SU NSG6005 All Case Studies Latest 2022 November (Full)

NSG6005 Advanced Pharmacology

Week 1 Case Study

You have a 58 year old African American male that is coming in for a follow-up visit after recently having a Myocardial infarction which was successfully treated via angioplasty.  He was started on Metoprolol for his consistently elevated high blood pressure during his hospital stay. 

His primary diagnoses include:

Coronary Artery Disease

Type 2 diabetes controlled with Metformin 1,000 mg BID and HgA1C of 6.7.

Asthma- Mild Intermittent- with no recent episodes of wheezing. Albuterol INH as needed.

All other pertinent labs Within Normal Limits

First consider what clinical guidelines noted below can help us choose the best medication treatment for this patient with diabetes, CAD, Asthma and Hypertension.

Joint National Committee JNC 8 - https://thepafp.org/website/wp-content/uploads/2017/05/2014-JNC-8-Hypertension.pdf

National Center for Biotechnology Information - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092891/table/T1/?report=objectonly

American Heart Association - https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15026

IHS Division of Diabetes https://www.ihs.gov/sites/diabetes/themes/responsive2017/display_objects/documents/algorithms/AlgorithmHypertension.pdf

Please answer each questions citing your response from evidence based clinical guidelines.  Your response should not be post as “I would recommend". Example of appropriate reference: The 2020 international Society of Hypertension Global Hypertension Practice Guidelines – recommend the use of selective ß1-receptor agonists in patients diagnosed with coronary heart disease and or heart failure ( Unger, T, et al, 2020).

Reference: 

Unger T;Borghi C;Charchar F;Khan NA;Poulter NR;Prabhakaran D;Ramirez A;Schlaich M;Stergiou GS;Tomaszewski M;Wainford RD;Williams B;Schutte AE; (n.d.). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension (Dallas, Tex. : 1979). Retrieved August 1, 2022, from https://pubmed.ncbi.nlm.nih.gov/32370572/ 

Metoprolol is selective for which adrenoceptor? ( pharmacodynamics)

What effects do agents such as metoprolol have on the cardiovascular system? ( pharmacodynamics)

In which organ is metoprolol primarily metabolized? (Pharmacokinetics)

Why would a provider be cautious when ordering a Beta Blocker in a patient with Asthma?

NSG6005 Advanced Pharmacology

Week 2 Case Study

Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee. She is 68 years old and complains of irritable bowel syndrome (IBS) with abdominal cramping and frequent diarrhea with occasional constipation. She has a history of domestic violence with resultant anxiety requiring inpatient hospitalization 8 years ago. She is also complaining of urinary retention, insomnia, and hip pain since a hip fracture 4 years ago. Her drugs include zolpidem 10 mg hs, bethanechol 25 mg tid, metoclopramide 10 mg tid, amitriptyline 100 mg hs, alprazolam 0.25 mg tid, hydrocodone/APAP 5/500 tid, and dicyclomine 20 mg four times daily.

What are your concerns about this drug regimen?

What recommendations do you have for this patient?

NSG6005 Advanced Pharmacology

Week 3 Case Study

A 78-year-old male patient comes to your office complaining of increased left knee pain for the past 3 to 4 months. He has had no history of recent injury. An x-ray done less than 4 months ago showed degenerative osteoarthritic changes. He has full range of motion and denies any recent swelling, pedal edema, or discoloration. He has been a long-distance runner for many years and was diagnosed with osteoarthritis of his left knee more than 10 years ago. He has decreased his weekly running, but the pain is persistent and is affecting his daily activities. He has been using over-the-counter NSAIDs on and off, but states they are no longer working and wants something “stronger.” His vital signs are all normal and he has no history of fever, chills, or rashes. He is otherwise healthy.

Which medications do you feel would be safe and appropriate for this patient’s chronic pain?

What education would you provide when prescribing pain medication for this patient?

NSG6005 Advanced Pharmacology

Week 4 Case Study

Zack, age 6, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 100.5ºF orally, and loose cough. Wheezing started on the day before the visit, so Zack’s mother administered albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 a.m. The cough and wheezing appear worse today, according to the mother. Zack had difficulty taking deep-enough breaths to inhale this morning’s dose of albuterol, even using the spacer.

Zack has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he has been generally healthy except for mild intermittent asthma. His asthma is usually precipitated by a viral upper respiratory infection. He has required oral prednisone an average of two or three times per year for the past 3 years. He has an albuterol MDI at home with a spacer, which his parents are comfortable using. He is in first grade. This is the first asthma exacerbation of the school year, and his mother expresses a concern about sending him to school with an inhaler.

