol levels can reduce the risk of heart disease and stroke.

An LDL cholesterol level of 130–159 mg/dl is borderline high, while a level of 160–189 mg/dl is considered high. A result of at least 190 mg/dl is considered extremely high. If the patient has an LDL of 166, this is considered high (Zafari, 2021). Nitroglycerin is still used to treat angina pectoris and acute myocardial infarction. Nitroglycerin works by producing nitric oxide, which induces vasodilation and increases blood flow to the myocardium (Zafari, 2021). Dieting and exercises are also major contributors to lowering LDL.

How does inflammation contribute to the development of atherosclerosis?

Low levels of inflammation over time irritate the blood vessels. Inflammation can encourage plaque formation and release of plaque in the arteries and generate blood clots, which are the leading cause of heart attacks and strokes (Hopkinsmedicine, 2021). Inflammation is important in all stages of atherosclerosis. Stable plaques have a persistent inflammatory infiltration, whereas susceptible and ruptured plaques have an active inflammation that causes the fibrous cap to weaken, predisposing the plaque to rupture.

The presence of several types of susceptible plaques implies that atherosclerosis is a widespread inflammatory process (Hopkinsmedicine, 2021). Morphologic and molecular indicators can distinguish between stable and fragile plaques, allowing individuals at high risk for acute cardiovascular and cerebrovascular events to be stratified before clinical symptoms arise.

Because of the result of a pleural friction rub, what does the APRN recognize?

A pleural friction rub is characterized by a raspy breathing sound produced by inflammation of the tissues around your lungs. When these two layers of pleural membranes become irritated or lose their lubrication, the patient feels discomfort and a pleural friction rub. A pleural friction rub might signify a more serious lung problem (Squires, 2022). The APRN detects a scraping, scratchy sound after breathing and the start of exhaling. It originates in the region right above the pleural irritation. An APRN may be able to detect a pleural effusion based on a reduction in breath sounds and a change in their quality (Squires, 2022).

Given the history of the patient, explain what contributed to the development of a deep venous thrombosis (DVT)

According to Virchow’s triad of hypercoagulability, venous stasis, and vascular wall damage give a paradigm for understanding many of the risk variables that lead to the onset of thrombosis. As Salahudheen (2018) notes, there is venous endothelial damage induced by surgery, venous stasis owing to perioperative immobilization, and hypercoagulability resulting from postoperative fibrinolytic shutdown in patients who have complete hip or knee replacement surgery, for example.

However, a significant minority of individuals have unexplained DVT that lacks “clinical” risk markers such as endothelium damage or venous stasis, as well as identified thrombophilias that produce hypercoagulability. Undoubtedly, some of these individuals have unidentified thrombophilias, although the DVT is now classified as idiopathic.

There is a clear relationship between emphysema and COPD, explain the pathophysiology of emphysema and the relationship to COPD.

COPD is a chronic respiratory disease that causes dyspnea, coughing, and sputum production. Expiratory flow restriction is the physiological cause of dyspnea. COPD lungs exhibit alveolar breakdown, expansion, and inflammation of the lung parenchyma and airways (Higham et al., 2019). Emphysema etiology can be caused by increased alveolar wall cell death and lack of alveolar wall maintenance.

Chronic inflammation and elevated oxidative stress, according to the research, contribute to greater damage and poorer lung maintenance and repair in emphysema (Higham et al., 2019). Because clinically severe emphysema affects only a small percentage of smokers, genetic factors may play a key role in susceptibility or resistance to cigarette smoke.

References

CDC. (2020). LDL and HDL cholesterol: “bad” and “good” cholesterol. Centers for Disease Control and Prevention. Accessed 16^th June 2022 from https://www.cdc.gov/cholesterol/ldl_hdl.htm

Higham, A., Quinn, A. M., Cançado, J. E. D., & Singh, D. (2019). The pathology of small airways disease in COPD: historical aspects and future directions. Respiratory Research, 20(1), 49. https://doi.org/10.1186/s12931-019-1017-y

Hopkinsmedicine. (2021). Fight inflammation to help prevent heart disease. Hopkinsmedicine.Org. Accessed 16^th June 2022 from  https://www.hopkinsmedicine.org/health/wellness-and-prevention/fight-inflammation-to-help-prevent-heart-disease

Salahudheen, M. (2018). A comprehensive study on incidence and risk factors of deep vein thrombosis in asymptomatic patient after prolonged surgery. Stanley Medical College, Chennai.

