NSG6005 Advanced Pharmacology
Week 1 Discussion
Ms. BD is a
33-year-old G2P1 female who has a history of chronic HTN. She was diagnosed
with this in the interim since her first pregnancy, and she has been well
controlled with Prinizide 12.5/20 PO BID. Her period, usually very regular, was
5 days late. She performed a home pregnancy test which was positive. She states
she feel "OK" but is concerned about both her HTN and her developing
fetus. She has no other medical problems, symptoms, or concerns.
Assessment: Physical
examination is unremarkable. Her BP is 128/68 and her pulse is 74. Her urine
human chorionic gonadotropin (HCG) is positive. Her potassium is 4.2, blood
urea nitrogen (BUN) is
14, and creatinine is 0.6. Alanine aminotransferase (ALT) is 29. White blood
cells (WBCs) are 6.5, hemoglobin (Hgb) is 12.8, hematocrit (Hct) is 39, and
platelets are 330,000.
Is there any
additional subjective or objective information you need for this client?
Explain.
Is Prinizide safe in
pregnancy? What are the possible complications to the pregnant woman and her
fetus?
Why is it important to
assess the above laboratory values? How might this information impact your
treatment plan?
Would you make any
changes to Ms. BD’s blood pressure medications? Explain. If yes, what would you
prescribe? Discuss the medications safety in pregnancy, mechanism of action,
route, the half-life; how it is metabolized in and eliminated from the body;
and contraindications and black box warnings.
What health
maintenance or preventive education is important for this client based on your
choice medication/treatment?
Would you treat this
patient or refer her? Where would you refer this patient?
NSG6005 Advanced Pharmacology
Week 2 Discussion
Gami is a 48-year-old
who you discover when completing a health history is taking cinnamon to treat
Type II Diabetes. She is specifically using cassia Cinnamon. You also discover
that she is taking Ginseng to assist with memory. Her prescribed medications
are Aricept and Coumadin.
Ms. GM is a
48-year-old who presents to your clinic to establish care. During the health
history, you learn that she has a history of Type II Diabetes. When asked about
prescription and non-traditional medications, she reports being prescribed
Aricept, Coumadin, Cassia cinnamon for Type II Diabetes and Ginseng for memory.
Is there any
additional subjective or objective information you need for this client?
Explain.
What would be your
position on the Ms. GMs use of alternative supplements for her diabetes and
memory? Explain and include contraindications, if any.
Are there any
additional test/assessments you would complete for this patient given this list
of medications? Explain.
How might your
treatment plan, in terms of medications, differ for this patient? Include the
class of the medication, mechanism of action, route, the half-life; how it is
metabolized in and eliminated from the body; contraindications and black box
warnings.
What health
maintenance or preventive education is important for this client based on your
choice medication/treatment?
NSG6005 Advanced Pharmacology
Week 3 Discussion
Mr. JD 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 for green mucous and has green nasal
discharge. He says 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 allergies.
In his assessment it
is found that his vital signs are stable, temperature is 99.9 degrees F,
tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no
exudate; there is greenish postnasal drainage; turbinates are swollen and red;
frontal sinus tenderness; no cervical adenopathy, and lungs are clear
bilaterally.
Is there any
additional subjective or objective information you need for this client?
Explain.
Would you treat Mr.
JDs cold? Why or why not?
What would you
prescribe and for how many days? Include the class of the medication, mechanism
of action, route, the half-life; how it is metabolized in and eliminated from
the body; and contraindications and black box warnings.
Would this treatment
vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the
medication, mechanism of action, dosing, route, the half-life; how it is
metabolized in and eliminated from the body; and contraindications and black
box warnings
What health
maintenance or preventive education is important for this client based on your
choice medication/treatment?
NSG6005 Advanced Pharmacology
Week 4 Discussion
Johnathan, age 7,
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
101.0 degrees F orally, and loose cough. Wheezing started on the day before the
visit, so Johnathan 's mother started administering albuterol metered-dose
inhaler (MDI) two puffs before bed and then two puffs at around 2 AM. The cough
and wheezing appear worse today, according to the mother. He had difficulty
taking deep-enough breaths to inhale this morning's dose of albuterol, even
using the spacer.
