NURS-6521 Week 1 assignment 1 Advance Pharmacology
First Scenario: A 52-year-old man with an INR of 8.8 was released from treatment while taking Warfarin and Amiodarone.
Due to Amiodarone’s ability to enhance Warfarin’s anticoagulant effect, the combination of the two medications may increase the risk of bleeding. Higher doses of anticoagulation are indicated by an INR of 8.8, which carries a high risk of bleeding problems (Kluwer, 2023).
To avoid future increases in anticoagulation, withholding the doses and consulting the patient cardiologist regarding taking Amiodarone and Warfarin therapy would be my nursing assessment. Also, I would assess the patient and conduct a history of dietary regime and instructions on items to avoid contributing to the patient’s heart and INR levels.
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A close monitoring of the patient for any signs of bleeding. Moreover, it assesses any significant changes requiring a Vitamin K prescription to counteract Warfarin’s effects (Grubb & Mentz, 2020). If bleeding is substantial, I will consider prothrombin complex concentrate (PCC) for quick reversal.
Additionally, depending on the patient’s condition and INR levels, I will consider lowering the doses of Warfarin and Amiodarone. Further follow-up with the patient cardiologist and the anticoagulation team for advice on best managing anticoagulant therapy (Teixeira et al., 2023). Also, I will work together with a chemist to evaluate the medication interaction and suggest any necessary intervention.
Second Scenario: A 44-year-old female patient was prescribed Ceftriaxone together with Glipizide and Phenytoin.
Since Ceftriaxone can displace Glipizide and Phenytoin from their protein-binding sites, all three medicines in this scenario are substantially protein-bound. This displacement may result in higher free concentrations of Phenytoin and Glipizide, potentially increasing the risk of toxicity for these drugs.
In addressing the problem, I will keep a close eye out for any indications of Glipizide and Phenytoin toxicity, such as assessing for signs and symptoms of hypoglycemia and any neurological problems in the patient. Also, to lessen the possibility of an increase in free concentrations, consider modifying the dosages of phenytoin and glipizide (Ter Heine et al., 2019). Additionally, I will also consider utilizing a different antibiotic that does not significantly affect protein binding to lower the potential of medication interactions (Fructuoso-González et al., 2023). Further. Collaborates with the neurologist team to seek advice on further managing this patient.
Drugs Highly Affected by the First Pass Effect
Propranolol – the liver’s extensive first-pass metabolism significantly decreases Propranolol’s bioavailability.
The counteractions include:
Prescribing a higher initial dose to compensate for the loss that first-pass metabolism is expected to cause.
Bypassing the first pass and administering intravenously guarantees a more consistent bioavailability (Srinivasan, 2019).
Keeping an eye on medication levels by checking propranolol levels frequently and changing dosages as necessary (Beringer, 2023).
Lidocaine – During the first pass, lidocaine undergoes substantial hepatic metabolism, which lowers its systemic bioavailability.
The counteractions include:
Giving a more significant starting dose to overcome first-pass metabolism and produce the intended therapeutic effect.
Using alternate routes to circumvent the initial pass and guarantee a more consistent reaction, intravenous administration may be considered (Wagner, 2018).
Check medication levels frequently to adjust dosages and, avoid toxicity, and check lidocaine levels.
Third Scenario: James, prescribed Atenolol, dislikes side effects
I will describe the common adverse effects of Atenolol, including cold extremities, weariness, and dizziness. Also, I will emphasize that these side effects might decrease as the body becomes used to the drug (Whelton et al., 2018).
Additionally, I will reinforce teaching on the importance of taking medication regularly to manage hypertension effectively. Also, I will discuss the possibility of any adverse effects of inconsistent drug adherence, like elevated risk of cardiovascular events and uncontrolled blood pressure (Mattingly et al., 2021).
Lastly, I will examine and provide substitutes for antihypertensive drugs that may have fewer adverse effects—in addition, evaluating the patient’s potential by looking at a new beta-blocker or other antihypertensive drug classes like calcium channel blockers or ACE inhibitors (Rodgers et al., 2024).
James should be encouraged to express his worries and side effects honestly. He discussed and educated patients on lifestyle changes, including meal choices, exercise regimes, and supplemental or drug therapy. Also, I will work together with James to develop a treatment strategy that complements his interests and way of life.