Squires, E. (2022). Assessment and examination of the respiratory system. Practice Nursing, 33(1), 18–24. https://doi.org/10.12968/pnur.2022.33.1.18

Zafari, M. (2021). Myocardial infarction. Medscape.Com. https://emedicine.medscape.com/article/155919-overview

NURS 6521 Week 4 Assignment Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Case study information: Please read some tips I have made below for getting a good score!

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea.

The patient has a history of drug abuse and possible Hepatitis C.

HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily

Instructor/Facilitator help:

1. One short paragraph on three differential diagnoses. Do not just say \”symptoms are vague, no diagnoses possible, I will just do further assessment.\”

Subjective & Objective information are intentionally provided vague (as a clinical case) so that you can develop a couple of pharmacological cases & discuss.

2. One short paragraph on how you will pharmacologically treat the three diagnoses you listed (Pharmacological Plan).
3. One short-short paragraph on Synthroid, Nifedipine, a peripheral calcium channel blocker & prednisone an anti-inflammatory immunosuppressor (pharmacological information) and why patient was on these drugs, discussion based on your objective & assessment.

Briefly state the mechanism of action and therapeutic applications of these agents.

4. Long discussions/stories of no relevance to advanced practice pharmacology will carry no value with this project.
5. Include NEWER AGENTS of cure for hepatitis C infection. Discuss how these NEWER hepatitis C drugs of CURE work.
6. Include peer reviewed, scholarly articles of past 4 years as reference.
7. A conclusion with clinician level pharmacology in focus.

Write a 1-page paper that addresses the following:

1. Explain your diagnosis for the patient, including your rationale for the diagnosis.
2. Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
3. Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Please include a title page, an introduction with a purpose statement, and a summary.

NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Discussion: Diabetes and Drug Treatments

Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images

Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/

To Prepare

Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.

Select one type of diabetes to focus on for this Discussion.

Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.

Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

Diabetes and Drug Treatments Example Solution

Diabetes is a condition characterized by elevated blood glucose resulting from impaired insulin secretion or the inability to use the insulin produced effectively. The Centers for Disease Control and Prevention (CDC) estimate that approximately thirty-seven adults in the United States have diabetes, with the condition being one of the major causes of mortality each year (Gruss et al., 2019). Diabetes is classified into type 1 diabetes, type 2 diabetes, gestational diabetes, and prediabetes.

 Type 1 diabetes is mostly a result of an autoimmune reaction affecting children, adolescents, and young adults. It is primarily due to impaired insulin secretion by the pancreas (Petrov & Basina, 2021). In type 2 diabetes, the body is unable to utilize the produced insulin effectively. Gestational diabetes is diagnosed in expectant women who have not previously been diagnosed with the condition. Prediabetes means that blood sugars are elevated but not to levels high enough to make a comprehensive diagnosis of diabetes.

Juvenile diabetes was a term previously used to describe type 1 diabetes. In juvenile diabetes, the pancreas produces little to no insulin. Genetics and certain viruses have been identified as the main predisposing factors to juvenile diabetes. The condition is mostly diagnosed during childhood though several cases have been identified in adults. With type 2 diabetes being prevalent among children nowadays, the term is hardly used nowadays. In this essay, I will focus on type 2 diabetes, highlighting medications used and their impact on the patient’s body.

Type 2 Diabetes

As highlighted above, type 2 diabetes is a condition caused by ineffective utilization of insulin produced by the pancreas resulting in elevated blood glucose levels. Out of the estimated 37 million people living with diabetes in the United States, it is estimated that approximately 90 to 95% of that number have type 2 diabetes (Gruss et al., 2019). The commonest presentations of this condition include polydipsia, polyuria, polyphagia, and easy fatiguability, among other symptoms.

Drugs Used In Management

Metformin is one of the commonly used drugs in the management of type 2 diabetes. Metformin impairs the process of gluconeogenesis, consequently lowering blood glucose levels (Rosenthal & Burchum, 2021). In addition, the drug minimizes the uptake of glucose by the intestines while also boosting insulin sensitivity. The drug is administered orally. The recommendation is to swallow the drug with meals during the initial stages to minimize related gastrointestinal side effects. It is recommended that the drug should be swallowed with a full glass of water without crushing or breaking it.