Johnathan 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 is generally healthy except for
mild intermittent asthma. This is his first asthma exacerbation of the school
year, and his mother expresses a concern about sending him to school with an
inhaler.
Johnathan is afebrile
with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs
45 pounds (20.5 kgs.). The examination is all within normal limits except for
his breath sounds. He has diffused expiratory wheezes and mild retractions.
Pulse oximetry readings have been 93% of oxygen saturation.
What is the
appropriate pharmacological therapies to be prescribed for Johnathan
What information is
necessary to provide to Johnathan and his mother regarding asthma exacerbation?
What is an appropriate
clinical assessment tool to be use with Johnathan?
What are the
classification of asthma?
How would you as the
NP address his mother’s concern regarding providing an inhaler at school?
What is an appropriate
plan of care for Johnathan?
NSG6005 Advanced Pharmacology
Week 5 Discussion
Discussion Question 1
Mr. EBR is a
74-year-old retired Hispanic gentleman with known coronary artery disease
(CAD), who presents to your clinic with substernal chest pain for the past 3
months. It is not positional; it reliably occurs with exertion, approximately
one to two times daily, and is relieved with rest, or one or two sublingual
nitroglycerin (NTG) tabs. It is similar in quality, but is much less severe,
than the chest pain that occurred with his previous inferior myocardial
infarction (MI) 3 years ago. Until the past 3 months, he has felt well.
The chest pain is
accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or
palpitations. He does not vomit. He denies orthopnea, paroxysmal nocturnal
dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of
stroke or transient ischemic attack (TIA). An echocardiogram done after his MI
demonstrated a preserved left ventricular ejection fraction (LVEF). Other
medical problems include well-controlled type 2 diabetes mellitus (DM),
well-controlled hypertension (HTN), and hyperlipidemia, with low-density
lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and
diabetic neuropathy. He no longer smokes and does not use alcohol or
recreational drugs. His daily medications include: Atenolol 25 mg PO bid,
Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each
evening, and metformin 500 mg PO bid.
Mr. EBR's physical examination
includes the following: height 68 inches, weight 185 lb, Blood pressure (BP)
126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F
orally. He is alert and oriented, and in no apparent distress (NAD). His neck
is without jugular venous distention (JVD) or carotid bruits. Lungs are clear
to auscultation bilaterally. Cardiovascular:normal S1 & S2, RRR, without
rubs, murmurs or gallops. Abdomen has active bowel tones and is soft,
nontender, and nondistended (NTND). Extremities are without clubbing, cyanosis,
or edema. Distal pedal pulses are 2+ bilaterally
What would you add to
the current treatment plan? Why?
Would you discontinue
any of the currently prescribed medication? Why or why not?
How does the diagnosis
stage 3 chronic kidney disease affect your choices?
Why is the patient
prescribed more than one antihypertensive?
What is the benefit of
the aspirin therapy in this patient?
Discussion Question 2
List three classes of
drugs affecting the Hematopoietic System. List the mechanism of action for each
class of drug. Choose one medication from the three classes and discuss what
disorder the drug is used to treat? How often the medication is given? What labs
should get monitored while the patient is taking this medication? Your response
should be at least 350 words.
NSG6005 Advanced Pharmacology
Week 6 Discussion
Discussion Question 1
Mike is a 46-year-old
who presents with a complaint of "heartburn" for 3 months. He
describes the pain as burning and it is located in the epigastric area. The
pain improves after he takes an antacid or drinks milk. He has been taking
either over-the-counter (OTC) famotidine or ranitidine off and on for the past
2 months and he still has recurring epigastric pain. He has lost 6 lb since his
last visit.
Assessment
His examination is
unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal
complete blood count (CBC) and a positive serum Helicobacter pylori test.
What would you
prescribe initially?
How long would you
prescribe these medications?
What other possible
meds could you prescribe to assist with the side effects from the medications
prescribed?
How would the
treatment vary if the patient has GERD instead?