References
Beringer, P. (2023). Winter’s basic clinical pharmacokinetics. Lippincott Williams & Wilkins.
Fructuoso-González, L., Najera-Perez, M. D., Manresa-Ramón, N., Torrano-Belmonte, P., Caracena-López, S., & Pacheco-López, P. (2023). Isavuconazole–tacrolimus drug–drug interactions in HSCT patients. Journal of Antimicrobial Chemotherapy, 78(10), 2559-2562.
Grubb, A., & Mentz, R. J. (2020). Pharmacological management of atrial fibrillation in patients with heart failure with reduced ejection fraction: review of current knowledge and future directions. Expert review of cardiovascular therapy, 18(2), 85-101.
Kluwer, W. (2023). Lexicomp: evidence-based drug referential content.
Mattingly, A. N., Gianturco, S. L., Pavlech, L. L., Storm, K. D., & Yuen, M. V. (2021). Atenolol: Summary Report.
Rodgers, A., Salam, A., Cushman, W., de Silva, A., Di Tanna, G. L., Gnanenthiran, S. R., … & Whelton, P. (2024). Rationale for a New Low-Dose Triple Single Pill Combination for the Treatment of Hypertension. Global Heart, 19(1).
Srinivasan, A. V. (2019). Propranolol: A 50-year historical perspective. Annals of Indian academy of neurology, 22(1), 21.
Teixeira, R. A., Fagundes, A. A., Baggio Junior, J. M., Oliveira, J. C. D., Medeiros, P. D. T. J., Valdigem, B. P., … & Leal, J. C. F. (2023). Brazilian Guidelines for Cardiac Implantable Electronic Devices–2023. Arquivos Brasileiros de Cardiologia, 120.
Ter Heine, R., Kane, S. P., Huitema, A. D., Krasowski, M. D., & van Maarseveen, E. M. (2019). Nonlinear protein binding of phenytoin in clinical practice: Development and validation of a mechanistic prediction model. British journal of clinical pharmacology, 85(10), 2360-2368.
Wagner, J. G. (2018). Pharmacokinetics for the pharmaceutical scientist. CRC Press.
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., … & Wright, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
Assignment 1: Case Studies
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the case study posted in “Announcements” by your Instructor for this Assignment
Review the information provided and answer questions posed in the case study
When recommending a medication, write out a complete prescription for the medication
Whenever possible, use clinical practice guidelines in developing your answers when possible
Include at least three references to support your answer and cite them in APA format.
By Day 7 of Week 1
Submit the Assignment.
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Rubric
NURS_6521_Week1_Assignment1_Rubric
NURS_6521_Week1_Assignment1_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
Scenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15
pts
This criterion is linked to a Learning Outcome
Scenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3
pts
This criterion is linked to a Learning Outcome
Scenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4
pts
This criterion is linked to a Learning Outcome
Scenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3
pts
This criterion is linked to a Learning Outcome
Scenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15
pts
This criterion is linked to a Learning Outcome
Scenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3
pts
This criterion is linked to a Learning Outcome
Scenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4
pts
This criterion is linked to a Learning Outcome
Scenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3
pts
This criterion is linked to a Learning Outcome
Scenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15
pts
This criterion is linked to a Learning Outcome
Scenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3
pts
This criterion is linked to a Learning Outcome
Scenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4
pts
This criterion is linked to a Learning Outcome
Scenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3
pts
This criterion is linked to a Learning Outcome
Scenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.
15
to >
11.0
pts
Excellent
Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.
11
to >
7.0
pts
Good
Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.
7
to >
3.0
pts
Fair
Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.
3
to >
0
pts
Poor
Medication selected is inappropriate or would not be provided based on patient unique characteristics.
15
pts
This criterion is linked to a Learning Outcome
Scenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
3
pts
Complete
Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.
0
pts
Poor
The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.
3
pts
This criterion is linked to a Learning Outcome
Scenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.
4
pts
Excellent
References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.
3
pts
Good
References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.
2
pts
Fair
References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.
0
pts
Poor
No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.
4
pts
This criterion is linked to a Learning Outcome
Scenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
3
pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.
2
pts
Good
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
1
pts
Fair
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0
pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
3
pts
Total Points:
100
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