Dietary Considerations

The recommended diet constitutes whole grains, fruits, and vegetables. Nuts and legumes are also highly recommended. Foods rich in fiber are highly recommended. The patient should be advised to either minimize or completely cease the consumption of alcohol and other fizzy drinks. Refined grains and processed foodstuffs such as meat should also be taken in moderation.

Impacts Of Diabetes

Short-term complications associated with type 2 diabetes include frequent urination and increased thirst, which may greatly inconvenience the patient. In addition, the patient may experience blurry vision, constant headaches, and fatigue. In the long run, diabetes causes damage to both the large and small blood vessels. As Speight et al. (2020) note, this has a significant impact on major organs resulting in cardiac failure, stroke, and complications related to the kidneys, eyes, nerves, and lower limbs.

Side Effects of Metformin

The commonest side effects associated with metformin use include nausea, vomiting, and diarrhea. In addition, abdominal pain, loss of appetite, and a metallic taste have been associated with the drug. In a few instances, much worse side effects have been reported. These include impaired or increased respiration rates, reduced pulse rate, jaundice, and vitamin B12 deficiency, commonly associated with fatiguability, pins and needles sensation, general malaise, aches, and mouth ulcers (Rosenthal & Burchum, 2021).

References

Gruss, S. M., Nhim, K., Gregg, E., Bell, M., Luman, E., & Albright, A. (2019). Public Health Approaches to Type 2 Diabetes Prevention: the US National Diabetes Prevention Program and Beyond. Current Diabetes Reports, 19(9), 78. https://doi.org/10.1007/s11892-019-1200-z

Petrov, M. S., & Basina, M. (2021). DIAGNOSIS OF ENDOCRINE DISEASE: Diagnosing and classifying diabetes in diseases of the exocrine pancreas. European Journal of Endocrinology, 184(4), R151–R163. https://doi.org/10.1530/EJE-20-0974

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.

Speight, J., Holmes-Truscott, E., Hendrieckx, C., Skovlund, S., & Cooke, D. (2020). Assessing the impact of diabetes on quality of life: what have the past 25 years taught us?. Diabetic Medicine: A Journal of the British Diabetic Association, 37(3), 483–492. https://doi.org/10.1111/dme.14196

Diabetes and Drug Treatment Discussion Sample 2.

 Diabetes is a chronic condition associated with a disorder of carbohydrate metabolism. Type 1 diabetes is an endocrine condition that accounts for 5% of diabetes associated with pancreatic B cell destruction resulting from autoimmune processes. The cause of autoimmune response is unknown; however, other factors like genetics, the environment, and infection are contributory.

Juvenile onset diabetes Mellitus and insulin-dependent diabetes Mellitus (IDDM) have changed over time for type 1 diabetes because insulin is now used to manage type 2 diabetes in many cases. Type 2 diabetes can occur at any age, no longer called non-insulin-dependent diabetes (NIDDM). Type 2 diabetes is associated with insulin resistance and impaired insulin secretion; it is predominant in about 90-95% of cases in the United States (Rosenthal & Burchum, 2021).

Gestational diabetes is pregnancy-induced due to estrogen, cortisol, and human placental lactogen blocking effects. These hormones prevent the systemic utilization of insulin, causing glucose to build in the blood because it is not absorbed by the cells. In addition, higher cortisol production during pregnancy increases the risk of hyperglycemia. Gestational diabetes resolves after the baby is delivered (Meccariello, 2022).

For type 2 diabetes the drug of focus will be metformin available as (Fortamet, Glucophage, Glucophage XR, Glumetza, and Riomet). The doses range from 500 -1000mg daily or twice a day as may be needed. Metformin is a biguanide oral medication that reduces the production of glucose by the liver and increases the response of insulin in tissues. Biguanides do not stimulate insulin release from the beta cells of the pancreas and do not actively reduce blood glucose levels, thus unlikely to cause hypoglycemia. Adverse effects include lactic acidosis, diarrhea, nausea, and anorexia (Rosenthal & Burchum, 2021).

 Metformin acts by inhibiting the production of glucose in the liver, it also lowers gut absorption of glucose, and sensitizes fat and skeletal muscles in targeted areas to increase the uptake of glucose to the available insulin. Pharmacokinetically, metformin is absorbed slowly from the small intestine, not metabolized, and eliminated unchanged by the kidneys.