Discussion Question 2
List differential
diagnosis that would help confirm GERD while ruling out other diagnosis. Which
medication is the best medication for treatment of GERD and why? What labs or
other diagnostic tests that are used to confirm GERD? Your response should be
at least 350 words.
NSG6005 Advanced Pharmacology
Week 7 Discussion
Discussion 1
Tom, a 26-year-old
runner, came in to the office today complaining of constant pain in the right
ankle. While running his usual route, he accidentally stepped on a branch lying
in his path, twisting his ankle inward. He denies hearing a "pop." He
was able to walk, or limp, the remaining ¼ mile back to his home, where he
immediately elevated and iced the ankle for 30 minutes. He took two acetaminophen
325 mg, showered and dressed for work, and drove to his place of employment. He
continued to experience significant pain in the ankle, worse when walking. His
foot became swollen. Since his job in a sporting goods store requires that he
be on his feet most of the day, he was unable to continue his normal workday,
and made a same-day appointment to be seen. He has no chronic diseases, takes
no medication, and denies recent use of NSAIDs, as aspirin and ibuprofen cause
him to have gastritis. He sprained the ankle last year, but was able to manage
that injury at home.
Assessment
A 26-year-old,
otherwise healthy male presents limping into the examination room, holding his
right shoe in his hand. He grimaces with partial weight-bearing of the affected
foot. He has local ecchymosis and 1+ edema over the anterolateral ligaments of
the right ankle. Capillary refill, pulses, and sensation of the foot and toes
are intact. There is no lateral or anterior instability of the joint or
tendons. X-ray of the ankle and foot are negative for fracture or dislocation.
He has a grade I lateral ankle sprain.
What pain relieving
medications would you prescribe? Defend your choice.
How would your
prescribe them?
What side effects
should you educate the patient about?
Does the age of the
patient influence what your choice?
Discussion Question 2
What organs are
damaged mostly by taking NSAIDS? What patient education would you provide to
someone taking NSAIDS? What organ is damaged by taking too much aspirin? What
patient education should you provide to a patient taking Aspirin? List 3
diagnosis for which you would administer NSAIDS.List 3 diagnosis for which you
would administer Aspirin. What labs or diagnostic tests would you perform for a
patient who has consumed too much Aspirin and NSAIDS. Your response should be
at least 350 words.
NSG6005 Advanced Pharmacology
Week 8 Discussion
Discussion 1:
Margaret is a
40-year-old white female in for her annual examination. She states she has been
under increased stress in her life for the past few months. She and her husband
are currently separated and considering divorce. Her teenaged sons are acting
out and she is working extra hours to make ends meet. Secondary to the
increased stress she has started smoking again, "about a pack per
day" and states "I know that I am not eating right."
Margaret has been on
the "pill" for almost 20 years and has always liked the method. She
states the she has heard that smoking and taking the pill are not good, and she
is worried about that. "I really do not need birth control since I am
separated but just in case I probably need something." She states that she
has been in a mutually monogamous relationship (as far as she knows) since her
marriage 18 years ago. She denies a new partner since her separation. Menarche
was at 11 years, her cycles when on the pill are regular and very light. Her
menstrual period should start tomorrow as she just finished her active pills.
She denies a personal history of abnormal Pap smears, gynecological issues,
hypertension (HTN), or diabetes. She is G2P2002, and her pregnancies were full
term and uncomplicated at ages 24 and 26. Family history is significant for
both parents with HTN and mom has type 2 diabetes. Her paternal grandfather
died at age 64 years from type 2 diabetes, HTN, and coronary artery disease.
Her other grandparents died in their late 70s early 80s and she is unaware of
any medical issues.
