NURS 6521 week 4 assignment case scenarios

NURS week 4 assignment case scenarios

Case studies are a useful way for you to apply your knowledge of pharmacokinetic and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For your week 4 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

Directions: For each of the scenarios below, answer the questions using your required learning resources, Medscape, and clinical practice guidelines (ie AHA, ACC, ADA). When recommending medications, write out a complete prescription for each medication. nurs 6521 week 4 assignment case scenarios  What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills etc. Also state if you would continue, discontinue or taper the patient’s current medications (if applicable). Use at least 3 sources for each scenario and cite sources using APA format.

SCENARIO 1

What are the errors in the following prescriptions (5 total)? Rewrite each prescription correctly. What is each medication classification? What is the mechanism of action (MOA)?

fluticasone/salmeterol (Advair) 115/21 mcg 1 inhalation BID #1 Diskus 3 RF

albuterol 4 mg po 15-30 min before exercise #30 2 RF

budesonide/fluticasone (Symbicort) 160/4.5 mcg, 2 puffs inhaled BID and 1-2 puffs prn asthma symptoms (max 12 inhalations in 24 hours) #1 inhaler 2 RF

tiatropium (Spiriva Respimat) 2.5 mcg/actuation inhaler; inhale 2 actuations po once daily for COPD #1 inhaler/60 actuations 1 RF

lamotrigine (Keppra) 500 mg po BID #60 2 RF

Scenario 1 – nurs 6521 week 4 assignment case scenarios 

Errors in Prescriptions (5 total) and Corrections

fluticasone/salmeterol (Advair) 115/21 mcg 1 inhalation BID #1 Diskus 3 RF

Error:
115/21 mcg is an Advair HFA strength, not available in Diskus form. Diskus strengths are 100/50, 250/50, and 500/50 mcg.

Corrected Prescription:

fluticasone/salmeterol (Advair) Diskus 100/50 mcg, 1 inhalation BID, Disp: 1 inhaler, Refills: 3

Classification:
Inhaled corticosteroid (ICS) + long-acting beta-2 agonist (LABA).

MOA:
Fluticasone decreases airway inflammation via glucocorticoid receptor agonism (Remien & Bowman, 2024); salmeterol stimulates beta-2 receptors, causing bronchodilation (Hsu & Bajaj, 2023).

albuterol 4 mg PO 15–30 min before exercise #30 2 RF

Error:
Oral albuterol tablets are rarely used and not first-line for exercise-induced bronchospasm (Johnson & Bounds, 2024). Inhaled form is recommended.

Corrected Prescription:

Albuterol HFA 90 mcg/actuation inhaler, inhale 2 puffs 15 minutes before exercise, Disp: 1 inhaler, Refills: 2

Classification:
Short-acting beta-2 agonist (SABA).

MOA:
Relaxes bronchial smooth muscle by activating beta-2 receptors (Johnson & Bounds, 2024).

budesonide/formoterol (Symbicort) 160/4.5 mcg, 2 puffs inhaled BID and 1–2 puffs PRN asthma symptoms (max 12 inhalations in 24 hours) #1 inhaler 2 RF

Error:
Listed as “budesonide/fluticasone” instead of budesonide/formoterol.

Corrected Prescription:

budesonide/formoterol (Symbicort) 160/4.5 mcg, inhale 2 puffs BID and 1–2 puffs PRN asthma symptoms (max 12 inhalations in 24 hours), Disp: 1 inhaler, Refills: 2

Classification:
ICS + LABA.

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MOA:
Budesonide decreases airway hyperresponsiveness by binding glucocorticoid receptors and suppressing pro-inflammatory cytokines, reducing edema, mucus, and chronic inflammation (Kalola & Ambati, 2023). Formoterol stimulates β2-adrenergic receptors in bronchial smooth muscle, increasing intracellular cAMP and causing rapid, sustained bronchodilation (Hsu & Bajaj, 2023) nurs 6521 week 4 assignment case scenarios .

tiatropium (Spiriva Respimat) 2.5 mcg/actuation inhaler; inhale 2 actuations PO once daily for COPD #1 inhaler/60 actuations 1 RF

Error:
“tiatropium” misspelled. Otherwise dosing and form are correct.

Corrected Prescription:

tiotropium (Spiriva Respimat) 2.5 mcg/actuation inhaler, inhale 2 actuations PO once daily, Disp: 1 inhaler (60 actuations), Refills: 1

Classification:
Long-acting muscarinic antagonist (LAMA).

MOA:
Blocks acetylcholine at muscarinic receptors in bronchial smooth muscle, leading to bronchodilation (Delgado & Bajaj, 2022).

lamotrigine (Keppra) 500 mg PO BID #60 2 RF

Error:
Lamotrigine and Keppra are two different drugs. Keppra = levetiracetam, not lamotrigine (Irelli et al., 2023).

Corrected Prescription:
Must clarify the intended drug. Assuming lamotrigine:

Lamotrigine 100 mg PO BID, Disp: 60 tablets, Refills: 2 (usual starting maintenance dose after titration).

Classification:
Antiepileptic drug.

MOA:
Inhibits voltage-sensitive sodium channels, stabilizing neuronal membranes (Betchel & Saadabadi, 2023).

SCENARIO 2

AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches. “I’m still getting migraines once a week, even though I take Ubrelvy when they start.” She reports experiencing 3 to 4 migraine attacks per month, typically associated with throbbing pain on one side, light sensitivity, and nausea. Migraines can last from 6-24 hours. AB has been taking Ubrelvy 50 mg po as needed at migraine onset for the past 3 months. She says it helps sometimes, but not consistently, and the pain often returns in a few hours. PMH: migraine without aura (diagnosed at age 27) Current medications: Ubrelvy 50 mg po PRN at onset of migraine, ondansetron 4 mg ODT dissolve on tongue PRN nausea, may repeat in 8 hours if needed. Vitals: BP 118/74, HR 78. What treatment plan would you implement for AB? What medication changes would you make? How would you monitor the effectiveness of this plan, and what patient education would you provide? Is a patient with migraines more likely to start on an acute or preventive agent? What are
examples
of each? nurs 6521 week 4 assignment case scenarios

SCENARIO 3

RC is a 58-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide a drug therapy plan. Include
complete medication orders
. How would you monitor therapy? Labs: TSH 3.4 mU/L, vitamin D 22 ng/mL, B12 501 pg/mL, Hgb 12.8 g/dL, BG 96 mg/dL, A1C 5.9%, BP 115/72, HR 76. Medications include: Tresiba 15 units SC once daily QHS, Novolog 5 units SC before each meal TID (adjusting based on carbohydrate intake and glucose monitoring), and lisinopril 10 mg po daily

SCENARIO 4

PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization. Current medications include dicyclomine 10 mg po QID prn abdominal pain, pantoprazole 40 mg po daily 30 minutes before breakfast, losartan 50 mg po daily, and probiotics daily. His lab work today includes: BG 196 mg/dL, A1C 8.6%, K+ 4.2, Cr 1.8, eGRF 27, BP 127/74. What
treatment plan would you implement for PL
(include complete medication order)? What is the classification and MOA of the drug you selected; why is it the best treatment option for PL? What education would you provide and how would you monitor the effectiveness of the treatment plan? What is his goal A1C? nurs 6521 week 4 assignment case scenarios