This explains the black box warning of severe metabolic acidosis in diabetic patients with insufficient kidney function. Metformin is used as a drug of choice for the initial treatment of diabetes and to delay the progression of type 2 diabetes in high-risk groups (Triggle et al., 2022). Metformin is cheap, easy to store, and readily available. It also has an anti-inflammatory effect and protects against degeneration and oxidative stress (Chang et al.,2022).

Vitamin B12 deficiency can result from prolonged use of metformin, checking B12 levels for patients on this medication periodically is recommended (Duggan et al., 2015).

Diabetes and Drug Treatment Discussion Sample 3.

I elected to review the case of a patient diagnosed with type 2 diabetes mellitus. It will include one type of medication that would be included in their treatment, how it is to be taken, and their dietary needs. Also are the short and long-term possible effects on the patient. 

Metformin is an oral medication used to help the body lower blood sugar levels. It increases insulin sensitivity in peripheral target sites, decreases glucose production in the liver, and decreases glucose absorption in the intestine (Rosenthal & Burchum, 2021, pp. 408-409). Doses are by mouth in either immediate release, which can be given in one or two doses, or in the extended-release form, which would be prescribed daily at nighttime.

It should follow a meal to avoid an upset stomach. It undergoes renal excretion, which can affect metformin levels if the patient has any renal impairments, and dosing should be adjusted accordingly. It is contraindicated in individuals with renal insufficiency (Rosenthal & Burchum, 2021, p. 409). 

Weight loss has repeatedly been shown to improve the body’s glucose sensitivity, resulting in the reduction or discontinuation of diabetic medications altogether. The patient’s diet needs should be adjusted to enhance weight loss through a low-fat diet, traditionally restricting 500-1000 kcal from their required maintenance intake to lose one to two pounds per week (van Wyk & Daniels, 2016, p.1). Also important is adding a regular exercise lifestyle program (Rosenthal & Burchum, 2021, p. 408).

Interestingly, van Wyk and Daniels (2016) reported on the success of using the very low-calorie diet (VLCD), which mimics the diet used in patients undergoing bariatric surgery, which results in patients reducing the need for medications, either oral or insulin (p. 1). This may seem dramatic but as one of the patients was quoted as saying,“You do not have diabetes (name of clinician), therefore you do not understand what I am willing to do to improve my health. Do not make the judgement of whether I will or will not be able to follow the diet” (van Wyk & Daniels, 2016, p. 5)

Drug treatment effectiveness depends mainly on the patient’s success in developing healthy lifestyle habits that improve their glycemic control. Poor glycemic control will require an increased amount of medications. It also significantly increases morbidity and mortality, such as stroke, renal failure, heart disease, and lower extremity amputations (Haines et al., 2018, p. 668). Good glycemic control and weight loss through diet and exercise dramatically increase their chances of not needing to take medications and significantly reduce their health risks. 

NURS 6521 Week 8 Assignment Decision Tree for Neurological and Musculoskeletal Disorders 

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images

To Prepare
Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

Write a 1- to 2-page summary paper that addresses the following:

1. Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
2. Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
3. What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
4. Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

NOTE:
PLEASE INCLUDE A TITLE PAGE, AN INTRODUCTION WITH A PURPOSE STATEMENT, AND A CONCLUSION.

I HAVE ATTACHED FILES WITH THE CASE STUDY AND THE DECISIONS TO BE MADE. DECISIONS 1-3. PLEASE USE IT.

Complex Regional Pain Disorder

White Male With Hip Pain.
White Male With Hip Pain

BACKGROUND

This week, a 43-year-old white male presents at the office with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. At the beginning of the clinical interview, the client reports that his family doctor sent him for psychiatric assessment because the doctor felt that the pain was “all in his head.” He further reports that his physician believes he is just making stuff up to get “narcotics to get high.”

SUBJECTIVE

The client reports that his pain began about 7 years ago when he sustained a fall at work. He states that he landed on his right hip. Over the years, he has had numerous diagnostic tests done (x-rays, CT scans, and MRIs). He reports that about 4 years ago, it was discovered that the cartilage surrounding his right hip joint was 75% torn (from the 3 o’clock to 12 o’clock position).