Assessment:
Margaret's examination
finds her height 5'5", weight 172 lb (up 10 lb. from last year), current
body mass index (BMI 28.6), and blood pressure (BP) 148/88. Head, eyes, ears,
nose, and throat (HEENT) are grossly within normal limits (WNL). No thyromegaly
or lymphadenopathy. Heart rate is regular and rhythm is without murmurs,
thrills, or rubs. Lungs are clear to auscultation in all lobes. Breasts are
without masses, nipple discharge, asymmetry, or lymphadenopathy; self breast
examination techniques and frequency reviewed during examination. Abdomen is
soft, nontender, with no masses or hepatosplenomegaly; bowel sounds present in
all four quadrants. Pelvic examination reveals normal vulva and negative
Bartholin's and Skene's glands; vagina is pink, rugated, with minimal white
nonodorous discharge; cervix is pink, multiparous os. Pap smear collected
during speculum examination was normal. Bimanual examination reveals a
retoverted, firm, mobile, nonenlarged, nontender uterus with negative cervical
motion tenderness; adnexa nontender; and ovaries palpable bilaterally, mobile,
without masses. Lower extremities were without edema or varicosities.
1. What options are
appropriate for this patient?
2. What contraceptive
options are contraindicated?
3. What type of
patient education is indicated?
4. Given that she has
a normal pelvic exam, does that change would that influence your decision?
NSG6005 Advanced Pharmacology
Week 9 Discussion
Discussion:
Angela is a
54-year-old married woman with three adult children. She has been the
officemanager of a small law firm for 20 years and has enjoyed her work until
this past year. She hasrheumatoid arthritis with minimal impairment that has
been managed well with NSAIDs. She hasbeen taking conjugated estrogens for 8
years and decided to stop taking them because of herconcern of their risks
without sufficient medical benefit. She has tolerated the discontinuation
without difficulty.
Assessment:
At her annual medical
checkup appointment, she told her primary care provider that she seemedto be
tired all the time, and she was gaining weight because she had no interest in
her usualexercise activities and had been overeating, not from appetite but out
of boredom. She deniedthat she and her husband have had marital difficulties
beyond the ordinary and she was pleasedwith the achievements of her children.
She noticed that she has difficulty falling asleep at nightand awakens around 4
a.m. most mornings without her alarm and cannot go back to sleep eventhough she
still feels tired. She finds little joy in her life but cannot pinpoint any
particularconcern. Although she denies suicidal feelings, she does not feel
that there is meaning to her life:
“My husband and kids
would go on fine if I died and probably wouldn’t miss me that much.”
The primary care
provider asks Angela to fill out a Beck’s Depression Scale, whichindicated she
has moderate depression.
1. What medication
would you first prescribe to this patient?
2. She comes back in 2
weeks and states she has not noticed and change in her mood since starting on
the medication. What would be your response?
3. What are the
possible problems with the medication you prescribed?
4. How long should you
continue the treatment regimen?
NSG6005 Advanced Pharmacology
Week 10 Discussion
Discussion 1
What would you do
first prior to prescribing any medication?
What are the various
schedules of medications for controlled substances?
Would you prescribe a
long or short acting narcotic? Why or why not?
Discussion 2
What other non
narcotic medication options can you offer to this patient?
What patient education
is needed with them?
What would you do if
the patient and his wife tell you that none of them work for him?
Discussion 3
You are concerned that
this patient may have a substance abuse problem.
What screening testing
is available for you to use that is reliable and valid?
What strategies would
you suggest for this patient if he was found to have a problem?
What type of referrals
would you make?
Discussion 4
After some
investigating, you find that Howard actually is seeing a pain specialist who
has given him epidural injections, and prescribes medication for him.
How does that impact
any intervention that you may consider?
What other
pharmacological options could you offer him?
What
nonpharmacological options could you suggest?
Discussion 5
After seeing Howard
and performing the appropriate screening tools, and a urine drug screen, he
admits to you that he does have a problem with opioids due to his back injury.
He states he has been admitted to an inpatient detox and twenty-eight day
rehabilitation unit previously and was able to quit using for 3 months, but relapsed
due to his pain. He states for the last 6 months he has been unable to get
opioids from physicians since there is a record of him being prescribed a large
amount over a short period of time. Due to this, he has started buying heroin
from an acquaintance who he went to high school with. His wife is very tearful
and states she is concerned that eventually Howard will end up killing himself.
What type of substance
abuse programs would be most appropriate for him?
What requirements are
there for a nurse practitioner to prescribe a medication to treat opioid
addiction?
What are the
requirements for a patient who is enrolled in a medication assisted opioid
treatment program?