The patient’s assessment is as follows:

Zack is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds. The examination is all within normal limits except for his breath sounds. He has diffuse expiratory wheezes and mild retractions. Pulse oximeter readings indicate oxygen saturation of 93%.

Answer the following questions.

Which medications do you feel are safe and appropriate to utilize initially?

Which medications do you feel will be safe and appropriate to prescribe and/or recommend for chronic, ongoing management?

NSG6005 Advanced Pharmacology

Week 5 Case Study

Students in their first graduate level pharmacology course are confused with the recommendations for hypertension (HTN) and treatment choices after ST-elevation myocardial infarction (STEMI) and with heart failure (HF). The drugs used several years ago and still seen commonly on the acute care floors the students work are not the ones now assuming a stronger role in cardiac health issues. For one, the primary order of which meds are selected for an initial level of blood pressure control has seemed to change.

Help your fellow students by explaining the following changes.

Which classification of drugs has taken the first-choice role in most patients with early hypertension? Is it wrong to select a thiazide diuretic or a beta blocker as was once done?

Is there another primary choice for African American patients? Why?

NSG6005 Advanced Pharmacology

Week 6 Case Study

A patient is followed for several years with heart failure. His case is early at stage A.

Answer the following questions.

Which stage A patients would benefit from adding an angiotensin-converting enzyme inhibitor?

As the patient progresses through the heart disease stages, when are diuretics typically added? Are all heart failure patients candidates for diuretics at this stage?

Submission Details:

Name your file W6_CaseStudy_LastName_FirstName

Submit this assignment to the Submission Area by the due date assigned.

NSG6005 Advanced Pharmacology

Week 7 Case Study

You have been following your patient for the past 2 years. You have worked with them to lose weight by changing lifestyle and nutritional habits. They continue to be overweight (body mass index [BMI] of 33) and have tried to cut down carbohydrate and fat intake, but now presents with polyuria, polydipsia, and an elevated random blood sugar of 164. You have ordered anHbA1c test in the past, and the values were less than 6.2%. However, the most recent test indicated an HbA1c greater than 7%. They are not on any medications, but does have a sulfa allergy.

You officially have enough evidence to officially start treating this patient for Type II Diabetes Mellitus.  Their 3 P symptoms, their random  blood sugar (BS), and A1C are all evidence ofT2DM.

Answer the following questions.

What is the first medication you would prescribe? Discuss how you determined which one to give first and how you based this decision on specific factors.

What education regarding medication management would you need to do?

NSG6005 Advanced Pharmacology

Week 8 Case Study

Patrick is a 24 year old male who was playing soccer and twisted his ankle approximately 4 hours before presenting at Urgent Care. He is healthy and takes no medications on a regular basis.

The patient’s assessment is as follows:

His x-ray is negative for fracture and his examination is consistent with a moderate ankle sprain.

Answer the following questions.

What medication would you anticipate recommending/prescribing and why?

What patient education would you anticipate giving this patient relating to the medication that you chose?

NSG6005 Advanced Pharmacology

Week 9 Case Study

Ann is a 34-year-old African American woman who presents with a 6 week history of initial and terminal insomnia and a 10 pound weight loss over that same period. She admits to feeling sad almost every day for the past 6 weeks that occurred after she lost her job. She denies feeling enjoyment, has not engaged in any previously enjoyable activities, and wonders if life is worth living. Her physical examination is negative, vital signs and blood work including a thyroid profile are all within normal limits, and her body mass index is 22. Her mother and sister both had episodes of depression and were treated successfully with sertraline.

Answer the following questions.

Which medication would you anticipate starting Ann on and why?

What is critical education to share with her?

NSG6005 Advanced Pharmacology

Week 10 Case Study

John is a 24-year-old who presents to urgent care with a 2 week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough of green mucous and has green nasal discharge. He says that he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known drug allergies.

The patient’s assessment is as follows:

Vital signs are stable and temperature is 99.9°F. Tympanic membranes (TMs) are clear bilaterally, pharynx is pink with no exudate, he has greenish postnasal drainage, turbinates' are swollen and red, there is tenderness when frontal sinuses palpated, there is no cervical adenopathy, and lungs are clear.

Answer the following questions.

What medications do you anticipate being prescribed/recommended and why?

What patient education would you anticipate giving the patient regarding the medications you chose?