He reports that none of the surgeons he saw would operate because they felt him too young for a total hip replacement and believed that the tissue would repair with the passage of time. Since then, he reported development of a strange constellation of symptoms including cooling of the extremity (measured by electromyogram). He also reports that he experiences severe cramping of the extremity.

He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS), also known as reflex sympathetic dystrophy (RSD). However, the neurologist referred him back to his family doctor for treatment of this condition. He reports that his family doctor said “there is no such thing as RSD, it comes from depression” and this was what prompted the referral to psychiatry. He reports that one specialist he saw a few years ago suggested that he use a wheelchair, to which the client states “I said ‘no,’ there is no need for a wheelchair, I can beat this!”

The client reports that he used to be a machinist where he made “pretty good money.” He was engaged to be married, but his fiancé got “sick and tired of putting up with me and my pain, she thought I was just turning into a junkie.”

He reports that he does get “down in the dumps” from time to time when he sees how his life has turned out, but emphatically denies depression. He states “you can’t let yourself get depressed… you can drive yourself crazy if you do. I’m not really sure what’s wrong with me, but I know I can beat it.”

During the client interview, the client states “oh! It’s happening, let me show you!” this prompts him to stand with the assistance of the corner of your desk, he pulls off his shoe and shows you his right leg. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward and his foot looks like it is folding in on itself. “It will last about a minute or two, then it will let up” he reports.

Sure enough, after about two minutes, the color begins to return and the cramping in the foot/toes appears to be releasing. The client states “if there is anything you can do to help me with this pain, I would really appreciate it.” He does report that his family doctor has been giving him hydrocodone, but he states that he uses is “sparingly” because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t really do anything for the pain.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is dressed appropriately for the weather and time of year. He makes good eye contact. Speech is clear, coherent, goal directed, and spontaneous. His self-reported mood is euthymic. Affect consistent to self-reported mood and content of conversation. He denies visual/auditory hallucinations. No overt delusional or paranoid thought processes appreciated. Judgment, insight, and reality contact are all intact. He denies suicidal/homicidal ideation, and is future oriented.

Diagnosis: Complex regional pain disorder (reflex sympathetic dystrophy)

Select what you should do:

Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

Neurontin 300 mg po BEDTIME with weekly increases of 300 mg per day to a max of 2400 mg if needed  // Complex Regional Pain Disorder

Complex Regional Pain Disorder – Decisions

White Male With Hip Pain

Decision Point One

Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day Amitriptyline 25 mg po QHS and titrate upward weekly by 25 mg to a max dose of 200 mg per day

RESULTS OF DECISION POINT ONE

•  Client returns to clinic in four weeks
•  Client comes to the office still using crutches. He states that the pain has improved but he is a bit groggy in the morning
•  Client’s pain level is currently a 6 out of 10. You question the client on what would be an acceptable pain level. He states, “I would rather have no pain but don’t think that is possible. I could live with a pain level of 3.” He states that his pain level normally hovers around a 9 out of 10 on most days of the week before the amitriptyline was started. You ask what makes the pain on a scale of 1-10 different when comparing a level of 9 to his current level of 6?” The client states, “I’m able to go to the bathroom or to the kitchen without using my crutches all the time. The achiness is less and my toes do not curl as often as they did before.” The client is also asked what would need to happen to get his pain from a current level of 6 to an acceptable level of 3. He states, “Well, that is kind of hard to answer. I guess I would like the achiness and throbbing in my right leg to not happen every day or at least not several times a day. I also could do without my toes curling in like they do. That really hurts.”
•  Client denies suicidal/homicidal ideation and is still future oriented

Decision Point Two

Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. I

Continue current medication and increase dose to 125 mg at BEDTIME this week continuing towards the goal dose of 200 mg daily. Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning

Instruct the client to take the medication an hour earlier than normal starting tonight and call the office in 3 days to report how his function is in the morning

RESULTS OF DECISION POINT TWO

•  Client returns to clinic in four weeks
•  The change in administration time seemed to help. The client states he is not as groggy in the morning and is able to start his day sooner than before
•  Client’s current pain level is a 4 out of 10. He states that he is now taking 125 mg of amitriptyline at bedtime.
•  Client’s has noticed that he is putting on a little weight. When asked, the client states that he has gained 5 pounds since he started taking this medication. He currently weighs in at 162 pounds. He is 5’ 7”. He states that his right leg doesn’t bother him nearly as much as it used to and his toes have only “cramped up” twice in the past month. He states that he is able to get around his apartment without his crutches and that he has even started seeing someone he met at the grocery store. The weight gain seems to bother him a lot and he is asking if there is a way to avoid it

Decision Point Three

C

Continue the current dose of Elavil of 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise

ontinue the current dose of Elavil of 125 mg per day, refer the client to a life coach who can counsel him on good dietary habits and exercise

Guidance to Student

At this point, the client is almost at his goal pain control and increased functionality. Weight gain is a common side effect with amitriptyline and should be a counseling point at the initiation of therapy. He has a small weight gain of 5 pounds in 8 weeks. A reduction in dose may have an effect on the weight gain but at a considerable cost of pain to the client. This would not be in the best interest of the client at this point. Amitriptyline has a side effect of cardiac arrhythmias.

He is not experiencing this at this point. The drug, qsymia contains a product called phentermine which has a history of causing cardiac arrhythmias at higher doses. This product is also only approved for a client with obesity defined as a BMI greater than 30 kg/m2. Your client’s BMI is currently 25.5 kg/m2. He does not meet the definition of obesity but is considered overweight. His best course of action would be to continue the same dose of Elavil, counsel him on good dietary and exercise habits and connect him with a life coach who will help him with this problem in a more meaningful way than a 10 minute counseling session will be able to accomplish.

NURS 6521 Week 8 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

Photo Credit: Getty Images/iStockphoto

Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.

To prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history with GAD.

Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

Pharmacologic Options for the Treatment of Generalized Anxiety Disorder Example Solution

DSM V medical diagnosis of generalized anxiety disorder (GAD) is characterized by considerable dysfunction that affects a person’s everyday psychological, physical, and social functioning. Psychological, pharmaceutical, or a combination of these modalities may be used as GAD treatments (Carl et al., 2020). Due to the expense and resource limitations of psychological alternatives, pharmacologic treatment is frequently the first choice for doctors. The paper compares and contrasts the five pharmacologic treatments for GAD: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs).

Pharmacokinetics and Pharmacodynamics Principles

SSRIs act by inhibiting the serotonin transporter on the presynaptic membrane; SNRIs inhibits both serotonin and norepinephrine transporters, while TCAs inhibit both serotonin and norepinephrine transporter, and muscarinic, histamine, and alpha-adrenergic receptors (Wyska, 2019). MAOIs block the action of monoamine oxidase, increasing the availability of monoamine neurotransmitters: norepinephrine, serotonin, and dopamine by limiting their breakdown.

Unlike antidepressant classes, SSRIs have little effect on other neurotransmitters, such as norepinephrine and dopamine. The liver’s cytochrome P-450 microsomal enzymes metabolize the four drug classes. They have a wide volume of distribution and are tightly bound to plasma proteins (Rosenthal & Burchum, 2020). The drugs are well absorbed orally and undergo extensive first-pass metabolism. Peak plasma level timing and half-lives vary from one drug class to another and between drugs in the same class. In 2 to 10 hours, peak plasma levels are reached for SSRIs, while MAOIs peak plasma concentrations are attained in 2–3 hours.

Safety, tolerability, and side-effect profiles of SSRIs and SNRIs are similar, except that venlafaxine and desvenlafaxine have been associated with a sustained rise in blood pressure. SSRIs and SNRIs mostly have similar side effects and are implicated in causing increased suicidal thoughts, serotonin syndrome, and increased risk of bleeding (Carl et al., 2020). Unlike TCAs, they do not have an affinity for other receptors such as adrenergic, muscarinic, and histamine; hence are better tolerated. The four drugs are implicated in the causation of serotonin syndrome. Therefore, serotonergic drugs should not be added to a patient’s regimen until 2 to 3 weeks after the stoppage of the drugs.

Pharmacokinetics and Pharmacodynamics Reflection

In my years of experience, dosing anxiolytics depends on the patient’s genetics, age, and comorbidities. Repeated tests showed that Serum antidepressant drug concentrations are typically over the suggested reference range in elderly patients compared to younger patients receiving the exact dosage. Secondly, due to the liver metabolism of the drugs, patients with liver diseases have been noted to have an increased incidence of toxicity. Therefore, anxiolytics doses in the old and patients with liver disease are slightly reduced. Women have been shown to have a worse safety profile, with adverse drug reactions being more common and severe in women than in men.

Factors Influencing Pharmacokinetics and Pharmacodynamics

Age, diet, gender, environment, pregnancy, body weight, the patient’s pathophysiology, genetics, and drug-drug or food-drug interactions all have an impact on pharmacokinetics.  Pharmacodynamics of a drug may be impacted by physiological changes brought on by illness, genetic mutations, aging, or other medications (Rosenthal & Burchum, 2020). These alterations result from the diseases’ capacity to modify receptor binding, alter the quantity of binding proteins, or reduce receptor sensitivity. Regarding the genetic component, it is possible to estimate that around 25% of the total variability in medication response is genetic in nature.

Personalizing Plan of Care

Regulatory agencies add pharmacogenomics medicine labels into the summaries of product information to make it easier for medical practitioners to communicate genetic information to patients. Here, they indicate which genetic variant information is crucial to take into account when prescribing a treatment. Mandatory instructions, recommendations, and details concerning how pharmacogenomic variation should be taken into account regarding the indication or dose are all included on such drug labels; these details are believed to be helpful for individualized care plans (Slee et al., 2019). The Plan of care for the patient also entails frequent monitoring and reassessment.

Conclusion

SSRIs are the first-line drugs for the management of generalized anxiety disorder. They have the benefit of ease of dosing and having low overdose toxicity. The SSRIs are vastly favored over other antidepressant classes because of their greater tolerability and relatively benign safety profile. Since SSRIs do not seem to impact blood pressure or cardiac conduction in people with cardiac illness, they are not considered as concerning. Standard second lines include SNRIs and TCAs.

References

Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., … & Powers, M. B. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): a meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1-21. https://doi.org/10.1080/16506073.2018.1560358

Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.

Slee, A., Nazareth, I., Bondaronek, P., Liu, Y., Cheng, Z., & Freemantle, N. (2019). Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. The Lancet, 393(10173), 768-777. https://doi.org/10.1016/S0140-6736(18)31793-8

Wyska, E. (2019). Pharmacokinetic considerations for current state-of-the-art antidepressants. Expert Opinion on Drug Metabolism & Toxicology, 15(10), 831-847. https://doi.org/10.1080/17425255.2019.1669560

NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

Photo Credit: Getty Images

To Prepare

Review the Resources for this module and reflect on the different health needs and body systems presented.

Your Instructor will assign you a complex case study to focus on for this Discussion.

Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

CASE STUDY:

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes.

He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3).

Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

Ht: 5’8″ Wt: 89 kg (196 pounds)

Allergies: Penicillin (delayed, rash)

Facilitator/Faculty Tips to do well:

NEED SUBSTANTIVE DISCUSSION.

Discuss very briefly any pharmacological intervention patient is presently on for COPD, HTN, hyperlipidemia & diabetes. Just one or two lines each on what would be drugs used, pharmacological relevance on treating these diseases.

Thoroughly discuss the anti-infective drugs used for for treating the infection Community Acquired Pneumonia (pharmacology to include mechanism of action, therapeutic effects, adverse effects, kinetics etc.).

Is the current empiric therapy based on any guidelines?

If allergic to penicillin, why was ceftriaxone given, which is another beta-lactam antibiotic (a cephalosporin which is also a beta lactam antibiotic)?

If penicillin allergy was immediate type, what are the alternate options for treating CAP? (tips: Doxycycline? Levofloxacin?)

Need a thorough discussion on a case like this on ADVANCED PHARMACOLOGY, CLINICIAN LEVEL.

USE PEER REVIEWED SCHOLARLY, US BASED, CURRENT, PRIMARY SOURCE, CLINICIAN BASED (NOT PATIENT BASED) REFERENCES.

NURS 6521 Week 11 Assignment : Off-Label Drug Use in Pediatrics

Please be mindful of plagiarism and APA format, I have included the rubric. Please use my course resources as one of my references as instructed. Please include Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier in the references.

Assignment: Off-Label Drug Use in Pediatrics

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just smaller adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.

Photo Credit: Getty Images

Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

Write a 1-page narrative in APA format that addresses the following:

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Please include an introduction with a purpose statement, a title page, and a summary.

I have uploaded the interactive media

Also Read: Leadership Theories in Practice Discussion NURS 6053